This post is part of an ongoing series about safety and young children, in which we'll explore what's dangerous, what's an acceptable risk, and what's just plain safetyshaming. You can view all of the posts in this series here.
The reaction to Mylan's price hike on EpiPens is a reminder that food allergies are a serious, even life-or-death issue for some families. Even those parents whose children are at a low risk for developing allergies tend to be hyper-alert during Junior's first few tastes of nuts. But how concerned should you be about giving nuts to your children? Should you listen to the tsking of your mom group when you open up a pack of peanut butter crackers?
It helps to remember that nut allergies are rare: in 2010, 1.4% of children in the U.S. had peanut allergies. So while peanut allergies are incredibly significant to those who have them, the likelihood that your child will develop a peanut allergy is quite low. But that 1.4% actually represents a rise: in 1997, that number was 0.4%.
What accounts for this rise? Recent evidence suggests that late exposure to nuts is making the problem worse. The untested, but widely-shared, thesis about food allergy prevention was that delaying introduction of certain foods might make reactions less severe. There's no good evidence that delaying introduction of a food will prevent children from reactions, but that has been the standard of care for about two decades, the same period during which peanut allergies in the country was climbing.
There is growing evidence that early introduction of foods may decrease the rate of allergies in children. The LEAP trial followed infants with early exposure to peanut protein and infants who were not exposed to peanut protein. At 5 years of age, children from the early introduction group had fewer positive allergy tests than those who had not been exposed to peanut protein.
Prior to the LEAP trial, the prevailing--but again, unstudied--notion in pediatrics was to wait to introduce allergenic foods, because many kids appear to eventually outgrow food allergies once their immune systems mature. In his summary of the LEAP findings, Scott Sicherer, former chair of the AAP's section on Allergy and Immunology Executive Committee, asserts that, as a result of these findings, "the need for a change in culture of early feeding practices with regard to allergy is clearly at hand." The study does not tell us that if you just feed more nuts to your babies, they'll be less likely to develop peanut allergies. But the results do suggest that the advice to wait to introduce possible allergens will not make your child any less allergic. That's exciting research, because it's rare that a finding has the potential to completely change the standard of medical care.
So, are peanuts safe? Serious peanut allergies are terrifying, but mercifully, rare. There is not yet any evidence that waiting to introduce a food will make a child less likely to develop an allergy; in fact, there's growing evidence that introducing a food earlier can make a child less likely to develop an allergy. If your child is going to develop a peanut allergy, it might be better to know early so that avoiding nuts becomes second nature to both of you before he goes to school.
It's understandable to avoid exposing your child to pain or fear. But doing that also means missing the joy of peanut butter. So when I first scooped out some for my child, I channeled Buffy of late Season 6: "I don't want to protect you from the world. I want to show it to you."
And I channeled her again when his teeth came in and he wanted to try whole peanuts. But choking's a safety fear for another post.
I am not a medical professional. But that's the point. All parents--all people, really--should develop the basic research skills necessary to read a scientific study and evaluate its findings. If you suspect your child has a severe allergy, or you have a family with a history of severe allergies, of course you should share your concerns with a pediatrician. If your pediatrician is suggesting that you wait to introduce potential allergens, share the LEAP trial and ask how the results are influencing his or her practice. If your pediatrician seems unaware of or uninterested in findings of the American Academy of Pediatrics, which has changed its practice guidelines based on the findings of the LEAP trial, it may be time to look for a new pediatrician.