ALLERGY ADVICE

From five to 10 months of age, children can develop tolerance to foods like peanuts without becoming allergic to them

No need to delay introducing solid food, says health columnist

Dear Dr. Wong: I grew up in a family full of allergies. Both of my parents have hay fever; I have eczema and asthma.

My younger brother had severe eczema when he was small. Our parents were told to avoid giving him peanuts and eggs until he was older. When he went to a birthday party at three, he ate a cookie with peanut and developed a severe allergic reaction. Since then, he has had several similar episodes; once he developed anaphylaxis and had to go to the emergency room.

Our family was always on edge; we carried an Epi-Pen all the time. I am now pregnant with our first child. I wonder whether there is anything that I can do to prevent her from developing peanut allergy.

Answer: The peanut is one of the most common causes of serious food allergy in North America. About one to two per cent of the population are allergic to peanuts; some have anaphylaxis and can die unless epinephrine and other medications are available quickly to counteract the allergy.

In the last few decades, because of the concern about peanut allergy, specialists (including allergists and pediatricians) recommended delaying the introduction of foods containing peanuts until three years of age. The reasoning is that if we delay giving children peanuts, it may be that they will be less likely to develop an allergy. Unfortunately, subsequent research showed that peanut allergy in children actually increased three times between 1997 and 2008. Clearly, avoiding peanut early in life didn’t prevent allergy.

Then, something remarkable happened. Researchers found that Jewish children in England were 10 times more likely to develop a peanut allergy compared with those growing up in Israel. It turned out that Israeli children were given Bamba, a snack food for infants, when they showed interest in solid food, usually before six months of age. Bamba was made with puffed corn and coated with peanut butter. When exposed to peanut at an early age, these children rarely developed peanut allergy.

This observation sparked a number of international research programs evaluating early versus late introduction of peanuts. They showed that early introduction of food containing peanut can significantly reduce the development of peanut allergy in children. It looks like that there is a window of opportunity, probably from five to 10 months of age, when children can develop tolerance to foods like peanuts without becoming allergic to them. If peanut is introduced later, the chance of developing an allergy is much greater.

Clearly, avoiding peanut early in life didn’t prevent allergy.

This is very humbling for doctors who try to do their best to provide good guidance to parents and children. The advice given in the last few decades to delay the introduction of foods like peanuts, eggs and fish was wrong and not based on scientific evidence.

The Canadian Paediatrics Association (CPS) and the American Academy of Pediatrics (AAP), two organizations that represent most of the pediatricians in North America, now recommend parents give peanut-containing food as soon as babies show an interest in taking solid food, usually from four to six months of age. They can mix smooth peanut butter with water, expressed breastmilk or pureed fruits and vegetables and give it daily.

Research also showed that other food allergies can be prevented the same way; there is no need to delay the introduction of any kind of solid food. The best commonsense approach came from the Australian Society of Clinical Immunology and Allergy, which states that: “when your infant is ready, introduce foods according to what the family eats, regardless of whether the food is considered to be a common food allergen.”

Other research also showed that pregnant women and breastfeeding mothers don’t have to avoid any food to prevent a food allergy in their children. Therefore, relax and eat all the normal food that you enjoy. I would also encourage you to breastfeed your baby for as long as you want; enjoy the bonding and motherhood.