Living Well: Talking To Your Pediatrician About New Peanut Allergy Guidelines

It might be time to rethink what you know about giving children peanut butter.

Dr. John Phillips

During the first week of January, the National Institute of Allergy and Infectious Diseases released new guidelines for parents and healthcare providers on peanut allergies. The new recommendations have a goal: To reduce the chances of children developing a peanut allergy.

That’s where parents and healthcare providers come in. The guidelines tell us that we all have a role to play in helping protect our children from this problem.

What Is An Allergy

Your body’s immune system defends against microscopic invaders like viruses. For some people, the immune system also reacts to other things, like peanuts. After the first exposure (where nothing will happen) the immune system will become sensitive to a substance and cause an allergic reaction.

Symptoms of allergic reaction include:

• Hives, flushed skin or rash
• Tingling or itchy sensation in the mouth
• Swelling (Can affect the tongue, lips, face, throat or vocal cords)
• Abdominal cramps, vomiting and/or diarrhea
• Coughing, wheezing or trouble breathing
• Dizziness, lightheadedness or loss of consciousness

Allergies aren’t one-size-fits-all. The symptoms and severity of allergies vary greatly from person to person. In the most severe cases, even tiny amounts of a substance (like peanut dust) can trigger a life-threatening reaction. That’s why people with peanut allergies can’t even be around (and why so many schools have banned) peanut-containing items.

Small Bite, Big Problem

In the past 10 years, the rate of peanut allergy in children in Western countries has doubled. According to the New England Journal of Medicine, as many as 3 in every 100 children have this allergy.

I know the dangers of food allergies, both as a pediatrician and as a parent. My son is allergic to tree nuts and will become very ill if they’re in something he eats. At home, it’s easy to make the kitchen and pantry safe. Out in public, it’s a lot more stressful. There’s more label-checking and asking questions. It takes constant vigilance.

It can be difficult for families with a food allergy because many people don’t realize that peanut allergies (and food allergies in general) can be a matter of life and death. I’ve seen firsthand where well-meaning individuals offer a child a food containing their particular allergen and will insist the child take it, even though the child is protesting, that they can’t eat it.

New Science

In February 2015, a study came out in the New England Journal of Medicine where researchers studied more than 600 children between the ages of 4 and 11 months. These children all had an egg allergy or severe eczema, both of which indicate a potential for other allergies. All of the children were then tested for peanut allergy.

As part of the study, the children were separated into two groups. One group would avoid peanut-based products entirely. The other would consume peanut products in gradually larger amounts. At age 5, the children were all re-tested for peanut allergy.

The result? In all the children, exposure to peanut products greatly decreased the rate of allergy.

In the children who initially tested negative for peanut allergy, exposure to peanuts reduced the rate of allergy by 86 percent. In the children who initially tested positive, exposure to peanuts reduced the rate of allergy by 70 percent.

New Guidelines & You

So what does this mean for you and your child? As a pediatrician, my advice is to talk to your child’s pediatrician so you can decide the best course of action. We can answer your questions, tell you how to give your child peanut-containing foods, and refer you to a specialist for further advice and testing if needed. We’ll help you decide how to apply (or not apply) the following guidelines:

• Guideline 1: If a child has severe eczema and/or egg allergy, peanut allergy testing may be recommended. A pediatrician or specialist can then advise you on whether or not to introduce peanut-containing foods at 4 to 6 months, and if this should be done under medical supervision.
• Guideline 2: If a child has mild to moderate eczema, peanut-containing foods may be introduced into the diet around 6 months of age, either at home or under medical supervision.
• Guideline 3: If a child has no eczema or another food allergy, peanut-containing foods may be introduced at an appropriate age.

If you have any questions about this topic or other food allergies, talk to your pediatrician. We want to make sure you and your child are happy, healthy and prepared for meals and snacks anywhere you go.

Dr. John Phillips is a board-certified pediatrician with Owensboro Health Medical Group. For more information or to schedule an appointment with Owensboro Health Medical Group Children's Center, call 270-688-4480.