Peanuts, when?

Gretchen asked, “When is it ok to feed a child peanut butter? I have heard that you should wait until 4 years old because if you try sooner then the child could become allergic. I have been feeding my 14 month old peanut butter since his first birthday and he has shown no signs of allergy, but can he develop one if I give him peanut butter too often (another rumor I have heard)? He eats it about 3 – 4 times a week.”

There is no consensus among allergists or pediatricians about when kids can safely start peanut butter. There is no “official” recommendation from either the American Academy of Pediatrics (AAP) nor the American Academy of Allergy Asthma and Immunology (AAAAI). Since there’s really no evidence that delaying introducing peanuts prevents allergies, there’s no good reason to delay peanuts as long as many people suggest.

For a long time, a strategy proposed to prevent allergy was to delay introducing certain foods. You’ll find all sort of tables with specific “recommendations”—strawberries at 12 months, or peanuts at 3 years, or whatever. But until recently there really was very little research to help guide these sorts of suggestions. The tables were arrived at by a process of “expert consensus,” a fancy term for “making things up.”

The best recent studies, summarized here, do not support delaying food introduction. In fact, some studies have found that by delaying certain foods, you might increase your child’s risk of allergy.

Keep in mind that your child’s risk of food allergy depends very much on the parent’s history. If neither parent has food allergies, a child has a very low chance of food allergy, less than 2%. If one parent has a food allergy, it’s up to 8%; if both parents have food allergies, their child has about a 50% chance. You could also consider siblings—the more siblings with allergy, the higher the chance. And once a child has one food allergy, the risk of having others is fairly high. So if there is no family history of allergy, and a child hasn’t shown signs of any other food allergies, the chance of a peanut allergy is very small.

Since your child is tolerating peanuts fine, there is no reason to restrict them. It is not true that frequent peanut ingestion can lead to allergy. Your child can continue to eat peanut products safely as often as he’d like.

I routinely suggest that children who don’t have a strong family history of allergy can start having peanut products at twelve months of age. It’s important for all families to keep Benadryl in the house, and know their child’s dose (ask your pediatrician.) If a rash develops after peanut (or any other food) is ingested, give Benadryl. If there are any signs of trouble breathing, tongue swelling, or decreased consciousness, call 911. If you’re not sure what to do, contact your child’s pediatrician immediately.

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4 Comments on “Peanuts, when?”

  1. Nancy Says:

    I am a little bit confused. I thought children under 2 could not have cold medicine but you said she could have Benadryl?Does that mean Benadryl is okay if a child has a rash from a food?

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  2. Dr. Roy Says:

    Benadryl isn’t a cold medicine, it’s an antihistamine– it treats allergy. It treats allergies like hives, watery nose, and watery eyes very well. It has a very long track record of safety.

    “Cold medicines” sometimes contain antihistamines, but that’s entirely for their sedating effect. Antihistamines like Benadryl or the ones in other cold medicines don’t help the runny or congested nose that goes with a cold.

    It is true that the marketing of Benadryl and similar drugs is confusing, and I fear this is deliberate from the drug companies to sell more of their product. That’s one reason why many people think allergy medicines are useful for colds.

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  3. Jennifer Lanham Says:

    Submitted on 2009/04/17 at 10:57am

    I spoke to you a while back about my daughter’s peanut allergy and how my OBGYN recommended that I avoid peanuts during my pregnancy with our son. At a more recent visit to the office, I mentioned this article to you and asked if you had read any research on the topic(early exposure to peanuts may prevent allergy). Here is the article I was referring to. Just wanted your opinion.

    http://www.msnbc.msn.com/id/27596933

    Thanks!
    Jennifer

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  4. Dr. Roy Says:

    That study compared children in Great Britain (where peanuts are started quite late) with children in Israel (who often start consuming peanuts well before six months of age.) The children were from somewhat similar genetic backgrounds. It turns out that at least in this comparison, the children who had early peanut exposure were less likely to become allergic.

    This study, while not perfect, adds further evidence that recommendations to delay the introduction of foods to prevent allergy are misguided, and may do more harm than good.

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