If the child has severe eczema or an egg allergy, do not avoid peanuts; add them early under a doctor's guidance, but never feed a whole peanut

An infant with severe eczema or an egg allergy should eat peanuts regularly from 4 to 11 months. Among those whose skin test showed no reaction at the start, 1.9% of the ones who ate peanuts had a peanut allergy at 5 years, against 13.7% of the ones who avoided peanuts completely. Among those whose skin test already showed a slight reaction, 10.6% of the ones who ate peanuts were allergic, against 35.3% of the ones who avoided them. See a doctor with the child before you add peanuts. Never feed a whole peanut. It can be inhaled into the airway.

Cost

A jar of peanut butter is a few dozen yuan. Feeding it a few times a week is easy to fit in. Before you add it, take the child to a doctor 1 time for an assessment.

Benefit

The UK LEAP randomized trial. 640 infants were enrolled, on the condition of severe eczema, an egg allergy, or both. They were 4 to 11 months old at enrollment. They were randomly split into 2 groups. 1 group ate peanut products regularly, and 1 group avoided them completely, and peanut allergy was checked at 60 months of age. Among the 530 whose peanut skin test was negative at enrollment, 13.7% of the avoidance group were allergic, against 1.9% of the group that ate peanuts (P<0.001). Among the 98 whose skin test was already weakly positive at enrollment, 35.3% of the avoidance group were allergic, against 10.6% of the group that ate peanuts (P=0.004). Serious adverse events did not differ between the 2 groups.

Notes

The form can only be thinned peanut butter, or peanut flour mixed into complementary food. Never give a whole peanut. The Health Commission's core feeding messages say it plainly: "Whole peanuts, nuts, jelly, and similar foods are easily inhaled into the airway and cause choking, and infants and young children should not eat them." What to do if a child chokes: under 1 year of age, see Section 13, item 43 (an infant choking and unable to cry); at 1 year or older, see Section 13, item 26 (someone choking and unable to speak). This applies only to high-risk children: those with severe eczema, or those already allergic to egg. You must see a doctor for an assessment before adding peanuts. Do not try it at home on your own. The LEAP trial gave every child a skin test before enrollment. Children whose skin-test reaction was greater than 4 millimeters were kept out of the trial and were not given peanuts to eat. The evidence for ordinary children is much weaker. In another trial of 1162 ordinary breastfed infants, counted by the group they were assigned to, food allergy was 5.6% in the early-introduction group and 7.1% in the usual group, and the difference was not significant (P=0.32). It was significant only among the children who actually did it (2.4% against 7.3%). That way of counting tends to make the effect look larger. The authors themselves say the assigned-group count did not prove efficacy, but it does show that early introduction is safe. Official Chinese feeding documents currently say nothing on "introduce allergenic foods early, or avoid them," so this item follows the international trial evidence. The timing needs care too: LEAP started at 4 months, while in China complementary foods start at a full 6 months. See item 4 of this section (breast milk only for the first 6 months). For a high-risk child, at how many months to start, and how to start, follow the doctor.

Sources · 3

1. Du Toit G, Roberts G, Sayre PH, 等 (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. doi.org/10.1056/NEJMoa1414850
2. 国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. gov.cn/zhengce/zhengceku/2020-08/01/content_5…
3. Perkin MR 等 (2016). Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. New England Journal of Medicine, 374(18), 1733-1743. doi.org/10.1056/NEJMoa1514210（备注里那项一般婴儿试验 EAT）