Allergy Shmallergy

Simplifying life for families with food allergies.

Ask Me Anything! September 19, 2017

Filed under: Parent Sanity — malawer @ 11:33 am
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My older child has food allergies.  Now, I’m afraid to introduce his allergens to his younger sibling.  I know I need to, but how can I do it safely?

 

Great question!  And, many of us can relate to your concerns.

 

What is the real risk?

Here’s something encouraging to keep in mind:  Most siblings of kids with food allergies do not develop food allergies themselves.  Studies by lead author Dr. Richi Gupta (2015) showed that siblings only have a minimally higher chance of having food allergies.  And, researchers warned against having siblings allergy tested before introducing food because it increases the odds of false positives, resulting in avoiding foods unnecessarily.

Bottom Line:  Most siblings have no greater risk of having food allergies than any other kid without a food allergic sibling.  That offers a little relief!

 

New Feeding Guidelines:

In January 2017, the experts at the National Institute of Allergy and Infectious Diseases (NIAID) recommended feeding infants appropriate eggs, fish, dairy, peanut-containing foods (not whole peanuts for fear of choking), or other highly allergenic foods between 4 and 6 months after speaking with your pediatrician.  Contrary to advice many of us were given with our first child, research now shows that delaying introduction may actually increase your baby’s risk of developing food allergies.

 

[Please read: Understanding the New Peanut Allergy Prevention Guidelines for more information and a list of peanut-containing foods.]

 

Bottom Line: You’re actually HELPING your baby by introducing highly allergenic food on time by reducing his/her risk of developing food allergies.  Now’s the time to overcome your fear!

 

What’s the best way to introduce your baby to a food your older child is allergic to? 

After your pediatrician okays introduction and your baby consistently tolerates solid food, plan to introduce one food at a time waiting 3-5 days in between new foods.

  • For the first introduction, buy the new food in single serving size if possible.  This limits accidental exposure and cross contamination risk.  Be sure to store extras, if any, somewhere out of reach of your older child.
  • It might be easiest to introduce a new food when you are alone with your child, so that you can carefully serve the first food, clean up, and observe for reactions.
  • Consider taking your baby on a picnic or outing close to home to minimize your concern about crumbs in the house.
  • Bring your cellphone with you in the unlikely case of a reaction.
  • Remember, that dishwashers are an effective way (but not the only way!) to wash away allergens.  And, hand sanitizers do not get rid of food protein.  Wash hands with soap and water after handling your older child’s allergen.
  • Feed your baby the new food then wait 10  minutes, looking for signs of negative reaction: hives, swelling, behavioral changes or trouble breathing.  If no reaction occurs, continue feeding and monitor for about 2 hours.

When my younger two children were ready to try peanut-containing food, I bought snack size peanut butter cracker sandwiches.  I took each child separately to the local park and had a picnic.  We brought lots of wipes to clean hands and mouth before returning home without a reaction!  It was a special (and productive) day for us both.

 

How Do I Keep Allergenic Food Safely in the House?

Once you’ve established that your baby isn’t allergic to each new food, you may wish to continue keeping it on hand in your home.  Often it is necessary for him or her nutritionally to continue eating allergenic foods like milk, eggs, wheat, etc.  But, it’s important to store the foods your older child is allergic to safely so that your older child avoids accidental ingestion and reaction.

 

If you haven’t already done so, consider implementing a system to label the safe foods in your kitchen  Please read, Food Labels to see the simple system we use here at my house.

 

Think of what a relief it will be once you know your baby can tolerate each new food.  You can do this!  Good luck!

 

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Understanding the New Peanut Allergy Prevention Guidelines January 31, 2017

**Not a medical professional.  As always, please discuss specific recommendations for your child with your doctor.  The below is to inform you of pediatric guideline changes and their purpose.**

 

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Earlier this month, experts from the National Institute of Allergy and Infectious Disease (NIAID) issued new recommendations to help families prevent peanut allergies.

 

While there are a lot of intricacies involved in the research and its findings, the results are clear:  early introduction of peanuts can help prevent the development of a peanut allergy.  And, that’s big news!

 

Background:

Peanut allergies (and food allergies in general) are a growing problem.  The rate of food allergy has doubled in the last 10 years alone.  And, only 1 of every 4 children allergic to peanuts will outgrow their allergy.

 

Prior to 2000, doctors didn’t give new parents much advice about feeding their infants allergenic foods (such as milk, eggs, peanuts, fish, etc).  Beginning around 2000, the general consensus was that delayed introduction might help developing immune systems handle these proteins more efficiently.  In 2008, doctors didn’t really give parents a strong direction either way.  However, that same year, researchers compared the rate of peanut allergy among Jewish kids in the UK (where they delay introduction), to those in Israel (where they feed a peanut-based snack as some of their babies’ first foods) and were stunned to see the difference.  Children in Israel had a far smaller rate of peanut allergy than their counterparts in the United Kingdom.  It became clear doctors and researchers needed to revisit their guidance.

 

Thus, began the 5 year LEAP study (Learning Early about Peanut Allergy), one of the most successful allergy trials that has been conducted to date.  It took children with severe eczema or egg allergy and broke them into two groups: one group was fed peanuts early and one avoided them.  Published in the New England Journal of Medicine, the study revealed that early introduction of peanut reduced the incidence of developing a peanut allergy by up to 80% and had lasting effects.

