What causes peanut allergy in babies

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All food additives go through strict safety testing before they can be used. Food labelling must clearly show additives in the list of ingredients, including their name or «E» number and their function, such as «colour» or «preservative».

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Peanut Allergy: Early Exposure Is Key to Prevention

Posted on by Dr.

Francis Collins

Credit: Thinkstock (BananaStock, Kenishirotie)

With peanut allergy on the rise in the United States, you’ve probably heard parents strategizing about ways to hold their kids from developing this potentially dangerous condition. But is it actually possible to prevent peanut allergy, and, if so, how do you go about doing it?

There’s an entirely new strategy emerging now! A group representing 26 professional organizations, advocacy groups, and federal agencies, including the National Institutes of Health (NIH), has just issued new clinical guidelines aimed at preventing peanut allergy [1].

The guidelines propose that parents should introduce most babies to peanut-containing foods around the time they start eating other solid foods, typically 4 to 6 months of age. While early introduction is especially significant for kids at specific risk for developing allergies, it is also recommended that high-risk infants—those with a history of severe eczema and/or egg allergy—undergo a blood or skin-prick test before being given foods containing peanuts.

What causes peanut allergy in babies

The test results can assist to determine how, or even if, peanuts should be introduced in the youngsters’ diets.

This recommendation is turning older guidelines on their head. In the past, pediatricians often advised parents to delay introducing peanuts and other common causes of food allergies into their kids’ diets. But in 2010, the thinking began shifting when a panel of food allergy experts concluded insufficient evidence existed to show that delaying the introduction of potentially problematic foods actually protected kids [2].

Still, there wasn’t a strategy waiting to assist prevent peanut or other food allergies.

As highlighted in a previous blog entry, the breakthrough came in 2015 with evidence from the NIH-funded Learning Early about Peanut Allergy (LEAP) trial [3]. That trial, involving hundreds of babies under a year ancient at high risk for developing peanut allergy, established that kids could be protected by regularly eating a favorite peanut butter-flavored Israeli snack called Bamba. A follow-up study later showed those kids remained allergy-free even after avoiding peanuts for a year [4].

Under the new recommendations, published simultaneously in six journals including the Journal of Allergy and Clinical Immunology, every infants who don’t already test positive for a peanut allergy are encouraged to eat peanut-enriched foods soon after they’ve tried a few other solid foods.

The guidelines are the first to offer specific recommendations for allergy prevention based on a child’s risk for peanut allergy:

  1. Infants at high risk for peanut allergy—based on severe eczema and/or egg allergy—are suggested to start consuming peanut-enriched foods between 4 to 6 months of age, but only after parents check with their health care providers. Infants already showing signs of peanut sensitivity in blood and/or skin-prick tests should attempt peanuts for the first time under the supervision of their doctor or allergist. In some cases, test results indicating a strong reaction to peanut protein might lead a specialist to recommend that a specific kid avoid peanuts.
  1. Infants with mild to moderate eczema should incorporate peanut-containing foods into their diets by about 6 months of age.

    It’s generally OK for them to own those first bites of peanut at home and without prior testing.

  1. Infants without eczema or any other food allergy aren’t likely to develop an allergy to peanuts.

    What causes peanut allergy in babies

    To be on the safe side, it’s still a excellent thought for them to start eating peanuts from an early age.

Once peanut-containing foods own been consumed safely, regular exposure is key to allergy prevention. The guidelines recommend that infants—and particularly those at the greatest risk of allergies—eat about 2 grams of peanut protein (the quantity in 2 teaspoons of peanut butter) 3 times a week.

Of course, it’s never a excellent thought to give infants whole peanuts, which are a choking hazard. Infants should instead get their peanuts in prepared peanut-containing foods or by stirring peanut powder into other familiar foods.

They might also attempt peanut butter spread on bread or crackers.

In recent years, peanut allergy in the U.S.

What causes peanut allergy in babies

has almost quadrupled, making it the leading cause of death due to severe, food-related allergic reactions. The hope is that, with widespread implementation of these new guidelines, numerous new cases of peanut allergy can now be prevented.

References:

[1] Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Togias A, Cooper SF, Acebal ML, et al.

Pediatr Dermatol. 2017 Jan;34(1):e1-e21.

[2] Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. NIAID-Sponsored Expert Panel., Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM. J Allergy Clin Immunol.

What causes peanut allergy in babies

2010 Dec;126(6 Suppl):S1-58.

[3] Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; the LEAP Study Team. N Engl J Med. 2015 Feb 23.

