— As a nurse, Amber Williams was well aware of the medical
recommendations for starting her daughter on solid foods. She
waited until Sienna turned 1 to give her milk, and was
planning to wait until age 2 to introduce eggs and age 3 for
Sienna was about 20 months old, her godmother gave her a bite
of a peanut granola bar while babysitting. Welts broke out on
her skin. Her blood pressure crashed. By the time she arrived
at Children’s Hospital of Pittsburgh of the University of
Pittsburgh Medical Center in an ambulance, her throat was so
swollen that a tube couldn’t fit inside.
still have the book that I followed to a ‘T,’"said
Williams. "I did exactly what the American Academy of
Pediatrics told me to."
released recently casts doubt on the advice once given to
parents of children like Sienna, now 8, to delay introducing
peanuts well into toddlerhood.
study, conducted in the United Kingdom and published in the
New England Journal of Medicine, followed 640 children deemed
high-risk for developing peanut allergies. One group was given
peanut products between 4 months and 11 months old, and
continued to eat them three or more times per week. The other
group wasn’t given peanuts at all.
time the children were 5 years old, 3.2 percent of those who
had eaten peanuts from an early age developed an allergy,
versus 17.2 percent of those who had not.
study, known as the Learning Early about Peanut Allergy (LEAP)
trial, has been highly anticipated. "It’s a study we’ve
all known about for the last five years and we’ve been eager
to see the results," said Todd Green, an allergist and
immunologist at Children’s Hospital of Pittsburgh. "The
results were what people were expecting but even more of a
dramatic effect than people thought. "
Freeman, an allergist with the Allegheny Health Network, was
in the audience at the American Academy of Allergy, Asthma and
Immunology conference in Houston recently where the study was
presented. "When it was announced, there was not an empty
seat," she said. "People were lining the
conclusions drawn from the study — that introducing peanuts
early can actually help prevent allergies — are completely
contrary to the theories espoused by doctors, including Dr.
Freeman, in the 1990s and early 2000s.
went crazy 20 years ago telling parents to avoid feeding these
allergenic foods to their newborns — moms even went to the
extent of avoiding it during pregnancy and
breastfeeding," she said. "I have a lot of personal
guilt. I had it all wrong, this is my mea culpa."
time, she said, doctors were looking for answers not
necessarily to the problem of peanut allergies but to rising
asthma rates, a condition often associated with peanut
allergies. On the theory that children would better be able to
handle peanuts if their immune systems and gut were given more
time to mature, they urged parents to wait before feeding them
the legumes. The AAP formally recommended in 2000 that parents
wait until children turn 3 to first try peanuts.
since that time, the number of peanut allergies has risen
sharply. One study found that the rate of peanut allergies in
the U.S. has more than quadrupled, jumping from 0.4 percent in
1997 to more than 2 percent in 2010.
has become a societal problem," said Dr. Freeman.
"These families can’t go to a restaurant, can’t go to
a birthday party, can’t trust the school system."
prevalence isn’t hard to spot: Day-care centers are
regularly peanut free, for example, and some local elementary
schools ban all snacks in the classroom that aren’t
pre-packaged. The popular line of American Girl dolls sells,
for $28, an "allergy-free lunch," complete with
berry smoothie, medical bracelet and toy allergy syringe.
affects almost every decision we make about where he goes in
the world," said Jodi Hirsh, whose 6-year-old son Simon
broke out in hives and starting coughing and grabbing his
throat after eating a small bit of his first peanut butter
sandwich when he was about 18 months old. "We think
about, will there be food there, will there be an adult there
who could administer a shot (that would administer
epinephrine, the drug that treats severe allergic reactions)?
In terms of everyday life, what if he’s at a playground
where someone was eating a peanut butter sandwich very messily
and he puts his hand down?"
Simon’s 3½-year-old sister, Ruby, was tested for a peanut
allergy at age 2 and came up borderline, doctors advised her
family to hold off on giving them to her. At this point in her
life, she’s never had a peanut, though Hirsh called last
week after hearing about the study to make an allergist
appointment for her.
a study comes out and says, if you had just done ‘X’ that
wouldn’t have happened, it can be frustrating; I followed
the medical guidelines," she said. "I have great
respect for the field of medicine, but allergic medicine has
been incredibly frustrating. There’s no consistent
between how countries deal with peanut introduction actually
spurred the idea for the study. During a talk in Israel about
15 years ago, study co-author Gideon Lack asked a room of
doctors to raise their hands if they had treated a patient
with a peanut allergy. Less than a handful of hands went up,
whereas when he asked that question of doctors in England
nearly every hand did.
theorized that the difference might be due to the popularity
of a puffed peanut snack, called Bamba, commonly given to
infants in Israel, vs. the practice in the United Kingdom to
delay the introduction of peanuts past a child’s first
2008 study, he found that the risk of developing a peanut
allergy was 10 times as high for Jewish children in the U.K.
versus children in Israel with a similar genetic history.
2008, the AAP backed off of its earlier recommendations,
saying that there was no evidence that delaying the
introduction of allergenic foods made allergies worse, though
there was also no evidence that introducing them earlier
current advice from allergists is likely to change based on
the results of the LEAP study.
a little bit dangerous to make big changes based on one study
but this was a very well-designed study and it was pretty
dramatic," said Dr. Green at Children’s. He believes an
official position statement from the AAP or a similar group
will likely come soon on the issue, and said he would change
his advice to patients accordingly.
Freeman at AHN isn’t waiting that long. She is urging
parents with infants who are high-risk for a peanut allergy
— those with severe eczema, other food allergies or siblings
with allergies — to make appointments as soon as possible to
figure out whether it is possible for them to safely introduce
study gave initial skin tests to its participants. Those with
a minor reaction to the test were still given peanuts under
supervision in a doctor’s office. In that group
specifically, 10.6 percent who were given peanuts had
developed an allergy by age 5, vs. 35.3 percent in the group
that did not consume peanuts.
infants with no risk factors for peanut allergies, Dr. Freeman
recommends trying peanuts and other allergens early in the
process of introducing solid foods. After a baby can tolerate
traditional baby foods like a vegetable or cereal, she
recommends the parents try egg yolk, then egg white, then
dairy and then peanut products (not the actual peanuts because
they could be a choking hazard for a child that young).
the baby has very bad skin, get in and talk to an allergist by
4 or 5 months of age," she said. "Up until this
point we probably wouldn’t have seen the child until they
were 1. I’d rather see a lot of babies and do a little
testing now and prevent the allergies rather than treating
that some pediatricians are regularly passing on outdated
information on delaying peanut consumption, Dr. Freeman is
planning to reach out directly to obstetricians, asking them
to share the new data with their pregnant patients.
Green cautioned that even though the results of the study were
strong, they were not 100 percent. Even among participants
with no initial reaction to the skin test, 1.9 percent who ate
peanuts went on to develop an allergy.
study also does not provide any good news for children like
Sienna who already have a peanut allergy. Only about 20
percent of children diagnosed with a peanut allergy eventually
her diagnosis, Sienna has been rushed to the hospital twice
— once while drinking from a cup at a restaurant that used
peanut oil and another time after eating Chex Mix at a friend’s
house. Sienna has a hot pink purse in which she carries
EpiPens at all times and has never eaten food from a bakery.
Grocery shopping takes about two hours, said Williams, because
she checks every label.
makes me wonder if we had started peanuts when we did solid
food, we wouldn’t be in the situation we’re in," said
Williams. "By the time she had it, her body was like, ‘What
the heck is that?’