United States Following Israeli Lead on Giving Peanuts to Infants

U.S. National Institutes of Health releases guidelines to introduce infants to peanuts in line with research showing low rate of allergies among Israeli children.

David Bachar

The Bamba effect is finally coming to the United States.

Two years after a study showed that Israeli children suffer from peanut allergies at only one-tenth the rate of their Western counterparts with similar genetic backgrounds, which medical researchers attribute to the consumption of the peanut-based puff snack called Bamba, the U.S. National Institutes of Health released guidelines on Thursday giving similar advice to stave off the dangerous allergy. The guidelines are based on landmark research that found early exposure dramatically lowers a baby's chances of becoming allergic.

What's the evidence? First came the research comparing British and Israeli children.

"Several years ago, we found that the risk of the development of peanut allergy was 10 times as high among Jewish children in the United Kingdom as it was in Israeli children of similar ancestry," wrote the scientists in an article that appeared in the New England Journal of Medicine. "This observation correlated with a striking difference in the time at which peanuts are introduced in the diet in these countries: in the United Kingdom infants typically do not consume peanut-based foods in the first year of life, whereas in Israel, peanut-based foods are usually introduced in the diet when infants are approximately 7 months of age, and their median monthly consumption of peanut protein is 7.1 grams. This finding led us to hypothesize that the early introduction of peanuts to the diet may offer protection from the development of peanut allergy."

Then in 2015, an NIH-funded study of 600 babies put that theory to the test, assigning them either to avoid or regularly eat age-appropriate peanut products. By age 5, only 2 percent of peanut eaters — and 11 percent of those at highest risk — had become allergic. Among peanut avoiders, 14 percent had become allergic, and 35 percent of those at highest risk.

Whether the dietary change will spur a drop in U.S. peanut allergies depends on how many parents heed the new advice — and if a parent seems skeptical, the guidelines urge doctors to follow up.

The recommendations spell out exactly how to introduce infants to peanut-based foods and when — for some, as early as 4 to 6 months of age — depending on whether they're at high, moderate or low risk of developing one of the most troublesome food allergies.

"We're on the cusp of hopefully being able to prevent a large number of cases of peanut allergy," said Dr. Matthew Greenhawt of the American College of Allergy, Asthma and Immunology, a member of the NIH-appointed panel that wrote the guidelines.

Babies at high risk — because they have a severe form of the skin rash eczema or egg allergies — need a check-up before any peanut exposure, and might get their first taste in the doctor's office.

For other tots, most parents can start adding peanut-containing foods to the diet much like they already introduced oatmeal or mushed peas.

"It's an important step forward," said Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, which appointed experts to turn the research findings into user-friendly guidelines. "When you do desensitize them from an early age, you have a very positive effect."

Peanut allergy is a growing problem, affecting about 2 percent of U.S. children who must avoid the wide array of peanut-containing foods or risk severe, even life-threatening, reactions.

For years, pediatricians advised avoiding peanuts until age 3 for children thought to be at risk. But the delay didn't help, and that recommendation was dropped in 2008 — although parent wariness of peanuts persists.

"It's old news, wrong old news, to wait," said Dr. Scott Sicherer, who represented the American Academy of Pediatrics on the guidelines panel.

Thursday's guidelines make that clear, urging parents and doctors to proactively introduce peanut-based foods early.