[4] Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. Du Toit G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, Brough HA, Santos AF, Harris KM, Radulovic S, Basting M, Turcanu V, Plaut M, Lack G; Immune Tolerance Network LEAP-On Study Team..N Engl J Med.

2016 Apr 14;374(15):1435-43.

Links:

Guidelines for Clinicians and Patients for Diagnosis and Management of Food Allergy in the United States (National Institute of Allergy and Infectious Diseases/NIH)

Food Allergy (National Institute of Allergy and Infectious Diseases/NIH)

Learning Early about Peanut Allergy (LEAP) Study

NIH Support: National Institute of Allergy and Infectious Diseases

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Posted In: Health, Science

Tags: allergy, Bamba, kid health, eczema, egg allergy, food allergy, infants, LEAP, Learning Early about Peanut Allergy, nih dir, peanut, peanut allergies, peanut allergy, peanuts, pediatrics

In July 2016, Natasha Ednan-Laperouse collapsed on a flight from London to Nice, suffering a fatal allergic reaction to a baguette bought from Pret a Manger.

At an inquest, the court heard how Natasha, who was 15 and had multiple severe food allergies, had carefully checked the ingredients on the packet. Sesame seeds – which were in the bread dough, the family later found out – were not listed. “It was their fault,” her dad Nadim said in a statement. “I was stunned that a large food company love Pret could mislabel a sandwich and this could cause my daughter to die.”

This horrifying case highlights how careful people with allergies need to be, as do the food companies – not least because allergies own been growing in prevalence in the past few decades.

“Food allergy is on the rise and has been for some time,” says Holly Shaw, nurse adviser for Allergy UK, a charity that supports people with allergies.

Children are more likely to be affected – between 6 and 8% of children are thought to own food allergies, compared with less than 3% of adults – but numbers are growing in westernised countries, as well as places such as China.

“Certainly, as a charity, we’ve seen an increase in the number of calls we get, from adults and parents of children with suspected or confirmed allergy,” says Shaw. Certain types of allergy are more common in childhood, such as cow’s milk or egg allergy but, she says: “It is possible at any point in life to develop an allergy to something previously tolerated.”

Stephen Till, professor of allergy at King’s College London and a consultant allergist at Guy’s and St Thomas’ hospital believe, says that an allergic reaction occurs when your immune system inappropriately recognises something foreign as a bug, and mounts an attack against it.

“You make antibodies which stick to your immune cells,” he says, “and when you get re-exposed at a later time to the allergen, those antibodies are already there and they trigger the immune cells to react.”

Allergies can own a huge impact on quality of life, and can, in rare cases such as that of Natasha Ednan-Laperouse, be fatal.

What causes peanut allergy in babies

There is no cure for a food allergy, although there has been recent promising work involving the use of probiotics and drug treatments. The first trial dedicated to treating adults with peanut allergy is just starting at Guy’s hospital.

“There is a lot of work going on in prevention to better understand the weaning process, and there’s a lot of buzz around desensitisation,” says Adam Fox, consultant paediatric allergist at Guy’s and St Thomas’ hospitals. Desensitisation is conducted by exposing the patient to minuscule, controlled amounts of the allergen.

It’s an ongoing treatment though, rather than a cure. “When they stop having it regularly, they’re allergic again, it doesn’t change the underlying process.”

What we do know is that we are more allergic than ever. “If you ponder in terms of decades, are we seeing more food allergy now than we were 20 or 30 years ago? I ponder we can confidently tell yes,” says Fox. “If you glance at the research from the 1990s and early 2000s there is beautiful excellent data that the quantity of peanut allergy trebled in a extremely short period.”

There has also been an increase in the number of people with severe reactions showing up in hospital emergency departments.

In 2015-16, 4,482 people in England were admitted to A&E for anaphylactic shock (although not every of these will own been below to food allergy). This number has been climbing each year and it’s the same across Europe, the US and Australia, says Fox.

Why is there this rise in allergies? The truth is, nobody knows. Fox doesn’t believe it is below to better diagnosis. And it won’t be below to one single thing. There own been suggestions that it could be caused by reasons ranging from a lack of vitamin D to gut health and pollution. Weaning practices could also influence food allergy, he says. “If you introduce something much earlier into the diet, then you’re less likely to become allergic to it,” he says.

A 2008 study found that the prevalence of peanut allergy in Jewish children in the UK, where the advice had been to avoid peanuts, was 10 times higher than that of children in Israel, where rates are low – there, babies are often given peanut snacks.

