Feeding Babies Peanut Snacks Can Help Them Avoid Future Allergies

Introducing peanut-containing foods into the diets of babies -- including those prone to allergies -- is a safe practice and drastically reduces their risk of developing peanut allergies later on, according to a landmark clinical trial published online Monday in the New England Journal of Medicine.

Allergy experts say the finding is likely to lead doctors to begin recommending that toddlers consume peanut butter and other peanut snacks even if they're deemed to be at high risk because they have asthma, severe eczema, siblings with peanut allergies and other food allergy risks.

In the study, researchers randomly assigned 640 babies with high allergy risks who were older than 4 months to either eat a peanut-flavored puffed snack food three times a week or avoid all peanut-containing products until they reached their fifth birthday; those who were mildly allergic to peanuts based on skin-prick tests were also included in the study.

At the end of the five-year study, researchers found that fewer than 2 percent of the babies who ate the peanut snack, called Bamba, developed peanut allergies compared to nearly 14 percent of those in the peanut-avoidance group. Nearly 11 percent of those who were mildly allergic to peanuts at the beginning of the study still had allergic reactions on skin tests at the end of the study compared to 35 percent of those who had avoided peanuts.

The British and American researchers didn't see any significant differences in allergic reactions like hives, stomach complaints and wheezing among the various groups.

"The data in paper are obviously very impressive," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the federal agency that funded and helped conduct the trial. "With regards to practicality of this now, we wouldn't recommend to parents to do anything on their own but to contact an allergist to see if this data warrants a change in their child's diet."

The prevalence of peanut allergies in the U.S. has skyrocketed in recent years -- quadrupling from 0.4 percent in 1997 to more than 2 percent in 2010. In fact, peanut allergies, which typically begin in early childhood and are rarely outgrown, have become the leading cause of severe food-related allergic reactions and death in this country.

The American Academy of Pediatrics began recommending 15 years ago that babies with a family history of food allergies or with symptoms of allergies themselves avoid certain high-risk foods like peanuts, shellfish and nuts until they reached age 3. But the pediatrician group withdrew those recommendations in 2008 after the number of kids with peanut allergies continued to rise and after studies began hinting at benefits to introducing allergenic foods during infancy.

In one striking finding, British researchers observed that the prevalence of peanut allergies among Jewish children in London who weren't fed peanut foods during their first year of life was 10 times higher than among Jewish Israeli children who were given Bamba, popular in Israel, when they were babies.

Fauci says the old recommendations for children to delay eating peanut foods may have contributed to the sharp rise in peanut allergies.

Current food allergy guidelines issued by Fauci's agency state that "there is no evidence that supports delaying the introduction of solid foods to an infant beyond 4 to 6 months of age to prevent allergic diseases from developing. This includes giving an infant a food containing milk, eggs, peanut, tree nuts, soy or wheat."

But those guidelines could be taken a step further, by encouraging parents to feed these foods to their young kids regularly to prevent allergies as a result of the new study, according to Rebecca Gruchalla, a pediatric allergist and director of the division of allergy and immunology at the University of Texas Southwestern Medical Center--Dallas. She also emphasizes that any new guidelines would have to be carefully worded to convey the complexity of food-allergy prevention in babies who already have signs of peanut allergies.

"I don't want every parent out there to say I'm going to give my 4-month-old peanut butter," Gruchalla says. "Kids with severe eczema, asthma or other food allergies need to be evaluated by an allergy specialist and have a skin test to see how allergic they are to peanuts."

She says she plans to change her guidance to recommend that babies with mild peanut allergies or other food allergies have peanut snacks as a regular part of their diets based on the new study -- under her close supervision -- but she would also hesitate to recommend this for those with severe peanut allergies.

Babies with severe peanut allergies based on a skin test were excluded from the clinical trial, so allergists have no way of knowing whether they can safely consume peanuts.

In an editorial accompanying the study, Gruchalla and her colleague also questioned the optimal dose that babies need to avoid peanut allergies.

"Do infants need to ingest 2 grams of peanut protein (approximately eight peanuts) three times a week on a regular basis for five years, or will it suffice to consume lesser amounts on a more intermittent basis for a shorter period of time?"