Peanut Allergies: Snacks With a Side of Drama

Filed under: Opinions

Young children shouldn't eat peanuts. Young children should eat peanuts. Maybe eat them, maybe not. Experts don't know how to prevent the dreaded peanut allergy. Even though rates of peanut allergies have risen steadily over the last decade, prevention is still a mystery.

Today it's a mystery. Ten years ago, not so much.

Back then pediatricians and allergists didn't seem so mystified. They preached "early avoidance," a belief that blamed allergies on immature immune systems: If young children avoided peanuts (even in utero or breast-feeding) their fragile immune systems would be spared and have time to develop before encountering known allergens. A smattering of what they now concede was "inadequate" data convinced the American Academy of Pediatrics in 2000 to officially recommend early avoidance -- no nuts during pregnancy, breast-feeding or the first three years of life ...

Especially for kids with a family history of allergies ... like mine.

I'm the mom who should have the kid with the peanut allergy. My "history" includes every other tree, plant and animal, penicillin and food (shell fish, strawberries, beef and possibly bananas and squash). My children have escaped unscathed despite several unexplained incidents ending in food challenges, skin tests and tears. Incidentally my first child was born a month after the official AAP verdict, so I "eliminated" nuts while breast-feeding and for months if not years thereafter out of guilt I'd doomed my unborn daughter and future offspring with the occasional peanut butter and jelly.

If only I'd foreseen the major plot twist.

In January 2008 the AAP revised (i.e. gutted) their no-nut recommendations. Why? Though the exact prevalence remains debated, peanut allergies continued to rise while newer studies failed to find lower risks for children whose mothers abstained.

Worse yet -- early avoidance appeared not only ineffective but harmful. It might have created more allergies. So eating peanuts early on may actually prove beneficial.

Tantalizing evidence comes from British researcher Gideon Lack, yes, with a name straight out of Screenwriting 101, who looked at peanut allergies in Jewish children living in London, where parents were told to avoid nuts, and in Israel, where even infants eat "Bamba," a nutty treat. His 2008 study showed kids in London had almost 11 times the rate of peanut allergies as those in Israel. I hope Dr. Lack will deliver more answers in a few years from LEAP (Learning Early about Peanut Allergy), a study pitting early avoidance against early exposure. Back in 2006, the possibly prophetic Lack randomly assigned children to either avoid or eat nuts so he could ultimately compare allergy rates between the groups.

Until then, experts don't know what to tell parents. Dr. Scott Sicherer, a professor of pediatrics at the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine -- a man who's devoted decades to cracking the peanut, told ParentDish this past fall "each family has to decide what they want to do." An amazingly candid admission.

So we wait and as much as I love suspense and intrigue, I feel for families coping with uncertainty and anxiety, not to mention soy butter and EpiPens. It's difficult to appreciate the inherent drama in science when you're trying to figure out if you're feeding your child a time bomb.

But real-life drama it is, high-brow even, as the story recently landed in the esteemed pages of The New Yorker in "The Peanut Puzzle." As if parents naturally seek answers sandwiched between literary ramblings and theater reviews.

Stay tuned.

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AdviceMama Says:
Start by teaching him that it is safe to do so.