To prevent peanut allergies, feed babies peanuts.
So says the American Academy of Pediatrics (AAP) in a new clinical report showing that early exposure to common allergens can prevent the development of allergies during childhood.
The group, which represents pediatricians often on the front lines of intervening in childhood allergies, first began urging parents to feed peanut-based food and other common allergens to infants in 2015.
The new study published in the journal Pediatrics reinforces this recommendation with more research and also updates guidance on allergies first issued in 2008.
“There is no reason to delay giving your baby foods that are thought of as allergens like peanut products, eggs, or fish,” said Dr. Scott Sicherer, an allergist at The Mount Sinai Hospital in New York and co-author of the report. “These foods can be added to the diet early, just like foods that are not common allergens, like rice, fruits, or vegetables.”
“The immune system develops very early in life, so if we can change it at that point, we can change the patient’s destiny,” Dr. Purvi Parikh, an allergist in New York and a spokesperson for the Allergy & Asthma Network, told Healthline.
The advice still gives some parents of children with allergies pause, however, especially since for years doctors explicitly advised parents against any early exposure to potential allergens.
Chris Schulter Bizarro, a Colorado parent of a daughter with a peanut allergy, said her pediatrician “advised waiting until she could talk to have her try them, so she could say something if she experienced a problem.”
Later, “My sister-in-law was watching her and didn’t know she’d never had peanut butter. One bite and she spit it out, broke out in hives, and started crying,” she said. “She was 18 months old. I’m not sure that earlier exposure would have made a difference.”
“My daughter had an anaphylactic reaction before her first birthday, so could not voice symptoms,” added Shelly Goudreau of Bristol, Rhode Island. “It was the scariest moment of my life. As with introducing any food, I would start with a very small taste and stop there, introducing extremely slowly with education on symptoms of any reaction.”
Dr. David Stukus, an associate professor of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio, and a spokesperson for the American College of Allergies, Asthma, and Immunology, told Healthline that introducing peanuts in infancy isn’t risk-free.
However, he said, 98 percent of people never develop peanut allergies, and even for those who are predisposed, the risk of early exposure pales in comparison to that of developing a lifelong allergy to peanuts.
“Parents come to me because they fed their kid something and they developed a rash, not because they’re dying,” he said. “So there’s time to figure this out.”
Even if an infant exhibits some sort of allergic reaction, their immune system is still developing antibodies that could protect them down the road, Stukus said. “It’s all about tolerance,” he added. “If you’re exposed to an allergen on a regular basis early in life, you become more tolerant to it.”
Experts recommend giving infants ground peanuts or special formulas including peanuts, not whole nuts, which can be a choking hazard.
Such foods can be introduced around six months of age, once other solid foods are tolerated, the AAP said.
The report also reinforced the earlier finding that there’s no evidence that delaying introduction of allergens beyond 4 to 6 months of age prevents atopic disease, which are allergies that produce reactions in areas remote from the site of exposure to allergens, such as allergic rhinitis, asthma, and eczema.
High-risk infants, such as those who have severe eczema requiring prescription treatment and those with egg allergies, may also be exposed to peanut foods while also being tested for possible peanut allergies, the report said.
“We encourage parents to talk to their pediatrician or allergist about the symptoms of allergies and whether their child should be tested,” said Dr. A. Wesley Burks, dean of the UNC School of Medicine and co-author of the report. “The physician can help track any changes in allergies, some of which may go away as a child grows older.”
Peanut allergies are well-known because of their sometimes fatal consequences. But peanuts are just one of eight groups of food allergens that must be declared on U.S. product labels, including cow’s milk, eggs, fish, crustacean shellfish, tree nuts, wheat, and soybeans.
These foods account for about 90 percent of all food allergies.
“We know that some children are predisposed to allergies because of their family history,” said Dr. Frank Greer, co-author of the report. “It’s clear that sometimes nutrition can play a key role in preventing or minimizing allergies that can be concerning — or even deadly — for some children.”
“Not only is early exposure a piece of the puzzle, we think it’s a big piece,” added Stukus. “We don’t need to protect a baby’s immune system — we need to challenge it.”
The clinical report also addressed a broader range of issues around infant allergy prevention. The AAP concluded that restricting the mother’s diet during pregnancy or breastfeeding doesn’t seem to prevent allergies. Nor does the use of hydrolyzed formula, even among children at high risk of allergies.
The latter finding updated previous allergy-related advice issued by AAP in 2008, which said there was some limited evidence that hydrolyzed formula might prevent infant dermatitis.
The pediatricians’ group also said that breastfeeding exclusively for the first 3 to 4 months of life helps protect against eczema during a child’s first 2 years, and that any amount of breastfeeding beyond 3 to 4 months protects against wheezing and may reduce long-term asthma risk.
Evidence doesn’t support excluding potential food allergens like peanuts from infant diets.
According to the AAP, infants should be exposed to such foods as soon as they begin eating solid foods.
Early food exposure may prevent the later development of food allergies. The risk of early exposure is far outweighed by the dangers of developing lifelong allergies.