On Nutrition

If you or your child have a peanut allergy, one odd benefit of staying at home during the pandemic was that it provided fewer opportunities for accidental exposure. But a return to school, travel and the office also means a return to hypervigilance.

Peanut allergy is the most common food allergy in children under the age of 18, and the second most common food allergy in adults. Unlike some food allergies, peanut allergy is usually lifelong, with only about 20% of children outgrowing it. Because peanut allergy — as with other food allergies — can be potentially fatal, let’s look at recent progress in treating peanut allergy, as well as what researchers have learned about preventing it.

The power of prevention

One recent success story is the early — and appropriate — introduction of peanut foods to infants. But first, let’s back up. In the 1990s, experts started advising parents to avoid feeding children peanuts and other potentially allergenic foods — eggs, cows’ milk products, tree nuts, wheat, shellfish, fish and soy — until they were at least 1 year old. However, by 2008 evidence was accumulating that this practice might increase allergy risk.

Then in 2015, findings from the Learning Early About Peanut (LEAP) study — funded by the National Institute of Allergy and Infectious Diseases (NIAID) — showed that introducing peanut-containing foods to infants at high risk for developing peanut allergy was safe and led to a dramatic reduction in the eventual development of peanut allergy. Accordingly, NIAID revised its guidelines to recommend that high-risk infants be introduced to peanuts after being introduced to other solid foods at age 4 to 6 months. Having severe eczema, egg allergy, or both increases peanut allergy risk.

Last year, the 2020-2025 Dietary Guidelines for Americans included recommendations for children ages birth to 2 for the first time. Among those recommendations is to introduce potentially allergenic foods when other complementary foods are introduced to an infant’s diet — and to introduce peanuts to high-risk infants at age 4 to 6 months.

Atlanta-based registered dietitian Sherry Coleman Collins, who specializes in food allergies and consults with the National Peanut Board, said including this recommendation in the dietary guidelines is that it supports the idea that it’s important for all babies — not just those at high risk. She points out that infants who are at high risk should be seen by their pediatrician for evaluation before introducing peanut foods. All other babies should be fed infant-safe peanut foods — such as peanut butter thinned with water, breast milk or formula — starting at around 6 months.

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“Like any major change in health advice, it is taking time to get people on board with early introduction of peanut and other potentially allergenic foods,” Coleman Collins said. “In order to make the biggest impact to reduce the numbers of new cases of peanut allergy in the next generation, we need everyone on the same page.” The National Peanut Board has a website with up-to-date information on preventing peanut allergies — including detailed guidelines for introducing peanuts and links to published research papers — at PreventPeanutAllergies.org.

Taking steps toward treatment

If you find life without peanut butter a little bit sad, you may wonder if a treatment for peanut allergy is on the horizon. The good news is that in January 2020 the Food and Drug Administration approved the oral immunotherapy drug Palforzia, which has been shown to increase peanut tolerance significantly. The bad news is that it doesn’t actually cure peanut allergies, so PB&Js won’t be back on the menu.

But back to the good news about oral immunotherapy: “It does increase the threshold for reactions, reducing the risk of a serious reaction due to an accidental ingestion,” Coleman Collins said. “For many individuals with peanut allergy and their families, this results in a better quality of life, lower anxiety and more freedom in their diet.”

Peanut allergy myths worth busting

There are many myths and misunderstandings about peanut allergy. Coleman Collins said one of the most pervasive myths is that while 2% of children and less than 1% of adults in the U.S. has a peanut allergy, people tend to believe that number is much higher. “While peanut allergies are significant and every effort should be made to keep those with peanut allergy safer, it’s important to put every health condition into perspective and context so we can better understand risk,” she said.

Another pervasive myth? That simply touching or being near peanut foods can cause anaphylaxis in someone with peanut allergy. Robust research says otherwise, including a 2016 study published in the Annals of Allergy, Asthma & Immunology. The study demonstrated that casual contact is not a cause for concern with “proximity challenges” that placed an open jar of peanut butter near a patient with peanut allergy, then putting a dab of peanut butter on the patient’s arm, with no ill effects.

“Ingestion is required to cause those serious and potentially life-threatening reactions,” Coleman Collins said. When schools and public venues [such as airplanes and sports stadiums] have proper food safety and food allergy management practices, having peanuts in these facilities does not on its own cause risk, she said. “This is why bans are not recommended by experts as a way to manage peanut allergies — it can lead to a false sense of security and doesn’t actually reduce the risk of reactions.”

With in-person learning planned for schools this fall, parents of peanut-allergic kids may naturally be feeling anxious about both COVID-19 and allergic reactions. Coleman Collins offers this perspective: “Keeping kids with peanut and other food allergies at school is a primary concern for those in education. By working together, schools can provide appropriate accommodations and students can feel safer and included.” The National Peanut Board website PeanutAllergyFacts.org includes resources for schools and others who want to learn more about managing peanut allergies.