I’m going nuts about peanuts: or are other people?

Maureen MinchinAllergies, Child Health, General News, Infant Health

The LEAP trial looking at prevention pf peanut allergy in Jewish children in the UK and Israel is interesting, but is being widely misquoted in the media and by health professionals as justification for 4 rather than 6 months for the introduction of solid food. Why is this inappropriate? Where to start…

Inclusion criteria were children between 4 and 11 months who already been “successfully introduced” to foods other than milk.They were skin-prick tested for peanut allergy before they were accepted, and some were rejected if the wheal size was too large. (These were arbitrarily determined to be sensitised by skin exposure, and there was no mention of infant feeding patterns, so that exposure to peanut oil in formula or to peanuts in utero or via an allergic mother’s milk was not discussed). The median age for this initial screening was just under 8 months, which suggests that most of the children were not 4-5 months old. (Data not given.) They were then randomised to exposure to at least 2g peanut three times a week until they were 60 months old, either before or after 11 months of age.

Note that well: EARLY exposure was between 4 and 11 months; LATE was after 11 months. And yes, there was a major difference, children who followed the c.1990+ medical advice to avoid peanuts for the first 12 months were more likely to be allergic to peanuts at five years of age than those who were regularly exposed under 11 months of age, which for most of them was within the WHO recommended period of after 6 months for breastfed children (not that we know whether these children were breastfed or not, and almost certainly none were being exclusively breastfed to 6 months.)

Yet EARLY is now being assumed by many to be to be 4-6 months. LATE is being assumed to be after 6 months. WHY? I can find no details in this study of just how many children already eating solids between 4-5, 5-6, and 6-11 months reacted when fed peanut or not fed peanut for five years, compared with those fed it after 11 months. I can therefore see no relevance of this study to the debate about when to widen the diet of exclusively breastfed infants, 4 or 6 months.

What am I missing? Is this senility advancing on me that I simply cannot understand why anyone would quote this study as justification for ignoring WHO’s recommendations, based on good science and common sense? After all, at 4 months babies are still being challenged immunologically with necessary vaccinations; they are still much smaller and less developed in every way than they will be at 6 months. Why would anyone introduce other foods unnecessarily at 4 months, when the mother is exposing the child to manageable doses of all the foods she is eating (along with immune factors to help build tolerance?) Why would we hasten the change from an optimal non-inflammatory gut microbiome at such a time?

Please someone, point out the errors in my thinking here. I find myself almost demented at seeing mindless media releases by different doctors and allergy groups all saying WHO should change its recommendations; parents are being incredibly badly treated as a result. The result of this lack of critical thought by health professionals is the reality some mothers are having to deal with. Read what follows and weep…

“I had my allergist appointment yesterday, and I’m so upset and confused. They wouldn’t do the prick test because she said Katie would react to everything because of her eczema.[which was severe before and hugely improved after milk elimination: ed.] So they want me to start her on food, including giving a boiled egg yolk first, then egg white; also to do crushed up peanuts on the inside of her lip. She is only 4 months. This is not sitting well with me at all.  They said it’s a new thing they are doing now to desensitize the body to the foods. Since I have been off dairy there has been a huge improvement with her, but she is still reacting to something. I told the allergist this, and that her poo is still green and runny and she is always still throwing up.  She said the more foods you eliminate, the more problems you cause. She also said just give a whole variety of foods at once, and when I said “shouldn’t it be one food for 3 days so I know what she is reacting to”, she said “yes you’re right”. I just don’t know what to do, as I’m not going to know what she is actually reacting to.”

I can’t begin to tell you how dangerous I think such advice is when a mother is sent home, without medical backup, to give peanuts and egg to a child once almost covered in disfiguring eczema, whose gut is still not fully healed. At least in the LEAP study positive skin-prick tests could result in the most reactive children being removed from a trial trying to assess whether allergy could be prevented. (In them it had not been.)

I have seen nothing but assertions about the preventive value of 4 rather than 6 months FOR THE FULLY BREASTFED INFANT; I can see why industry wants 4 months (see my previous post) for the artificially fed infant; what I can’t see is why so many intelligent people are citing the LEAP study as having any relevance to that debate.Is the Emperor fully clothed and I should retire?