Peanut Allergies, Genetics, and When to Introduce Peanuts in Your Infant/Child’s Diet

peanuttyI love it when what we have told patients and thought to be true ends up being exactly the opposite of what actually is going on. Not happy that we had it wrong. Just happy we are now getting it right!

Bottom line: Introduce peanut protein (peanut butter or cooked into a teething biscuit) as soon as you can introduce solid foods to your infant (OK to start at 4-6 months)!

That’s crazy you say. My doctor told me no peanuts until age 3 due to peanut allergies in our family. Finally there is a well done study to clarify what to do. In the study, “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy,” (which you can read here… ) researchers  divided 640 atopic infants (with severe eczema, egg allergy, or both) aged from 4 months to 11 months into 2 groups—those who had a positive skin-prick test for peanut allergy in 1 group and those who did not in another. Children in each of these 2 groups were then assigned to a group that would consume peanuts or to one that would not. Infants in the peanut-eating group received at least 6 grams of peanut protein (about 24 peanuts) a week, either in a peanut butter/puffed maize snack food or peanut butter itself, until they were aged 60 months. Infants in the avoidance group had no peanut protein until they were aged 60 months.

They found that of 530 infants who initially had negative results on the skin-prick test, 13.7% in the avoidance group had peanut allergy compared with 1.9% in the group that ate peanuts. Among the 98 infants with positive skin-prick results, only 10.6% of those fed food containing peanuts had developed peanut allergy compared with 35.3% of those whose parents had avoided feeding them peanuts.

This is a powerful study. If you don’t have obvious allergies and don’t eat peanuts, you have a 1 in 7 chance of becoming allergic to peanuts but if you do eat peanuts your chances are 1 in 53! If you are already skin prick reacting to peanuts you have a 1 in 9 chance of becoming allergic if you eat peanuts early or a 1 in 3 chance of being allergic if you avoid peanuts.

My guess is that if you eat organic peanuts, and start your babies on that early (by 6-9 months of age) allergies will be rare indeed, even when there is a family history or risk of developing allergies.

In another study, “Genome-wide association study identifies peanut allergy-specific loci and evidence of epigenetic mediation in US children,” (read the study here… ) found that the HLA-DR and -DQ gene region probably poses significant genetic risk for peanut allergy. “Not everyone with these mutations, however, develops peanut allergy, and researchers wondered why. One possible reason, they determined, was that epigenetic changes may also play a role. Epigenetic changes, in which a methyl group attaches itself to the DNA, alter the expression of a gene without altering its underlying code. The levels of DNA methylation regulate whether people with genetic susceptibility to the peanut allergy actually developed it.

So there you have it. Methylation, that key step in so many body reactions and functions, may be affected by the environment, in this case, eat your peanut butter and start young!

Obviously this will be controversial, so check with your doctor. Chances are, they may not be aware of this key study, so best you take it to them and then ask them. Before I read this, I would have given you the standard, old, tired, and WRONG line, “wait until your child is 2 or 3 years old, and perhaps never give peanuts if you have a strong family history.”

 

Dr. Paul

 

 

 

 

Integrative Medicine, Naturopathic Medicine, Chiropractic, Acupuncture, Oriental Medicine, Massage Therapy- The partners in health and wellness you should not do without

integrativemedicineAs an Integrative Medicine physician, board-certified (ABIHM) in Integrative and Holistic Medicine, I am often asked what I mean by “Integrative Medicine”?  There are a number of medical professionals who are sharing similar approaches that emphasize life-style, optimal nutrients, minimizing toxins, and using the best evidenced-based medicine research to apply modalities of nutritional medicine, herbal, and nutrient medicine as the first line in prevention of chronic diseases. There are conditions that seem to improve dramatically when approached in a manner that determines food sensitivities.  Other conditions respond to herbal treatments that seemed resistant to pharmaceuticals.

Integrative Medicine is knowing when to collaborate with our peers, MD, DO, Acupuncture, Chiropractic, Naturopathic, Massage, Herbal, Chinese Medicine, etc.  Integrative Medicine, Naturopathic, and functional medicine approaches look for underlying causes and conditions that may predispose the individual to less than optimal health.  This is a very satisfying practice style in contrast the “business as usual” practice where you wait for a disease to develop, then you treat the symptoms.

Some think of Integrative in terms of one provider using and integrating approaches from many of these disciplines.  Others consider integrative practices as those that actually have practitioners of many of these modalities working as a team in one clinic or virtual clinic through collaboration.

Here is an overview article on this topic.

Don’t forget about our other clinic, Natura Integrative Medicine. While mostly for adults, Natura features many of the modalities I have mentioned above to bring the best approach to patients looking for care beyond the traditional western methods. I encourage you to look at the website to see a very comprehensive list of treatments Natura is offering.

 

 

Dr. Paul

 

Begin Solids After 16 weeks, and Continue Breast Feeding to Reduce Allergies

solid foodsDr Grimshaw et. al. have published in Pediatrics November 2013,  “Introduction of Complementary Foods and the Relationship to Food Allergy.”

This was not a large study and it compared 41 infants who developed food allergies by age 2 to 82 infants who did not develop allergies.  Since we have conflicting studies in the world literature on early introduction of solids causing or preventing allergies (depending on the study), this study does support the concept of starting solids at 4 months and not before. 

Two key points from this article:

1. Breast feeding promotes tolerance to solid foods reducing allergies.

2. Introducing solid foods before 17 weeks (4 months age) especially if not breast feeding, creates more allergies. 

 

Dr. Paul

 

Eczema and Food Sensitivities

dermatitisFlohr and colleagues have published a study called, “Atopic Dermatitis and Disease Severity are the Main Risk Factors for Food Sensitization in Exclusively Breast fed Infants”, in The Journal of Investigative Dermatology.  What is known to the authors is that 1 out of 5 children in the UK have eczema and 1 out of 12 have food allergies. What the authors are proposing is that a breakdown in the skin barrier that occurs in eczema could trigger food allergies rather than this being a gut associated immune system issue. They are assuming that because the infants were exclusively breast fed, “this suggests that allergic sensitization to foods can be mediated by cutaneous antigen-presenting cells”.

I couldn’t disagree more. Clinical experience has shown that infants who develop eczema recover when you identify the foods that are triggering the immune response and remove them from the diet.  Treating the skin is like closing the barn door after the horses have left the barn!  Breast milk will contain proteins that are eaten by the mother.  If mom eats gluten and this protein is sensitizing to the baby, you have a gluten issue that can trigger eczema in that baby, even if they are exclusively breast fed. The origin of the immune response is in the gut- GALT (Gut Associated Lymphoid Tissue).  

While the skin barrier is indeed an important barrier that protects us from toxins and allergens in the environment, it is my experience that you can heal the skin (eczema) by healing the gut and not the other way around.  I have seen hundreds of eczema patients who have seen dermatologists and had their skin treated by the most powerful steroids and immune suppressors, yet they never get better until we identify the food sensitivities and remove those foods.  Almost without fail— eczema cured!

Dr. Paul

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