Should parents wean their babies earlier, and introduce foods such as peanuts? Fox says it’s a “minefield”, but he advises sticking to the Department of Health and World Health Organization’s line that promotes exclusive breastfeeding for six months before introducing other foods, “and to not delay the introduction of allergenic foods such as peanut and egg beyond that, as this may increase the risk of allergy, particularly in kids with eczema”.

What causes peanut allergy in babies

(Fox says there is a direct relationship between a baby having eczema and the chances of them having a food allergy.)

The adults Till sees are those whose allergies started in childhood (people are more likely to grow out of milk or egg allergies, than peanut allergies, for instance) or those with allergy that started in adolescence or adulthood. Again, it is not clear why you can tolerate something every your life and then develop an allergy to it. It could be to do with our changing diets in recent decades.

“The commonest new onset severe food allergy I see is to shellfish, and particularly prawns,” says Till.

“It’s my own observation that the types of food we eat has changed fairly a lot in recent decades as a result of changes in the food industry and supply chain.” He says we are now eating foods such as tiger prawns that we probably didn’t eat so often in the past.

He has started to see people with an allergy to lupin flour, which comes from a legume in the same family as peanuts, which is more commonly used in continental Europe but has been increasingly used in the UK. Sesame – thought to own been the cause of Natasha Ednan-Laperouse’s reaction – is another growing allergen, thanks to its inclusion in products that are now mainstream, such as hummus.

One problem with sesame, says Till, is: “It often doesn’t show up extremely well in our tests, so it can be hard to gauge just how allergic someone is to it.”

Fox says it’s significant to stress that deaths from food allergy are still rare. “Food allergy is not the leading cause of death of people with food allergies – it’s still a extremely remote risk,” says Fox. “But of course you don’t desire to be that one who is incredibly unlucky, so it causes grand anxiety.

The genuine challenge of managing kids with food allergy is it’s really hard to predict which of the children are going to own the bad reactions, so everybody has to act as if they might be that one.”

Because children generally do not outgrow peanut allergies, they must avoid peanuts, peanut oil and foods contaminated with traces of peanuts for their entire lives.

More than a dozen parents traveled to the hearing in Silver Spring, Md., with their children to urge the advisory committee to approve the drug, often breaking into tears as they spoke.

They recounted how their children’s lives had changed after they took part in the study. (The company paid travel expenses for some of the families.)

Guiliana Ortega, who participated in the Aimmune study, described life as an 8-year-old with a severe peanut allergy: sitting at a separate peanut-free lunch table in the cafeteria, for example, and having to enquire relatives if they own eaten peanuts before giving them a hug.

“It means getting only two friends at lunch instead of 20,” she told the committee. “It means not getting to eat cake at parties, and eating my safe snack while watching others enjoy it.”

“It means feeling diverse every the time,” she said.

“It’s a world of no.

What causes peanut allergy in babies

‘No, you can’t own that — it may not be safe.’”

Tessa Grosso, 16, a high school junior from Menlo Park, Calif., told the panel she was allergic to peanuts, dairy and numerous other foods until she was 10, when she was treated with an early form of oral immunotherapy at Stanford University.

Now, she said, she eats just about anything and has peanut butter every morning before school.

“Before I was treated, my life was love navigating a minefield,” Ms.

Grosso said in an interview. “I couldn’t go to anyone’s home, and a crumb of something on my hands could own killed me. At one point, a glass of milk spilled on my hand and I went into anaphylactic shock and almost died.”

Peanuts and straight peanut butter are a choking hazard for infants, doctors tell, but a bit of watered-down puree of peanut butter, starting at around 6-months-old, can assist prevent peanut allergies. Brian Hagiwara/Getty Images hide caption

toggle caption Brian Hagiwara/Getty Images

Peanuts and straight peanut butter are a choking hazard for infants, doctors tell, but a bit of watered-down puree of peanut butter, starting at around 6-months-old, can assist prevent peanut allergies.

Brian Hagiwara/Getty Images

Peanut allergies can be among a parent’s biggest worries, though we’ve had excellent evidence for more than a year that when most babies are 6 months ancient or so, introducing foods that contain finely ground peanuts can actually reduce babies’ chances of becoming allergic to the legumes.

Even so, numerous parents are terrified to do that.

At this week’s annual scientific meeting of the American College of Allergy, Asthma and Immunology in San Francisco, doctors are discussing the coming federal guidelines about how and when to safely add peanuts to an infant’s diet.

