NUTRITION HOTLINE
QUESTION: I'm concerned that my new baby, whom we plan to raise vegan, might become allergic to peanuts. Is there anything I can do to reduce her risk?
NM, via e-mail
ANSWER: Peanut allergy is a relatively common problem that seems to be increasing in frequency. In 2010, about 2% of children in the U.S. had a peanut allergy.1 In children with a peanut allergy, exposure to even small amounts of peanuts can cause a severe, potentially life-threatening allergic reaction called anaphylaxis in which warning signs like an itchy rash, swollen throat, wheezing, and difficult breathing can occur. It's definitely possible for a vegan child to have a healthy diet without peanuts or peanut butter. Still, it's understandable that you'd like to reduce the risk of your child having a peanut allergy.
Exclusive breastfeeding for the first four to six months may help to reduce the risk of food allergies overall. There does not seem to be any benefit of the mom avoiding peanuts or peanut butter although this is an area of active research.2 In 2017, the National Institute of Allergy and Infectious Diseases introduced guidelines for when to give peanuts to infants.3 Their guidelines differ depending on whether or not a baby has eczema or food allergies.
For babies with no eczema or food allergies, products containing peanuts can be introduced whenever the baby is eating solid foods. Of course, for all babies and young children, peanuts should be finely ground and incorporated into other foods, like cooked grains, to reduce the risk of choking. Similarly, smooth peanut butter should be mixed with other foods and not given by the spoonful.
Babies with mild to moderate eczema should be given peanut products when they are around six months-old, after discussing the introduction of peanuts with the baby's doctor. The baby should be developmentally ready for solid foods before introducing peanuts or products containing peanuts.
Babies with eczema severe enough that it often needs to be treated with prescription creams and those with an egg allergy should be tested for peanut allergy and the introduction of peanuts discussed with the baby's doctor. If the doctor approves, early peanut introduction, around age four to six months, in these infants, reduces the risk of peanut allergy.3 These babies may need to have their first taste of peanut products in the doctor's office so that they can be quickly treated if they have a reaction to the peanuts.
REFERENCES
1 Gupta RS, Springston EE, Warrier MR, et al. 2011. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 128:e9ee17.
2 Burks AW, Jones SM, Boyce JA, et al. 2011. NIAID-Sponsored 2010 Guidelines for Managing Food Allergy: Applications in the Pediatric Population. Pediatrics. 128: 955-65.
3 Togias A, Cooper SF, Acebal ML, et al. 2017. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases Sponsored Expert Panel. J Acad Nutr Diet. 117:788-93.
