NEW THINK­ING ON RE­STRICT­ING PEANUTS

The Star Early Edition - - VERVE -

WHEN my hus­band and I had our first child seven years ago, the pre­vail­ing wis­dom was that ba­bies at risk of al­ler­gies should avoid peanuts or peanut prod­ucts un­til age 3 or older. The idea be­hind this re­stric­tion – based on Amer­i­can Academy of Pe­di­atrics (AAP) guide­lines re­leased in 2000 – was that feed­ing peanuts too early to lit­tle ones might risk se­vere, pos­si­bly life-threat­en­ing al­ler­gic re­ac­tions.

Over the years that think­ing has done a 180. Now, sci­en­tists be­lieve the ex­act op­po­site: Giv­ing your baby peanuts ear­lier rather than later might pre­vent them from de­vel­op­ing an al­lergy.

While many doc­tors and med­i­cal groups have come out over the past year to en­dorse this view, there has been a lot of con­fu­sion about which kids could ben­e­fit from early ex­po­sure, the op­ti­mal tim­ing of the ex­po­sure, and how ex­actly one should feed peanuts (which, af­ter all, are a chok­ing haz­ard in their raw form) to ba­bies.

The Na­tional In­sti­tute of Al­lergy and In­fec­tious Dis­eases (NIAID) has re­leased for­mal, de­tailed guide­lines for pe­di­a­tri­cians and al­ler­gists.

The doc­u­ment, pub­lished in six med­i­cal jour­nals, in­cludes three sep­a­rate sets of rec­om­men­da­tions based on the level of risk an in­fant has for de­vel­op­ing a peanut al­lergy. Those at high­est risk are de­fined as ba­bies with se­vere eczema or egg al­lergy or both. Those in the mid­dle group have mild-to-mod­er­ate eczema. And those in the low­est-risk group have no eczema or food al­ler­gies.

The guide­lines come at a ter­ri­fy­ing time for new par­ents in terms of al­ler­gies. The num­ber of Amer­i­can chil­dren with nut al­ler­gies has quadru­pled in the past 13 years, and peanut al­ler­gies are now estimated to af­fect 2% of them. Most schools now ban foods with peanuts, and man­u­fac­tur­ers are re­quired to la­bel whether food con­tains peanuts or was man­u­fac­tured in a fa­cil­ity that pro­cesses them.

The soar­ing price of EpiPens, used to treat a se­vere al­ler­gic re­ac­tion, has be­come a hot po­lit­i­cal topic.

An­thony S Fauci, NIAID di­rec­tor, said the new think­ing on peanut ex­po­sure grew out of ob­ser­va­tions of Is­raeli chil­dren in Is­rael versus Is­raeli chil­dren in Bri­tain. In the former, he said, par­ents as part of their cul­ture of­ten give var­i­ous types of peanut prepa­ra­tions such as paste or nuggets in the very ear­li­est days of a child’s life. Sci­en­tists noted that the in­ci­dence of peanut al­ler­gies in Is­raeli chil­dren in Is­rael is lower than in Is­raeli chil­dren in Bri­tain and won­dered whether the two things could be re­lated.

That the­ory was put to a test in the much-praised Learn­ing Early About Peanut Al­lergy (LEAP) study, a ran­domised trial led by Gideon Lack of King’s Col­lege Lon­don in­volv­ing 640 in­fants con­sid­ered at high risk of de­vel­op­ing peanut al­ler­gies. The re­sults, pub­lished in 2015 in the New Eng­land Jour­nal of Medicine, showed that chil­dren at high risk who reg­u­larly con­sumed peanuts as in­fants had an 81% lower chance of de­vel­op­ing a peanut al­lergy by age 5.

Fauci called the re­sults “very strik­ing” and estimated the guide­lines could pre­vent thou­sands of chil­dren from de­vel­op­ing peanut al­ler­gies. – The Wash­ing­ton Post

Study shows that chil­dren who reg­u­larly con­sumed peanuts as in­fants had an 81% lower chance of de­vel­op­ing a peanut al­lergy by age 5.

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