PB&J…thirty years ago, the debate was not if children should enjoy this staple food but rather what flavor of jelly should be used (I have always been a traditionalist - grape all the way) or should you mix the peanut butter and jelly together before applying it to the bread (I was a peanut butter on one side and jelly on the other side kind of girl).  However, given that the rate of peanut allergies in children in the United States has more than quadrupled, rising from 0.4% in 1997 to over 2% in 2010, the majority of daycares, schools and now, even some airlines, have strict policies to eliminate peanut products in their facilities.

“The study entitled “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy” was published by the New England Journal of Medicine, and many are calling it “landmark” and one that will likely impact future recommendations on introduction of peanuts to infants.”

In 2000, the American Academy of Pediatrics (AAP) made a recommendation that parents should avoid giving peanut products to children until at least 3 years of age.  However, in the years following this recommendation, the rates of peanut allergy continued to rise despite (or perhaps because of) avoidance of peanuts, so this recommendation was retracted in 2008.  Over the past five years, there have been several studies looking at the timing of introduction of other allergenic foods such as milk and eggs, and these studies have found that earlier introduction of these foods actually decreases the risk of allergy development in kids.

However, none have been quite so stark and impactful as the study that was released this past week.  The study entitled “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy” was published by the New England Journal of Medicine, and many are calling it “landmark” and one that will likely impact future recommendations on introduction of peanuts to infants (click here to see the full study).  The study looked at over 600 infants who had severe eczema, egg allergy or both (so an overall higher risk group for possible food allergies) to see if introduction of peanut product before 11 months of age, even to infants who had mild reaction to peanuts on skin testing, could have an impact on the development of allergy to peanuts at 5 years of age.  To cut to the chase, the results were rather impressive.  In the group that had negative skin testing to peanuts as infants (and therefore were considered not quite as susceptible to developing peanut allergies from the outset), approximately 13.7% of the infants that avoided peanut products developed a peanut allergy by 5 years of age while only 1.9% of those infants who were given peanut products developed peanut allergy at the end of the study.  For those infants that did screen positive for possible peanut allergy on the initial skin prick testing, 35.3% of the avoidance group developed a peanut allergy by 5 years of age, yet only 10.5% of the consumption group tested positive when they turned 5.

“I would cautiously give the go-ahead to bring home the jar of creamy Jif goodness after discussing it with your child’s pediatrician first.”

So should this study make parents flock to the peanut butter aisle at their local grocery store? Well, not quite so fast for all infants.  I would cautiously give the go-ahead to bring home the jar of creamy Jif goodness after discussing it with your child’s pediatrician first.  In children who have a family history of food allergies, particularly nut allergies that cause anaphylactic reactions (which means a life threatening reaction resulting in emergency visits to the hospital), allergy testing may be indicated before introducing foods such as peanuts, eggs, milk or shellfish.  If you are given the all clear to begin introducing peanuts, be aware that infants and young children should NEVER receive a whole peanut until they can spell the word “peanut” as whole nuts are a choking hazard.  I also recommend that when parents start a possible allergenic food such as peanuts, that they make sure and offer small amounts of the food daily for several days in a row to really know how your child’s system will respond.  Given that true allergic food reactions are mediated by the immune system, it is not the first time that your body sees a food that the reaction will occur.  Rather, it is subsequent exposures as your body’s immune system becomes sensitized to the food proteins that severe allergic reactions may occur.

There is certainly more research to be done when it comes to understanding food allergies and what role the timing of introduction of foods may play in the development of these allergies.  However, this most recent study lends significant support to the notion that earlier introduction of allergenic foods in certain groups of infants may actually serve to prevent allergies in the future.

Now, back to the important stuff:  PB&J sandwich triangles or squares?  …crusts or no crusts?  …bananas?  Jif or Peter Pan?  Decisions, decisions…(If you have any questions or preferences about the very best way to make your PB&J, or this study and its findings, please leave your comment below!)