Is it Peanut Butter Time? Introducing Peanuts to Your Children

By Lindsey Johnson
Peanut butter in bowl

Over recent years, recommendations about when to introduce highly allergenic foods has been a moving target. Parents want to minimize risks of their children developing a life-threatening allergy and figure out when they should introduce peanuts. Current recommendations may surprise you.

Peanut Allergies

The American College of Allergy, Asthma and Immunology (ACAAI) cites a 2017 report that found a 21% increase in peanut allergies from 2010 to 2017, with an estimated 2.5% of American children (approximately two million kids) suffering from this allergy. Peanut allergies are not just a nuisance, they are potentially deadly. Someone with a peanut allergy may suffer anaphylaxis, a state of shock that can cause trouble breathing and systemic reactions. According to Johns Hopkins Medicine, only about 20% of children with a peanut allergy will outgrow it, unlike with some other common food allergies that children often outgrow.

When to Introduce Peanuts to Your Children

For many years, people thought that strict avoidance and delaying introduction of foods that could be highly allergenic was the best path to preventing allergies. This was to allow time for the child’s immune system to further develop. However, Allergology International reports that studies underestimated the exposure to allergens in house dust. This means children still encounter allergenic products even if they do not intentionally ingest the foods.

In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) published new guidelines on when to introduce peanut products to babies, depending on their risk for allergy. Babies who have eczema, an allergic skin condition, or a known egg allergy are at a greater risk for developing a peanut allergy. The more severe the eczema, the greater the risk.

Experts now recommend that parents introduce peanut-containing products at the same time as they introduce other solid foods, usually around four to six months of age. The greater the risk of allergy, the earlier on this spectrum they may recommend introduction. While peanut products can be introduced safely to many children in these early months, experts advise to introduce other foods with a lower allergy risk first.

Talk to your pediatrician or an allergist for their advice on when to introduce peanut foods to your baby, particularly if they are at an increased risk of peanut allergy. Some providers may wish to do the introduction in a clinical setting in case of a possible reaction. Because peanut allergies can be life threatening, in the case of anaphylaxis, an epinephrine shot (or Epi-pen) may be necessary to alleviate symptoms.

The Future of Peanut Allergies

While most peanut allergies will be long-term, new therapies are emerging to help minimize the severity of reactions. One option is sublingual immunotherapy (SLIT) that provides very small amounts of peanut exposure over time to build a tolerance. Existing therapies such as Palforzia administer small amounts of peanut flour to the child (initially in a healthcare setting) over a period of time.

A clinical trial at the University of North Carolina wrapped up its four-year study in February 2023, using a similar sublingual immunotherapy, but starting with 1/75th of a peanut kernel. In May 2023, a phase three clinical trial concluded that a subcutaneous patch for toddlers to reduce sensitivity to peanuts was effective in minimizing reactions. While all of these therapies do not “cure” the allergy (sorry, still no PB&Js in lunchboxes), they do help minimize the risk of a severe reaction in case of accidental exposure.

Know your baby’s risk of developing a peanut allergy and discuss with your pediatrician when the appropriate time is to introduce peanut products to your child. Be aware that babies cannot eat peanut kernels due to a choking hazard but could be exposed to peanuts through small amounts of peanut butter, peanut flour or snacks that contain peanut products. Your pediatrician or allergist can advise the best time, amount and product that is suitable for your child. Keep in mind that every child is different, so assess when you should introduce peanuts to your children with your doctor for each of them.

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