Food Allergy Awareness Week (May 9-15) presents an excellent opportunity to address peanut allergy, as many parents come to us with questions about this topic. If you or a loved one is living with a peanut allergy, then you know that it’s a condition that always needs to be taken seriously. We have seen many patients with peanut allergy at Nicklaus Children’s and I tell parents that it requires constant vigilance to avoid peanuts and the dangerous, sometimes life-threatening reactions that accompany them.

Peanut allergy symptoms, along with other true food allergies, happen shortly after ingestion, with a majority occurring within the first 30 minutes after ingestion. These symptoms can include: stomach cramps, vomiting, diarrhea, hives, trouble breathing, swelling in the throat, coughing, pale skin, dizziness, and fainting. This can lead to a life-threatening reaction and requires immediate treatment with epinephrine (sometimes called an Epi-Pen or Auvi-q) to stop the symptoms.

The History of Peanut Exposure in Infants

For many years, allergy experts felt that the best way to prevent peanut allergies and their dangerous symptoms was to delay the age when children were first exposed to peanuts. For this reason, many people in the early 2000s did not feed their children peanuts until they were around 1 year old. In 2000, the American Academy of Pediatrics actually recommended delaying exposure until age 3 for children with a family history of peanut allergy or other risk factors for it.

However, more recent research has led to considerable changes to this advice. One of the most important pieces of research in this area was a landmark 2015 study published in the New England Journal of Medicine.

In the study, more than 600 infants ages 4 months to 11 months with existing eczema or egg allergy were divided into two different groups. The first group avoided peanuts entirely and the second group consumed peanut products regularly. At the age of 5 years they were assessed for peanut allergy. The peanut consumption group showed an 86 percent reduction in peanut allergy in those who had a negative peanut allergy test at study onset and a 70 percent reduction in peanut allergy among those who had a positive peanut test results at study entry.

Changing Recommendations

The results of this study were so dramatic, in fact, that they led to experts changing the recommendations for infants and peanut consumption. In 2017, the National Institute of Allergy and Infectious Diseases released new guidelines for introducing infants to peanut products that went as follows: 

• If a child has severe eczema, an egg allergy or both, speak with your health care provider and consider having an allergy test. Based on the allergist’s recommendation, it may be prudent to introduce peanut products as early as 4 to 6 months of age.
• If a child has mild to moderate eczema, peanuts can be introduced around 6 months of age. It’s still a good idea to speak with your healthcare provider about your concerns around this time.
• If your child does not have eczema or food allergy, you can introduce peanuts in accordance with your cultural or family preferences. No specific age is recommended.

With young infants, keep in mind that whole peanuts or chunks of peanuts present a choking hazard. So, it’s very important to only use age-appropriate products with peanuts when beginning the process of introducing peanuts.

Introducing a child to a potential allergen can be concerning, of course, which is why we recommend staying in close communication with your allergist throughout the process and notify them immediately if you see any warning signs of an allergic reaction. However, recent research has clearly shown that early introduction of peanut helps to reduce a child’s likelihood of developing a peanut allergy.