Many of our families struggle with allergies to foods which can be severe.  One common food allergy is peanuts.  Over the last decade, widely divergent recommendations regarding the best age to expose a child to peanuts have been circulated.  Introduction as late as 24 months and as early as 4 months have been recommended by allergists studying this problem.  Over the last two years, it has become clear that earlier introduction was better.  As a pediatrician in Fort Collins, I get this question every day: How early?

The American Association of Pediatrics recommends a 4 month to 11 month window, but cautions that infants with severe eczema or egg allergy may benefit from allergy testing and an evaluation by a pediatric allergist subspecialist.  A recent study by our colleagues at the University of Colorado adds to the discussion.

http://onlinelibrary.wiley.com/doi/10.1111/all.13100/full
http://www.physiciansbriefing.com/Article.asp?AID=717291

These researchers compared the rate of allergy in five year olds in two groups.  In one, the children received the peanut products between 4 and 6 months.  The other group was exposed to peanut between 6 and 11 months.  Those who were exposed to peanuts in the 6 to 11 month period had the lower rates of allergy at age 5 years.

Pediatric Associates of Northern Colorado recommends that peanut not be one of the first foods introduced.  Work through several vegetables, fruits, grains and pureed meats first.  After 8 months, if all is going well with these foods, it can be time for peanuts.  However, for those children who have significant eczema rashes or who have suspected allergies to some of these first foods, we recommend a visit to discuss timing of peanut introduction and whether precautions like an allergist evaluation or observed first exposure to peanuts would be appropriate.  Remember, too, that peanuts are a different sort of nut than “tree nuts” like almonds, walnuts, cashews or pistachios.  A child could have allergy to peanut and tolerate tree nuts or vice-versa.

How does one expose an 8 – 10 month old baby to peanut?  A trip to the ball game won’t do it.  Nor should one give whole nuts to these little guys.  One good way to introduce the food is to add hot water to 2 teaspoons of peanut butter to make a warm puree. Put a little of this puree on the tip of a spoon and feed it to your child. Then wait and watch for 10 minutes checking the baby for any negative reaction, such as hives, a rash, behavior changes or trouble breathing. If all is OK you can continue to feed the puree slowly; but keep an eye on the child for about two hours.  Watch for any rashes, difficulty breathing, facial swelling, vomiting or excessive fussiness.  Should any of these occur, call our office to talk over next steps.  A corollary of this is that if your baby has an intercurrent illness — fever, vomiting, cold symptoms, a rash — hold off on peanut introduction until this has resolved.  Otherwise, we won’t have these signs to rely upon as indicators that there may be a problem with peanuts.

If the fateful day of peanut introduction, your baby shows no signs of an allergic reaction, it’s safe to continue adding other peanut-containing foods as time goes on.  A favorite of mine is peanut butter banana sandwiches.  Yum.

Michael Hobaugh MD