 

Current Recommendations:

Based on their findings, the NIAID broke down their recommendations into three categories:

 

Guideline 1:

If the baby has an egg allergy (which is inexplicably related to peanut allergy) or has severe eczema (a persistent, scaly rash associated with allergy), speak with your doctor or a specialist about testing for peanut allergy.  And, speak with her/him about best ways to proceed with introduction.

 

In their own words, the NIAID states:

“Guideline 1 recommends that if your infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), he or she should have peanut-containing foods introduced into the diet as early as 4 to 6 months of age. This will reduce the risk of developing peanut allergy.

Check with your infant’s healthcare provider before feeding your infant peanut-containing foods. He or she may choose to perform an allergy blood test or send your infant to a specialist for other tests, such as a skin prick test. The results of these tests will help to determine if peanut should be introduced into your infant’s diet and, if so, the safest way to introduce it. If your infant’s test results indicate that it is safe to introduce peanut-containing foods, the healthcare provider may recommend that you introduce peanut-containing foods to your infant at home. Or, if you prefer, the first feeding may be done in the healthcare provider’s office under supervision. On the other hand, testing may indicate that peanut should be carefully introduced at a specialist’s facility or not introduced at all because your child may already have developed an allergy to peanut.

Follow your healthcare provider’s instructions for introducing peanut-containing foods to your infant.”

 

Guideline 2:

If your child has mild to moderate eczema, peanut-containing products can be introduced beginning at 6 months of age.  Check with your doctor or specialist to confirm that his/her case of eczema is considered mild to moderate and discuss introduction.

From NIAID:

“Guideline 2 suggests that if your infant has mild to moderate eczema, he or she may have peanut-containing foods introduced into the diet around 6 months of age to reduce the risk of developing peanut allergy. However, this should be done with your family’s dietary preferences in mind. If peanut-containing foods are not a regular part of your family’s diet (and your infant does not have severe eczema, egg allergy, or both), do not feel compelled to introduce peanut at such an early stage.

Your child’s healthcare provider can tell you whether your child’s eczema is mild to moderate. You may then choose to introduce peanut-containing foods at home. However, if you or your healthcare provider prefer, the first feeding can be done in the provider’s office under supervision.”

 

Guideline 3:

If your child does not have an egg allergy OR eczema, you may freely introduce peanuts with other solid foods.

 

The flow chart and summary from Science News, spells it out clearly if you need a visual.

 

 

How DO you introduce peanuts to an infant?  Do I need to look out for anything special?

  • First feeds should be offered after you have tried other first foods (such as rice cereal) so that the baby learns to suck and swallow these news textures and to ensure that your baby tolerates these typical foods.
  •  DO NOT feed babies whole peanuts as they pose a choking hazard.  Babies lack both the teeth and the development to properly manage peanuts.
  • Once introduced, watch for 10 minutes and up to 2 hours for signs of a reaction.  In a baby, you might see: hives, cough or gasping, vomiting, you might notice they are more cuddly and needy.  If you suspect a reaction, seek immediate medical attention.
  • Once tolerated, aim for regular ingestion.  The recommended frequency is 2g of peanut protein three times a week.

 

What does 2g of peanut protein look like?

In Israel, parents feed their children a snack called Bamba – a dissolvable, airy snack that contains peanut protein.  Shaped like a Cheese Doodle, 2/3 bag of Bamba equals 2g of peanut protein.  To begin, you can crush the Bamba and mix it with water to feed.

 

spoon-of-peanut-butter-robinmcnicoll-flickr

photo by robinmcnicoll via Flickr – unaltered and posted according to Creative Commons Attribution 2.0

If you’d like to use peanut butter, 2g of peanut protein is equal to 2 tsp or 1 household spoon (as in, from your utensil drawer).  Mix SMOOTH peanut butter with hot water and COOL.  You can then mix it with fruit or vegetable puree before serving.

 

Two grams of peanut flour or protein is equal to 2 tsp.  Again, these can be mixed with fruit or vegetable purees.

 

(Peanut containing cereals were not specifically recommended because of the varying levels of peanut protein as well as sugar and sodium content by brand.)

 

A few notes: 

For those of you, like me, whose children are already allergic.  This is not instruction to begin feeding them peanuts.  DO NOT!

 

And for those of you, like me, who read these guidelines and felt guilty about eating peanuts during pregnancy and breastfeeding… or NOT eating peanuts during pregnancy and breastfeeding…  or delaying introduction (as we were instructed at that time):

 

You did not cause your child’s food allergy.  There IS no single cause of food allergies.  As Dr. Matthew Greenhawt of Children’s Hospital Colorado kindly offered, “This was nobody’s fault.  You followed the best data at the time.  Your avoidance didn’t cause [your child’s] peanut allergy.”  I’ll be honest, I welled with tears hearing this from an allergist.

 

This exciting news represents a paradigm shift in the prevention of food allergies.  Here’s hoping that future generations won’t be plagued by the same number and severity of cases!

 

Download NIAID’s full recommendation report here:  Addendum Guidelines for the Prevention of Peanut Allergy in the United States.