Peanuts and other food allergies

What should I know about food allergies?

All solid foods should be offered to babies around six months of age. Some are more likely than others to cause an allergic reaction: cow’s milk, eggs, tree nuts, peanuts, fish, seafood, soy, and wheat. Most breastfed babies do very well when they start eating solid foods, but they should be watched for reactions. There are number of ways to reduce the risk of allergic reactions. Babies at the highest risk of developing a peanut allergy may benefit from getting food containing peanuts between four and six months of age, even though the usual recommendation for starting solid foods is around six months.

A) Describing foods that can cause allergic reactions

It is estimated that 2% to 10% of the population has food allergies (Chafen 2010).

Babies who have eczema, an egg allergy, or a close family member with allergic illness may be at a higher risk of food allergies. Please discuss the current recommendations with your health-care providers as this is a very active area of research.

Foods that may produce an allergic reaction (allergenic foods) include:

  • Cow’s milk
  • Eggs
  • Tree nuts
  • Peanuts
  • Fish
  • Seafood
  • Soy
  • Wheat

Babies with food allergies react to foods in different waysSome babies with food allergies will develop immediate and life-threatening reactions with swelling of the mouth and throat and hives, a skin rash. Others can react with vomiting and low blood pressure within hours of eating. If your baby has a severe allergic reaction, seek medical help immediately.

Allergic reactions can also be chronic and babies may have poor growth, eczema, and blood in the stools (poop). For example, celiac disease, a chronic disease, is a type of food allergy.

B) Starting foods that may cause allergic reactions

In the past, mothers were told to avoid giving their babies allergenic foods during the entire first year of life. This was not appropriate and actually increased the risk of food allergies.  

Currently, caregivers are advised to start all foods, even allergenic ones, around six months. They may consider giving allergenic foods during daytime feeds and one at a time. This allows them to notice any reactions and identify the food that caused it.

Recommendations for the gap between introducing each allergenic food varies with some organizations having no comments on this topic (Abrams 2018; ASCIA 2019; CDC 2019).  A reasonable approach is to offer a new allergenic food every one to two days. Once started, each food should be given at least several times a week to ensure the baby stays used to it.

C) Preventing food allergies

1) Breastfeeding

Breastfeeding may reduce the risk of food allergies. It reduces the risk of eczema and supports the development of a healthy gut bacteria (microbiome) and may in turn reduce the risk of food allergies.

Breastfeeding mothers are encouraged to eat a balanced diet and should not avoid eating allergy-causing foods unless they themselves are allergic to them. 

2) Avoiding certain medication

Avoiding giving babies acid-suppressing medication and unnecessary antibiotics are recommended as ways to prevent food and other allergies (Mitre 2018).

3) Early solid foods for babies at high risk of food allergies

It is now accepted that foods that are likely to cause allergies should start by six months. 

4) Non-allergenic infant formula

Using infant formula that has some or all cow’s milk protein broken down, instead of regular infant formula, does not decrease the risk of food allergy (Fleischer 2020).

D) Preventing peanut allergy

Peanut allergy can be serious and even deadly and researchers have been trying to find ways to prevent it (Du Toitet al. 2015).  

1) Early peanut introduction for high risk babies

There is evidence that babies at the highest risk of developing peanut allergies may benefit from being exposed to peanut-containing foods between four and six months (Du Toit 2015; Greer 2019; Togias 2017).  

Having certain genes can make babies susceptible to peanut and other food allergies (Asai 2018) and siblings are slightly more likely to share allergies (Gupta 2016).

2) Babies who are not at high risk of peanut allergy

Peanuts, along with other complementary foods should be introduced by six months of age (Ferrante 2020).

3) Other approaches to prevent peanut allergies

Research has found that eating peanuts while pregnant and and breastfeeding reduces the risk of peanut allergies in babies (Azad 2020; Frazier 2014). 

Other approaches to prevent peanut allergy have not shown consistent benefits (Chen 2018). These include:

4) Examples of peanut-containing foods

Plain peanut butter can be a choking risk for babies. Safer peanut-containing foods can be:

  • Smooth peanut butter mixed with breast milk or boiled water
  • Smooth peanut butter mixed with pureed fruit or vegetables
  • Homemade peanut-containing snacks
  • Commercial peanut-containing snacks

Peanut butter can be made at home by grinding unsalted peanuts.

Some commercial peanut butter contains only peanuts and salt. However, it may also contain palm oil, hydrogenated oils, sweeters, sugars such as maltodextrin, soy protein, and emulsifiers such as mono- and diglycerides. These ingredients make it smoother, creamier, and sweeter, keep it from separating, and prolong shelf life but may make it less healthy.

References

Abrams EM, Hildebrand K, Blair B, et al.  Timing of introduction of allergenic solids for infants at high risk. Paediatr Child Health. 2019 Feb;24(1):56-57

Asai Y, Eslami A, van Ginkel CD, et al. Genome-wide association study and meta-analysis in multiple populations identifies new loci for peanut allergy and establishes C11orf30/EMSY as a genetic risk factor for food allergy. J Allergy Clin Immunol. 2018 Mar;141(3):991-1001

Australasian Society of Clinical Immunology and Allergy (ASCIA). ASCIA Information on how to introduce solid foods to babies for allergy prevention. Balgowlah, Australia: Australasian Society of Clinical Immunology and Allergy; 2019 May [cited 2020 Apr 6]

Azad MB, Dharma C, Simons E, et al. Reduced peanut sensitization with maternal peanut consumption and early peanut introduction while breastfeeding. J Dev Orig Health Dis. 2020 Dec 9:1-8

Centers for Disease Control and Prevention (CDC). When, What, and How to Introduce Solid Foods. Atlanta: Centers for Disease Control and Prevention; 2019 Oct 17 [cited 2020 Apr 6]

Chen M, Welch M, Laubach S. Preventing Peanut Allergy. Pediatr Allergy Immunol Polmonol. 2018 Mar 1;31(1):2-8

Chafen JJ, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: A systematic review. JAMA 2010;303(18):1848-56

Du Toit G, Roberts G, Sayre PH et al.; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13-23

Ferrante G, Carta M, Montante C, et al. Current Insights on Early Life Nutrition and Prevention of Allergy. Front Pediatr. 2020 Aug 6;8:448

Frazier AL, Camargo CA Jr, Malspeis S, et al. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr. 2014 Feb;168(2):156-62

Greer FR, Sicherer SH, Burks AW; COMMITTEE ON NUTRITION; SECTION ON ALLERGY AND IMMUNOLOGY. The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics. 2019 Apr;143(4). pii: e20190281

Gupta RS, Walkner MM, Greenhawt M, et al. Food Allergy Sensitization and Presentation in Siblings of Food Allergic Children. J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):956-62
 
Mitre E, Susi A, Kropp LE, et al. Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood. JAMA Pediatr. 2018 Jun 4;172(6):e180315 

Togias A, Cooper SF, Acebal ML. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017 Jan;139(1):29-44