Signs of Peanut Allergy in Baby | Risk Reduction

Medically reviewed by Abbey Sharp, Registered Dietitian (RD), BASc.

I discuss the signs of peanut allergy in baby, the new guidelines to reduce the risk of peanut allergies, and how to to prevent anaphylaxis and other reactions.

Growing up, my mom was a Montessori teacher and would tell me horror stories about children’s seizures and using epi-pens to save kids’ lives. Back then, I just thought my mom was a hero (and she still totally is), but today, as a new momma-to-be, all I can think of is how terrified I would be letting my kids out of my sight with a peanut allergy. So, when I learned about the new guidelines to reduce the risk of peanut allergy in babies and kids, I breathed a sigh of relief. While a peanut allergy, like all allergies, can always still happen, it’s reassuring to know there are steps we can take to reduce the risk. I’ve already talked a lot about the role of the microbiome and food allergies, but let’s look specifically at the new guidelines for peanuts and signs of peanut allergy in baby.

Peanuts 101

First of all, a few thoughts on peanuts. Admittedly a misnomer, peanuts are actually not nuts, they’re in fact a type of legume (much like chickpeas, and lentils!) More than 85% of peanuts and peanut products consumed in Canada come from the United States, since our chilly climates aren’t conducive to their growth.

Nutrition-wise, peanuts actually have more protein than any other nut! They are also an excellent source of magnesium, manganese, niacin and Vitamin A through E! And of course, there’s that amazing fat- 85% of the fat in peanuts is the “good” unsaturated fat. So, there’s good reason to want our kids to be able to enjoy them. I know that personally, some of my favourite recipes include yummy peanuts (like these PB Rice Krispie Treats, PB Banana Vegan Protein Bars, and Peanut Cherry Energy Balls).

And apparently, I’m not alone in my love affair. Reports suggest that 97% of Canadian households consume peanuts at least every few months and 60% enjoy them at least once a week! And then there are people like me, who eat peanut butter right out of the jar- apparently this is the habit of about 1/3 of Canadians.

Guidelines to Reduce the Risk of Peanut Allergy

Okay, so since there’s so much goodness going on in the mighty peanut, and clearly people love them, how can we ensure our little ones can enjoy them, too? How do we look for the signs of peanut allergy in baby?

There was a recent randomized control trial called the LEAP (Learning Early about Peanut Allergy) study conducted by the Immune Tolerant Network (ITN). Over 600 children between the ages of 4 to 11 months who were identified as being at high risk for peanut allergies based on an existing egg allergy or severe eczema were included in the study.

Their findings?

There were lower rates of peanut allergy in infants who ate peanuts early (3.2%) compared to those who avoided it (17.2%). This study found that eating peanuts early in life was safe for high-risk children, and their follow up study, LEAP-On, found that continuing to eat peanuts until they turn five years old didn’t increase the risk of a peanut allergy during their sixth year of life – even if they avoided peanuts!

So, what’s the big deal with these new guidelines to reduce the risk of peanut allergy and what are the signs of peanut allergy in baby?

Well, for second-time parents, or even kids who grew up with peanut allergy, you might notice that these recommendations are the opposite of what moms were told to do before. Older guidelines recommended avoiding peanut products until three years of age because the thought was that this time would allow the gut and immune system to mature and help prevent allergies. But this waiting period had a few notable impacts:

• Peanut allergy rates increased about three-fold!!
• Research was released linking delaying allergenic foods to an increase in the risk of food allergy.
• Studies were suggesting that children with eczema who were exposed to certain foods in the atmosphere, but not actually consuming them, had increased allergies.

All things considered, I’m so grateful for the breakthroughs of the LEAP study in helping to shift our current guidelines to reduce the risk of peanut allergy.

When Can I Introduce Peanuts to Reduce the Risk of Peanut Allergy?

So for kiddos with no eczema or food allergy, it’s recommended that you introduce peanut-containing foods at any age according to family preferences, cultural preferences and general readiness for solids (more on this below!)

For those who are at high risk of peanut allergy (egg allergy or severe eczema), it’s recommended to introduce peanuts at four-to-six months after being evaluated by their doctor to rule out an existing peanut allergy.

