Times and guidelines are changing
Once upon a time expecting mothers were advised to not eat allergenic foods like peanuts during their pregnancy in hopes that it would prevent a peanut allergy for baby. In addition, once baby was beginning solid foods, the recommendation to avoid peanuts continued until three years of age. According to the American Academy of Pediatrics, this severe and life-threatening allergy has almost doubled over the last decade. This is why the recommendations have taken a huge swing in the other direction.
The chance of having a child with a peanut allergy along with changing recommendations have left parents a bit uneasy, and understandably so. Sherry Coleman Collins, RDN, food allergy expert and consultant to the National Peanut Board says “there’s a great misunderstanding among parents about risk. The actual prevalence of peanut allergies among children is less than 2 percent. That means that more than 98 percent of children will not develop peanut allergies.” The updated guidelines provide good news and specific advice for parents and practitioners alike.
The AAP, the National Institute of Allergy and Infectious Diseases, and the Australasian Society of Clinical Immunology and Allergy now recommend that infants be exposed to high allergen foods like peanuts as soon as they’re developmentally ready for solids. When the AAP realized that abstaining from peanut exposures wasn’t helping, they rescinded their recommendation. Children in other countries weren’t having nearly the amount of diagnosed peanut allergies as children in the United States or the United Kingdom. After studying the infants’ diets with no peanut allergy, they realized the main difference was early exposure.
Exposure during pregnancy and breastfeeding
There is no evidence that abstaining from high allergy foods prevents the development of food allergies. Exposure begins during fetal development. Unless the expecting mother has a food allergy, all potential allergens should be included in a balanced maternal diet. Emerging research suggests that including three servings of fatty, or omega-3 rich, fish per week may reduce the development of eczema. Infants with eczema, a related allergic disease, are at higher risk for developing food allergies.
Just like during pregnancy, a varied and balanced diet that includes all types of food is recommended. Breastfeeding is recommended through the first six months of life for a variety of reasons, one being the possibility that it may reduce the incidence of food allergy. If breastfeeding isn’t an option, a traditional cow’s milk-based formula is recommended since there is currently no evidence that hypoallergenic formulas reduce the development of a food allergy.
Early solid feeding exposure
As soon as baby is ready for solids, evidence suggests that introducing high allergen foods may reduce the risk of developing an allergy, particularly egg and peanut allergies. If there is a family history of food allergies or allergic diseases, baby may be at greater risk. It’s recommended to introduce those allergens even at 4-6 months of age (but not before 4 months). This can be a scary time for parents with infants at higher risk. Your pediatrician can help guide the introductions and can even plan for baby to be exposed in their medical office. If there is no history of allergic disease then introducing peanuts when baby begins solids is key.
Peanuts are a choking hazard but can be offered in several safe ways like mixing thinned peanut butter with water or into Greek yogurt. Coleman suggests that infants “eat approximately 2 teaspoons of peanut butter or powdered peanut butter that has been added to rice cereal, purees, or thinned with breast milk or water, three times per week.” Even though some infants are at greater risk of developing food allergies, any child can develop one. For this reason, early exposure is appropriate for all infants.
“The big thing to know is that early introduction of peanut foods, as early as 4-6 months in high-risk infants after proper screening, can reduce the risk of allergies exponentially. For high-risk infants, that reduction of risk is more than 80 percent. Early introduction prevents peanut allergies” says Coleman.
The news of reducing risk is very exciting. Yet no matter the steps expectant parents take, there are still some children that will develop food allergies. If you’re concerned about food allergies, make sure to discuss how you’ll introduce high allergen foods with your pediatrician.