Preventing Food Allergies
Fifteen million Americans have food allergies, and the number is rising. As people become more aware of this potentially life-threatening disease, many parents and caregivers wonder:
What can I do to prevent food allergies in my newborn child?
At FARE, we seek to help everyone better understand food allergy. We also want to provide hope for the future. Anything that can be done to prevent children from developing food allergies is a big step forward, while we work toward treatments and cures.
Research in this area is still evolving. Here we explain recent progress and the new guidelines for preventing peanut allergy, as well as what it means for other food allergies.
Q: Can food allergies be prevented?
A: In some case, yes. In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) introduced new guidelines to help prevent peanut allergy in high-risk children. These guidelines, aimed at healthcare professionals and parents, are the result of a pair of groundbreaking studies about peanut allergy.
Q: What does research say about the prevention of peanut allergy?
A: Released in February 2015, Learning Early About Peanut Allergy (LEAP) was the first major study to look at whether feeding babies a specific food was likely to increase or decrease their risk of allergy. Earlier studies on the topic were neither large nor well-controlled and could not provide a definitive answer.
LEAP researchers studied a large, diverse group of infants in Britain. All were at high risk for peanut allergy because they had been diagnosed with egg allergy and/or moderate to severe eczema, a skin rash often linked to allergies.
The results showed that children who were introduced to peanut before age 1 and who regularly ate food that contain peanut had a much lower chance (81 percent) of developing peanut allergy. Meanwhile, the children who avoided peanuts during the five-year study had a higher chance of developing the food allergy.
One year later, a follow-up study called Persistence of Oral Tolerance to Peanut (LEAP-On) demonstrated that this approach prevents, rather than delays, food allergy. The same children who ate peanut as infants could avoid the food from ages 5 to 6, and still not develop peanut allergy.
LEAP and LEAP-On received most of their funding from FARE and NIAID, a division of the National Institutes of Health (NIH). Learn more about these studies.
Q: How has this changed medical advice?
A: As many people affected by food allergy know, for decades allergists recommended young infants avoid eating peanut. They believed that early exposure to common allergens would lead to food allergies.
The LEAP findings suggest this advice was incorrect. In fact, it may have influenced the rise in the peanut and other food allergies.
Q: What are the limitations of this research?
A: Early introduction is not foolproof. While this approach was effective — reducing the prevalence of peanut allergy by 81 percent — it did not prevent the allergy in all the children from LEAP’s consumption group.
Also, it’s important to know that LEAP and LEAP-On studied allergy prevention, not treatment. Researchers tested all participants at the start and left out anyone with a known peanut allergy (though they could show a mild sensitivity to peanut).
Q: What are the new guidelines for preventing peanut allergy?
A: In January 2017, NIAID issued official clinical guidelines recommending that parents and caregivers introduce peanut-containing foods during infancy, to lower the risk of peanut allergy.
The guidelines vary depending on risk level. Ask your doctor if you are unsure about your child’s risk level.
- High risk (child has severe eczema, egg allergy or both): Introduce age-appropriate peanut-containing foods between 4 and 6 months. It’s a very good idea to have your child professionally tested for peanut allergy first (using either a skin prick test or blood test). This will help you decide whether to introduce peanut at home or in a healthcare setting.
- Moderate risk (child has mild or moderate eczema alone): Introduce age-appropriate peanut-containing foods around 6 months. See your doctor if you have any specific concerns.
- Low risk (child has neither eczema nor food allergy): Introduce peanut-containing foods depending on your family’s preferences and cultural practices. This is considered safe and should lead to a lower rate of peanut allergy.
NIAID developed guidelines for the moderate and low-risk groups based on the safety of early introduction for high-risk children, as proven by the LEAP trials.
Let your baby try other foods before you introduce anything with peanut. You want to make sure he or she is ready for solids.
Never give infants and small children whole peanuts or straight peanut butter, as these are choking hazards. Safe forms of peanut described in the NIAID feeding guidelines are Bamba (peanut butter-flavored corn puffs, manufactured by Osem), softened with water for younger babies; smooth peanut butter thinned with water; smooth peanut butter mixed with pureed fruits or vegetables; and peanut butter powder or peanut flour mixed with pureed fruits or vegetables.
Q: Why focus on peanuts?
A: Peanut allergy prevention was studied for several reasons.
Scientists have a lot of data about the rates of peanut allergy in the U.S. and around the world. We know that peanut is one of the most common food allergies and that it usually develops in infancy or early childhood. In fact, the number of American children with peanut allergy more than tripled between 1997 and 2008.
We also know that small amounts of peanut can produce very serious allergic reactions. Most of the time, a child’s first reaction happens the first time they eat peanut. And while any food allergy can be life-threatening, peanut causes the most deaths from anaphylaxis (which is, thankfully, still rare).
Q: Someone in my household already has a peanut allergy, so we don’t keep peanuts in the house. What should I do for my infant?
A: Do what feels right for your family. Consider following the prevention guidelines while practicing good storage and hygiene. This may help prevent the young child from developing a peanut allergy while protecting the other person from cross-contact.
Q: My child already has a peanut allergy. What does this mean for us?
A: LEAP and LEAP-On did not study children with peanut allergy. The researchers only looked at children with certain risk factors.
Never give peanuts to anyone with a peanut allergy without first talking to your doctor. Anyone with a diagnosed food allergy should continue to avoid that food to stay safe.
Q: What about foods other than peanut?
A: Most of what we know about food allergy prevention pertains to peanut. NIAID has not adjusted its guidelines for any other food.
Other studies have looked at egg and cow’s milk, but the results aren’t as conclusive as those from the LEAP trials on peanuts. It may be reasonable to think that early exposure could also prevent other food allergies, but we don't know for sure. We need more information on how, when and for how long we should give these foods to infants and young children — and whether it’s as effective.
Research also shows that early introduction to allergenic foods does not disrupt breastfeeding or negatively affect overall nutrition in infants younger than 6 months. This bodes well for further research into other food allergens.
If your child has no known risk factors, you can introduce all foods consistent with family preferences, whether or not they are considered common allergens. If your child has a risk factor, or if you have any questions or concerns, see your pediatrician, allergist or other healthcare provider.
Q: I’m pregnant or breastfeeding. Should I eat peanuts to help prevent food allergies in my baby?
A: Eating a variety of nutritious foods during pregnancy and breastfeeding will not promote food allergies in developing babies. We do not know whether eating food allergens during pregnancy and breastfeeding can protect babies from food allergy. The LEAP research involved feeding peanut products directly to the infants.
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Suspected food allergies should always be evaluated, diagnosed and treated by a qualified medical professional, such as a board-certified allergist.