Rethinking Baby Peanut Allergies with Dr. Ron Sunog

By Ron Sunog, MD (see bio below)

Dr. Ron Sunog shares his thoughts on the newest LEAP study that provided groundbreaking news about baby peanut allergies and introducing baby food allergens early on in infancy. If you’re looking to introduce peanuts to your little one or feel skeptic, we definitely suggest reading on.

If you could give your infant a vaccine to prevent a food allergy, you would. How about just feeding them nutritious food instead?

As a reader of Itchy Little World you are no doubt well aware of the magnitude and burdens of having a child with food allergies. Approximately 8% of children have an allergy to one or more foods.

To put this in perspective: the average classroom has two children with food allergies and of the 4,000,000 infants born this year, we can expect 320,000 to develop an allergy to some food. The family of a child with food allergies experiences a great deal of stress and an annual financial burden of $4000 on average.

About 40% of children with food allergies have experienced anaphylaxis.

In 2015, The Learning Early About Peanut (LEAP) study was published in the New England Journal of Medicine. The results of this study showed that feeding a safe-to-eat peanut food to infants at high risk of developing peanut allergy reduced their risk by over 80% (safe-to-eat means in a form that infants can’t choke on, such as peanut powder, diluted peanut butter, or peanut butter puffs).

The study was so well done—The Society for Clinical Trials chose LEAP from tens of thousands of studies as Trial of the Year for 2015—and the results are so groundbreaking that experts believed it would revolutionize infant feeding.

Director of The National Institute of Health and Infectious Disease Dr. Anthony Fauci, said, “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention.”

Misunderstanding Baby Food Allergens

Yet some parents remain apprehensive about feeding peanuts to their infants.

That’s because they are very accustomed to the idea that the Big Eight baby food allergens—peanut, milk, shellfish, tree nut, egg, fish, wheat, and soy, the foods that are responsible for 90% of food allergies—should not be fed to infants, since that is what pediatric providers had been telling them for many years.

Those incorrect guidelines were established by the American Academy of Pediatrics (AAP) in 2000 when researchers, anxious and hopeful for a way to reduce the number of children with food allergies, had no better advice to offer.

When it became clear that the number of children with food allergies actually increased, the AAP established guidelines in 2008 that delaying introduction of the Big Eight baby food allergens did not help and infants could eat them.

Change does not come easy—to either physicians or parents—so the idea that these foods are safe for infants has been slow to catch on. Now we know that not only are these foods safe for infants, but early introduction can actually reduce their risk of developing food allergy.

The infants who are likely to benefit most are those with egg allergies and/or severe eczema, because they are at highest risk.

For these infants it is recommended that testing for baby peanut allergies be considered prior to giving peanuts, as they may already be allergic to peanuts. For infants with no egg allergy and mild eczema, no prior evaluation is recommended. And for low risk infants—those with no egg allergy or eczema at all— although the guidelines do not emphasize the importance of early introduction, many experts do, because around 10,000 low-risk infants develop peanut allergy every year.

Why focus on Eczema?

Because of what is known as the dual allergen theory of food allergy.

According to this theory, when infants are exposed to food proteins through their skin rather than by eating them, they become allergic. Eczematous skin has a weakened protective barrier and peanut protein can be found in the dust around cribs when peanuts are present in the house (which is the case in 90% of all households).

This is also why it’s so important to treat an infant’s eczema appropriately by a) treating the eczema aggressively to keep the skin barrier strong and b) continuing feeding any food if that food is not actually the cause of the eczema.

This can be complicated and you may need the guidance of your pediatric provider or an allergist.

Here are the most important points to remember:

• For detailed information, see the guidelines and talk with your pediatric provider.
• Although the evidence that early introduction of peanuts can prevent peanut allergy is only four years old, the evidence that the Big Eight foods are safe for infants was established about nine years ago.
• Any time an infant eats a new food there is the possibility of an allergic reaction, but there is a lot of evidence that infants who eat these foods are less likely to develop allergies than older children.
• The chance of an infant having a severe reaction is extremely low.
• Adding the Big Eight to an infant’s diet makes it more varied and nutritious. Also studies show that this will increase the chance that they will remain a healthy eater. Many experts suggest to introduce the eight allergens early and often.

Ron Sunog, MD has been in private practice in MA for over 30 years and is the author of Eat The Eight, Preventing Food Allergy with Food and the Imperfect Art of Medicine, published by The Nasiona. He is also Medical Advisor to Puffworks, makers of Organic, non-GMO peanut butter puffs, including Puffworks baby, designed specifically for the early introduction of peanut to infants.