What the new Peanut Findings Mean

The food allergy community was rocked Monday when researchers at the AAAAI Annual Meeting revealed the results of a study stating that early introduction of peanut dramatically reduced the incidence of peanut allergy in children.

You can read (one of many) accounts of the study and announcement here.

The team identified 640 babies considered to be at a higher risk for developing a peanut allergy because they had eczema or egg allergies, things which are often tied together. For half of the babies, the parents were asked to avoid peanuts (I don't know for how long, at least for the first year.) For the other half of the babies, the parents were asked to feed their babies peanut products in some form before their 1st birthday (they were introduced between 4 and 11 months.)  The study followed the participants until their 5th birthday.

It's hard not to wonder, "what if we'd
opened those Reese's cups?

17% of the babies who avoided peanuts went on to develop peanut allergies.  If the 640 participants were divided exactly in half, that means that 54 of those children developed peanut allergies.

On the other hand, only 3.2% of the babies who ate peanut products earlier developed peanut allergies.  That means only 10 out of roughly 320 babies.  Much better numbers!

This study has lit many sparks among the food allergy community.  I'd like to say a few things based on my experiences and on the comments I've seen on the various posts and articles.

First of all, parents, don't blame yourselves.  Food allergies are complex, and as I stress in each and every "science of food allergies" post I write, I believe that there are many variables that must come together in order for a child (or adult, for that matter) to develop food allergies.  Based on these numbers, age of introduction sounds like it's definitely a factor, but it's not the only one.  And in addition, we can't blame ourselves for things we didn't know.  Nor can we blame our allergists for things they didn't know.  With food allergies on the rise for the past few decades, all sorts of hypotheses have been formed about what's causing them and what we can do to prevent them, but if we knew for sure how to prevent allergies, most parents would be doing it.  We don't know, we can only muddle along and hope for the best.  So feel better, mom!

We also don't need to refute the study because our child doesn't fit within it.  I've seen a ton of comments from parents saying variations of "my child was diagnosed at under 6 months when s/he was exclusively breastfed" or "my child would have died if I'd done this, s/he had an ANA reaction at 9 months when s/he touched my peanut butter sandwich."  This isn't going to be One Size Fits All.  Remember, 10 babies in the eat-peanut half of the study still developed allergies.  Specifics weren't given, but some of those may have been to the first, very young, exposure.  Those of us with children who didn't fit the mould of this study don't need to feel angry or insulted by it.  Researchers have found a way to possibly prevent a lot of peanut allergies, but they aren't going to prevent all of them.  This is also only referring to peanut, and there's no word on other highly allergenic foods.  As with our children's original diagnosis, we must make peace and move on.

This is good news.  It is more akin to a vaccination than a cure, because this knowledge will do nothing for those already allergic to peanut, but careful implementation of recommendations stemming from this study could prevent allergies in many children. Maybe we'll even see numbers drop from here on out, instead of continuing to rise.  For those still having kids, it may mean that your younger kiddos get through with no allergies.

We need to exercise caution, or at least be vigilant.  I don't know for sure, but I would bet that the parents in the study were armed with epinephrine and trained on what symptoms to look for before feeding peanut to their infants.  Heck, the articles I read didn't specify so baby's first taste might even have been done in a doctor's office.

We need to stay tuned for recommendations on feeding our babies.  Hundreds if not thousands of allergists and other doctors will be discussing and analyzing these study results, and the AAP may even release new infant feeding guidelines.  However, I would bet that "official" guidelines will take a while to develop, and in the mean time our doctors will not all be in agreement with one another.  There may be difficult times ahead, as parents who have babies now will have a hard time getting feeding recommendations.

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Personally, I think this is good.  I have heard many things filter through the pipeline over the last few years regarding the upswing in food allergies, and peanut allergies in particular.  Considering that I have allergies myself, I was almost expecting Zax to get allergies.  His reaction to egg was worrisome (but not severe) and just confirmed my feeling that he'd inherited my genes.  I was surprised by his positive test results to peanut at 10.5 months considering that he'd never eaten any.  I guess that puts us in the camp of "it wouldn't have worked for us anyway," however I don't know that for sure.  For one, if we'd exposed him much earlier, it's possible he may not have developed the allergy.  In addition, we didn't challenge him on peanut until 3.5 years old, so we don't know for sure if he might have had a false positive at his first visit, and only developed a genuine allergy later, contributed to by lack of exposure.  I'll never know, and I'm not going to waste time brooding over it.

By the time Kal came around, I had heard the statistic stating that rates of peanut allergies rose after the AAP recommended waiting until after age 1 or even 2 before introducing peanuts.  Some doctors were beginning to suggest that waiting was only increasing allergies and that we should feed our children allergenic foods earlier.  I asked our allergist about that, looking for advice on feeding Kal.  I was informed that such research was preliminary, that nobody knew for sure, and that with family history of severe allergies she recommended delaying peanut and tree nut for Kal as well.We followed that advice, but I've learned even more since then and wish I hadn't.

For instance, I had heard that in other parts of the world (don't remember which country, sorry, maybe India?) peanut broth is one of the first foods fed to babies, and rates of peanut allergies there are very low.  I had also heard that in Israel, puffed peanut snacks were a common toddler food, and rates of peanut allergies were very low there as well. This is, in fact, one of the things that led Dr. Gideon Lack to perform this study:  he noticed that Israeli children in the US and the UK had lower rates of peanut allergies, possibly because their parents often fed them "Bamba," a puffed snack food made of corn and peanut butter.

I can't help but wonder if this technique would have worked on Kal.  We avoided peanut with him, but he wasn't tested for food allergies until shortly after his 2nd birthday.  He had a very minor reaction to peanut.  We debated giving him peanut then to see if he could tolerate it, but couldn't agree and let it fall by the wayside.  Once we finally got around to it, right after he turned 3, his skin reaction was off the charts.  We challenged anyway, and his reaction was minor (although it was only to a small amount brushed on his lips, and it was his very first exposure.)  I often felt that if I'd fed him peanut at 2, or if I'd ignored our allergist's advice and given it even sooner, he might have been allergy free.  Kal's diagnosis stuck with me longer than Zax's, but eventually I had to let that go, too.  I can't change what I did, I can only direct what I will do next.

Because of all of these findings, correlations, and studies (including many I have not mentioned) I had already decided that if hubby and I have a third child, we will feed that child very differently than we fed the boys.  This week's study findings only reinforced this conviction.  I figure that we've got nothing to lose.  We followed old AAP guidelines of avoidance with both of our sons, and both wound up with food allergies.  If we try something new (for example, wheat, fish, and even peanut within the first few months of solids) the child may avoid allergies, or may still get them.  But I see no harm in trying, especially since we know what to look for and have all necessary medications in the house already.

And being prepared is probably just as important as these new findings.  Perhaps all new parents should be advised to invest in a bottle of children's Benadryl, and if at all concerned about food allergies, they ought to borrow a friend's Epi Pen, or visit the house of a friend with allergic children, or even park themselves in an ER parking lot before feeding those all-important first bites.  I don't want anyone to put their child in danger because of this study, but we also need to remember that most of the world doesn't consider peanut to be a danger.  Most of today's allergy parents didn't consider peanut to be dangerous either, until their child suffered an allergic reaction to peanut or another food.  So if we advise "Don't just run out and do this, you could be placing your child in danger!" well, the danger may not be as great as we perceive it to be.

Those are my thoughts.  What do you think of this groundbreaking study?