This is one in an occasional series about children’s health issues. We know that many of our readers are grandparents keenly interested in the health and well-being of grandchildren. We hope this series will provide readers useful health information they can share with their families.
Most parents have some level of concern about how a food allergy could impact their child’s health and quality of life. Now comes a study from the United Kingdom that concludes prevention may lie in the very first months of life.
Michael Wein, MD, a board-certified pediatric and adult allergist with offices in both Vero Beach and St. Lucie West, is familiar with the study. He says “this is a very important subject, and more complicated than it may seem.”
Researchers from Imperial College in London analyzed data from nearly 150 previous studies that involved upwards of 200,000 children. Those studies examined at exactly what age eggs and peanuts were introduced to children during their first year of life, and the impact it had on the development of allergies.
The results showed that kids who were first fed eggs when they were 4 to 6 months old were 40 percent less likely to develop an egg allergy, compared to kids who were introduced to eggs at an older age. Even more dramatically, kids who were fed food that contained peanuts when they were 4 to 11 months old were 70 percent less likely to later develop a peanut allergy compared to kids who were not fed such foods until later.
An important note of caution: Babies who already have a peanut or egg allergy, or who have another allergic condition such as eczema, should not automatically be fed eggs or peanuts; rather, parents should speak with their child’s pediatrician before introducing these foods. (Dr. Wein says this also holds true if there is a sibling with food allergies, or a strong family history of this type of allergy.)
And, of course, babies and toddlers should not be fed whole nuts, because of the risk of choking –peanuts should be served in the form of smooth peanut butter.
In addition to consulting with the child’s pediatrician, Dr. Wein says an evaluation by a board-certified allergist is beneficial for babies at high-risk for food allergies, and that the evaluation should take place between the ages of 4 and 8 months.
Food allergy symptoms are caused by the interaction between a food allergen and an antibody known as IgE (immunoglobulin E). To diagnose a food allergy, the allergist will likely use a skin prick test (SPT) to measure the presence of IgE antibodies for the suspect food. During the test, the allergist will place a drop of solution containing the food allergen on the child’s forearm, and will then gently scratch the skin to allow a tiny amount of the solution to enter the skin just below the surface.
In a reassurance to parents, there is very little pain and no bleeding associated with SPTs. And an advantage is that they produce results quickly – usually within 30 minutes. Positive results (indicating that a food allergy may exist) are indicated by a “wheal,” a raised white bump surrounded by a small circle of itchy red skin.
Specific to peanut allergies, Dr. Wein cited a 2015 article in the New England Journal of Medicine which says that if the results of the SPT are negative, the child should be started on a diet that includes 2 grams of peanut protein three times a week for at least three years. If the results of the SPT are positive, but show only mild sensitivity (the wheal is less than 4mm), the child should undergo a “food challenge,” in which some form of peanut is administered and the child’s response observed by a physician experienced with this type of test. The article says, “Children who are nonreactive should then be started on the peanut-containing diet.”
In the not-too-distant past, doctors recommended that children who were at high risk for food allergies should avoid risky foods such as eggs and peanuts until they were at least 2 years old. But in a 2015 turnaround, the American Academy of Pediatrics issued interim guidance that “healthcare providers should recommend introducing peanut-containing products into the diets of high-risk infants between ages 4 and 11 months.” The National Institute of Allergy and Infectious Diseases is expected to soon release similar guidelines.
While this is a complicated issue, one thing is clear: Parents should consult with their child’s pediatrician before giving either peanut or egg products to babies at high-risk for food allergies.
The Imperial College researchers acknowledged that additional studies are needed to validate the findings, noting that estimates of how much the early introduction of eggs and peanuts lowers the risk of developing allergies could change.
The study also looked at – but did not come to any conclusions about – whether the early introduction of milk, fish, tree nuts and wheat was tied to a reduced allergy risk later in life.
Dr. Wein’s Vero Beach office is located at 3375 20th Street; the phone number is 772-299-7299. His St. Lucie West office is located at 320 NW Bethany DR # 322; the phone number is 772-621-9992.
