There was a time when peanut butter and jelly sandwiches were a lunchbox staple for many a parent. As we learned more about food allergies and the risks they pose to children, lunchbox menus and lunchroom patterns have changed.
This was all for a good reason. Peanuts are the most common childhood food allergy associated with anaphylaxis, a life-threatening response by the immune system to exposure to an allergen. Imagine if you had a child who was deathly ill due to peanut protein.
Upward of 2 percent of children in the U.S. have a peanut allergy, and less than 20 percent outgrow this allergy by adulthood. Peanut allergy has increased three-fold since the late 1990s.
In 2000, parents were advised by the American Academy of Pediatrics (AAP) to delay feeding their at-risk children highly allergenic foods, including foods containing peanuts, until they were older. Three years old in the case of peanuts. Recommendations from the AAP were modified for this high-risk group in 2008 to encourage early introduction of allergenic foods starting at 4-6 months of age.
Intermountain Health pediatrician Jeffrey Richker, MD, shared that he recommends starting at 4 to 6 months of age children be given a tablespoon of peanut butter once a week.
Interestingly, it was noted that children in Israel have a low incidence of peanut allergy (0.17%) and are commonly fed teething snacks made of peanut and corn, called Bamba. This prompted the LEAP study (Learning Early About Peanut Allergy). Results were published in 2015 that gave pediatricians and allergist/immunologists information about when to safely introduce peanut-containing food to children. Essentially, the earlier, the better.
Children with eczema, egg allergy or other severe food allergies coupled with eczema should consult their pediatrician and be referred to an allergist/immunologist before consuming peanuts or other highly allergenic foods. Skin and blood testing may be recommended as part of a peanut allergy workup.
Some children still go on to develop an allergy despite the early introduction of thinned peanut butter as one of their first solid foods. This leaves parents and eventually the allergic child with worry about future exposures that can cause an anaphylactic reaction.
According to the Mayo Clinic, signs and symptoms of anaphylaxis can include:
Constriction of airways
Swelling of the lips, tongue, and throat that makes it hard to breathe
A severe drop in blood pressure, also known as shock
Rapid pulse
Dizziness, lightheadedness, or loss of consciousness
There is no cure for peanut allergy yet. Avoiding peanuts and carrying two epi-pens is advised for those with severe allergies. Several treatments have been developed in hopes of reducing the severity of an allergic reaction.
These treatments include oral immunotherapy , sublingual, or under the tongue, immunotherapy and epicutaneous immunotherapy, also known as the “peanut patch.”
The FDA has approved Palforzia, a once-daily oral preparation of peanut allergen for use in the 4-17 year age group. It has shown desensitization in about 68 percent of subjects and remission for 21 percent. The FDA has also approved XOLAIR (omalizumab), monoclonal antibody administered subcutaneously every 2-4 weeks. Treatment can be started as early as one year of age.
Ongoing studies are looking at the benefits of probiotics and bacteria in the gut, a vaccine that delivers virus-like particles, an intra-nasal vaccine, and oral mucosal immunotherapy , similar to sublingual immunotherapy.
A push for allergy awareness and education of parents, school staff and the affected child are being pursued in some school districts. It is thought that a false sense of security exists when foods are banned. Perhaps including this type of age-appropriate education will prepare the child to navigate the world and its risks outside the classroom.
