If a child has severe eczema or an egg allergy, don't avoid peanuts: add them early as the doctor directs, but never give whole peanuts

Cost

A jar of peanut butter costs a few dozen yuan. A few feedings a week, easy to do along the way. Before you add it, take the child to see a doctor once for an assessment.

What you get

The UK's LEAP randomized trial. 640 infants were enrolled, on the condition of severe eczema, egg allergy, or both. They were 4 to 11 months old at enrollment. They were randomly split into two groups, one regularly eating peanut products and one avoiding them completely, and the peanut allergy rate was checked at 60 months of age. Among the 530 whose peanut skin test was negative at enrollment, 13.7% in the avoiding group became allergic versus 1.9% in the eating group (P<0.001). Among the 98 who already had a weakly positive skin test at enrollment, it was 35.3% in the avoiding group and 10.6% in the eating group (P=0.004). There was no difference in serious adverse events between the groups.

Notes

The form can only be thinned peanut butter or peanut powder stirred into solid food, never a whole peanut. The National Health Commission's core feeding messages say it plainly: "Whole peanuts, nuts, jelly and similar foods are easily inhaled into the windpipe and cause choking, and infants and young children should avoid them." For what to do when someone is choking, see §13.26 (someone is choking and can't speak). This applies only to high-risk children: those with severe eczema, or who are already allergic to eggs. You must see a doctor for an assessment before adding it, and don't try it at home on your own: the LEAP trial gave every child a skin test before enrollment, and children whose skin test reaction was larger than 4 mm were left out of the trial and were not fed. The evidence for ordinary children is much weaker. In another trial of 1,162 ordinary breastfed infants, by assigned group, food allergy was 5.6% in the early-introduction group and 7.1% in the usual group, a difference that was not significant (P=0.32); it was significant only among the children who really followed it (2.4% versus 7.3%). That way of calculating tends to make the effect look larger, and the authors themselves said that by assigned group the trial failed to prove efficacy, but it also shows early introduction is safe. China's official feeding documents currently say nothing on whether to introduce allergenic foods early or avoid them, so this item is written from international trial evidence. Mind the timing too: LEAP began at 4 months, while in China solid foods start at 6 full months; see §20.4 (feed only breast milk for the first 6 months). For a high-risk child, at what age and how to start, follow the doctor.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

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. https://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. https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm
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. https://doi.org/10.1056/NEJMoa1514210（备注里那项一般婴儿试验 EAT）

Translated from the Chinese original. Original book, section 20, tip 12. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer