Weaning: when should you introduce nuts and peanuts?

Before my son’s anaphylactic reaction to peanuts, I knew that:

  • Some people are allergic to peanuts and nuts.
  • A thing called “anaphylactic shock” existed and that it was life threatening.
  • My son (D) had eczema.
  • D probably had asthma too.
  • I had mild asthma (although I no longer had an inhaler).
  • Things like asthma, eczema and hay fever are all linked.

What I hadn’t done was to join all the dots, to realise that D’s eczema and suspected asthma put him at higher risk of food allergies (and therefore at a higher risk of a life threatening allergic reaction to peanuts)

There was no history of food allergy in either mine or Ian’s families. D had already eaten (a lot of) Maryland chocolate chip and hazelnut cookies with no adverse reaction. So I think our feeling (to the extent we stopped and thought about it at all) was that he was “okay with nuts”.

Before his reaction, I also didn’t fully know how peanuts were different from other nuts. In fact, it was a taxi driver, taking me to Queen’s Medical Centre to visit D, who educated me on the difference between legumes and tree nuts.

When D was in hospital, pretty much every health care professional we spoke to mentioned the obvious link between his eczema, asthma and food allergy. In fact, it was more than obvious. A food allergy was almost predictable given his medical history.

Should we have anticipated it too? Should we have delayed introducing potentially dangerous foods? For how long? Is there ever a good time to introduce nuts and peanuts to your child’s diet?

In “Weaning”, Annabel Karmel says that there is no evidence that avoiding introducing potentially allergenic foods (including peanuts) will reduce the likelihood of developing allergies. She suggests that “higher risk” babies (see below) should wait 48-72 hours between trying potentially allergenic foods, to see if there is a reaction.

What do the NHS say?

The NHS advise that:

  • Babies need nothing but breastmilk or infant formula for their first six months.
  • Weaning should begin around six months of age.
  • The eight foods most likely to cause an allergic reaction in young children are peanuts, nuts, seeds, milk, eggs, wheat, fish and shellfish. These foods should be avoided if you wean your baby before six months.
  • Although, in the past, parents were told not to give peanuts to children under three years of age, “this advice has now changed … and you only need to avoid giving peanuts before six months of age”.
  • However, there is a higher risk of peanut allergy if:
    • your child has a known allergy (such as eczema or a food allergy); or
    • your child’s immediate family (his parents or siblings) have a food allergy or other allergic condition, such as hayfever, asthma or eczema.
  • For “higher risk” babies, you should seek medical advice before giving peanuts or peanut-containing foods.
  • Don’t give whole peanuts or nuts to children under 5 (because of the choking risk).

Should doctors spell out the peanut allergy risk to parents of “higher risk” babies?

So, following this, we should have spoken to our GP or health visitor before introducing peanuts. It’s really all by the by for us now, given our ticking time bomb has already exploded. However, I wonder how many parents are unaware that their child is at a higher risk of developing a severe peanut allergy?

It would be interesting to know how many people read the NHS advice before starting to wean their baby onto solid foods. I would guess that there are also many people who would think “there’s no family history of food allergies, so we’re not high risk”, without realising that eczema, asthma and hay fever also nudge the child into the higher risk bracket.

In my view, it would be safer if, when diagnosing eczema or another atopic illness in babies, doctors routinely warned the parent of the associated (potentially life threatening) peanut allergy risk. However, I would be very interested to hear what others think about this issue.

Sources:

2 comments

  1. Hi Louise.

    Just in response to your entry: We are in a similar situation. Our son has eczema and potentially asthma (even though doctors still say I shouldn’t be concerned, he is thriving…). Yes we read up everything on eczema, asthma, allergies and weaning and thereby came across the link between allergies and eczema and asthma. I also attended weaning groups and did further reading and we chose to introduce peanuts as a weaning food also to see if he’d react. He has had nuts a number of times by now and always been fine but I understand that an anaphylactic shock can sometimes occur after having previously been exposed (like with your son) so we are still a little worried. The only thing I didn’t know before introducing nuts was that apparently exposure to the skin can make the development of an allergy more likely…

    Best wishes for D, I hope he learns well to live with his allergy!
    Dana

    1. Thanks Dana! Yes, I do now wonder if that’s how D was sensitised – he did have a broken skin barrier with his eczema for a few months as a baby. I hope your son has avoided food allergies – best of luck with it, Louise

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