The final version, being developed under the auspices of the National Institutes of Allergy and Infectious Diseases, won’t be released until early next year. But Dr. Amal Assa’ad, an immunologist and allergist with the Cincinnati Children’s Hospital Medical Middle who helped record the recommendations, offered Shots a hint of where she and her colleagues are headed.

First, parents need to know whether their baby is at high risk of developing a peanut allergy, Assa’ad says.

Signs of that include a history of severe eczema — which causes dry, itchy skin and rashes — or an allergy to eggs.

If your baby falls into that category, she says, enquire your pediatrician whether the baby should be further checked by an allergist for a specific sensitivity to peanuts. Even most babies who show that sort of sensitivity can be introduced to age-appropriate foods containing peanuts and get the allergy-preventing benefit, she says, though in some cases doctors will advise the introduction take put in the doctor’s office, not at home.

The guidelines are largely based on dramatic findings from a large study published in the New England Journal of Medicine in 2015.

Researchers found that babies at high risk of developing a peanut allergy who were fed the equivalent of about 4 heaping teaspoons of peanut butter each week, starting at the age of 4 to 11 months, were about 80 percent less likely to develop an allergy to the legume by age 5 than similar kids who avoided peanuts. The benefit held up even after the children stopped getting the puree, a follow-up study found.

Allergic reactions to peanuts can range from hives or rashes to, in the most extreme cases, trouble breathing and even death.

For children who are not at high risk for developing a peanut allergy, foods containing the legume can be introduced at home starting at about 6 months, after a healthy baby has started to eat some other solid food, Assa’ad says.

(Peanut products shouldn’t be the first solid food a baby gets, she adds.)

Still, under no circumstance should parents feed their babies whole peanuts, which is a clear choking hazard, cautions Dr. Ruchi S. Gupta, a pediatrician and immunologist at Northwestern University, in an ACAAI video aimed at parents. Even peanut butter can be risky at that age, Gupta explains, because it’s thick and sticky.

The best way to introduce the food, she says, is to add boiling water to 2 teaspoons of peanut butter to make a warm puree.

What causes peanut allergy in babies

Put a little of this puree on the tip of a spoon and feed it to your kid. Then wait and watch for 10 minutes, she advises, checking the baby for any negative reaction, such as hives, a rash, behavior changes or trouble breathing. If every is OK you can continue to feed the puree slowly; but hold an eye on the kid for about two hours.

If the baby continues to show no signs of an allergic reaction, Gupta says, it’s safe to continue, adding other peanut-containing foods as time goes on.


How will I know if my kid has a food allergy?

An allergic reaction can consist of 1 or more of the following:

  1. wheezing and shortness of breath
  2. diarrhoea or vomiting
  3. itchy throat and tongue
  4. runny or blocked nose
  5. itchy skin or rash
  6. a cough
  7. swollen lips and throat
  8. sore, red and itchy eyes

In a few cases, foods can cause a severe allergic reaction (anaphylaxis) that can be life-threatening.

Get medical advice if you ponder your kid is having an allergic reaction to a specific food.

Don’t be tempted to experiment by cutting out a major food, such as milk, because this could lead to your kid not getting the nutrients they need. Talk to your health visitor or GP, who may refer you to a registered dietitian.


Introducing foods that could trigger allergy

When you start introducing solid foods to your baby from around 6 months ancient, introduce the foods that can trigger allergic reactions one at a time and in extremely little amounts so that you can spot any reaction.

These foods are:

  1. foods that contain gluten, including wheat, barley and rye
  2. cows’ milk
  3. nuts and peanuts (serve them crushed or ground)
  4. shellfish (don’t serve raw or lightly cooked)
  5. seeds (serve them crushed or ground)
  6. eggs (eggs without a red lion stamp should not be eaten raw or lightly cooked)
  7. soya
  8. fish

See more about foods to avoid giving babies and young children.

These foods can be introduced from around 6 months as part of your baby’s diet, just love any other foods.

Once introduced and if tolerated, these foods should become part of your baby’s usual diet to minimise the risk of allergy.

Evidence has shown that delaying the introduction of peanut and hen’s eggs beyond 6 to 12 months may increase the risk of developing an allergy to these foods.

Lots of children outgrow their allergies to milk or eggs, but a peanut allergy is generally lifelong.

If your kid has a food allergy, read food labels carefully.

Avoid foods if you are not certain whether they contain the food your kid is allergic to.


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