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We've Done Peanut Allergies All Wrong and Risked Kids' Health

Photograph by Twenty20

Everything parents have been told about peanut allergies in the last 20 or so years is wrong. This week, the nation's top health agency issued new guidelines aimed to prevent severe reactions to peanuts—and they read as if we're living some kind of Peanut Allergy Opposite Day.

The National Institutes of Health are saying parents should introduce peanut butter to babies alongside the introduction of other solids, including babies who might be prone to allergies.

The new recommendations are based on studies that found the earlier peanuts are introduced to babies, the lower the rate children develop severe allergies to what has long been considered a highly allergic food.

The National Institute of Allergy and Infectious Diseases released the new guidelines for pediatricians and allergists this week, explaining the 180 came about after observations of Israeli children led researchers to look more closely at what the best practices might be.

Anthony S. Fauci, director of National Institute of Allergy and Infectious Diseases, told the Washington Post that whereas Israeli kids in Israel were typically given peanut products at a very young age, those being raised in the U.K. tended to first be exposed at 3, which has been the recommendation for nearly 15 years. And yet, those Israeli kids had dramatically lower rates of peanut allergies.

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So that hypothesis was tested on a randomized trail of 640 infants who were considered at high risk for developing peanut allergies. The results, "Learning Early About Peanut Allergy (LEAP)," were published in 2015 in the New England Journal of Medicine. Researchers led by Gideon Lack of King's College London concluded that kids at high risk whose diets as infants included peanuts had an 81 percent lower chance of peanut allergies by age 5.

Eighty-one percent is pretty dramatic. That's saving thousands and thousands of kids from developing childhood (and lifelong) peanut allergies. It also means the slow dismantling of peanut-free schools, which have frustrated peanut-butter-and-jelly packing parents for nearly a generation.

What the paradigm of these new guidelines is that a body needs exposure to peanuts in order to not become allergic.

To be clear, it's not a peanuts and babies free-for-all. First of all, the guidelines state that peanut concoctions should not be the first solid these babies are introduced to. Start with other foods and then bring in the peanut butter. Second, while MOST babies fall into the category of harmless introduction of peanut butter, there are some who should seek medical tests before starting: those whose babies have been diagnosed with eczema.

Most parents know whether their baby has eczema, a persistent red itchy rash. These babies make up a small part of the population and should seeking skin prick tests, according to the new guidelines. Under watch from doctors, these babies should still be introduced to peanut products, the guidelines say, and as eary as 4 months.

It's all kind of counter-intuitive for those operating under the idea that waiting on exposure gives a child's body time to develop. What the paradigm of these new guidelines is that a body needs exposure to peanuts in order to not become allergic.

The Washington Post broke down the guidelines to help parents decide whether their baby would benefit or be harmed by early peanut products introduction:

    • "Group 1: At highest risk, with severe eczema, egg allergy or both. Strongly consider evaluation by blood test, skin prick test or oral food challenge. Based on test results, introduce peanut-containing foods at 4 to 6 months.
      • Group 2: Moderate risk, with mild-to-moderate eczema. Introduce peanut-containing foods around 6 months.
      • Group 3: Less risk, with no eczema or any food allergy. Introduce peanut-containing foods at an appropriate age (e.g. 6 months old) and in accordance with family preferences and cultural practices."

      Of course, peanut butter is a choking hazard and so they recommended thinning your Jif with water, mixing peanut powder with veggie and fruit purées or offering those peanut puff snacks. (The NIH even included some infant-friendly peanut recipes in their guidelines!)

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      Parents of the low- and moderate-risk babies should, like in the old days, continue to introduce these foods slowly and with caution, offering it on the tip of a spoon, letting the baby taste it and waiting 10 minutes to see whether there is a reaction. If there is none, feed the rest to the baby.

      Researchers have now turned their attention to early exposure to tree nuts and eggs, though results for these will come in in a few years at the earliest.

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