For those with mild to moderate eczema, it’s recommended that you introduce peanuts or peanut-containing foods around six months.

How Can I Introduce Peanuts to My Infant?

So, first, you need to determine that your baby is ready for complementary foods (that is, food that isn’t breastmilk or formula). This should be done in conversation with your pediatrician but you should be looking for some of the following signs:

• Baby can hold its head up and has good neck control
• Baby can sit with support
• Baby appears curious and interested in other family member’s eating and foods
• Baby is transitioning from sucking reflex to swallowing (for example, they don’t push a spoon out of their mouth with their tongue).

You’ll want to make sure to give peanuts to your baby for the first time at home, and not at a restaurant or their day care. You also want to make sure there is a trusted adult to watch baby while they eat and for about two hours afterwards to ensure no symptoms arise. You don’t have to go to the ER parking lot as a lot of mommy blogs suggest, since peanut butter is very safe for the vast majority of babies and not a choking hazard.

The easiest way to serve peanuts to your Baby is to take about 2 teaspoons of peanut butter and stir it well with 2-3 teaspoons of hot water. Once cool, baby can enjoy it on its own, or mixed with a few tablespoons of infant cereal, pureed fruit or veggies, or any other soft food like yogurt.

Once you give them a small amount (about what would fit on the tip of a spoon), wait 10 minutes to watch for any symptoms of peanut allergy. If things look in the clear, you can continue to serve peanut-containing foods at your baby’s natural eating pace.

Once you’ve introduced peanut products and no allergy seems to be apparent, you should aim to have about 6-7 grams of peanut protein over three or more feedings each week. So, the 2 teaspoons of peanut butter should be offered about three times each week to meet the guidelines to reduce the risk of peanut allergy.

While peanut butter is not a choking hazard, whole peanuts shouldn’t be given until about four years of age to avoid potential choking. Just stick with good old PB until then.

What Are the Signs of Peanut Allergy in Baby? How Do I Know If Baby Is Having an Allergic Reaction?

Obviously, it’s important to pay attention to your baby before introducing any new food to ensure there’s no adverse reactions. Signs of peanut allergy in baby include:

• A new rash or hives around the mouth
• Swelling of the lips, eyes, or face
• Vomiting
• Hives all over the body
• Breathing issues with a repetitive cough, wheeze or challenges breathing
• A change in skin colour to pale or blue
• Sudden tiredness, lethargy or seeming limp

If you see any of these symptoms of an allergic reaction, call 911 and seek medical attention.

What If I (The Parent) Have a Peanut Allergy?

So, this is really a risk vs. benefit analysis that you can speak to your pediatrician about. The risk isn’t to the child, but rather, potentially to the parent with the allergy, whom depending on the severity, may be at risk of an allergic reaction if they’re handling peanut products. If possible, have designated eating areas for serving peanut products that are well sanitized, or have another caregiver offer the peanut products at a relative’s home or outdoors. And moms and dads with allergies, please be careful not to kiss babe on the mouth after he/she has had a peanut-y snack.

What About During Pregnancy? Is There Anything I Can Do Before Baby is Born to Reduce the Risk of Peanut Allergy?

Good news to my fellow pregnant mommas-to-be, your eating-the-PB-out-of-the-jar-with-a-spoon may actually be good for your babe! New research published in 2014 found that eating more peanuts and tree nuts during pregnancy was linked to a lower risk in peanut and tree nut allergies in their offspring. This is in direct opposition to older, lower-quality research that found no impact or even a higher risk of allergies in peanut-loving mommas. These new findings are much more aligned with the research and recommendations on early introduction of peanut products. So if you’re not allergic to peanuts, then feel free to whip up a big batch of my Homemade Peanut Butter Cups and face plant into them ASAP.

So, mommas, dads and parents-to-be, I hope this article helped clear up some confusion about how to reduce the risk of peanut allergy with the new guidelines. Considering how healthy peanuts are for our kids, and how devastating an allergy can be, I’m sure it’s in all our best interest to make any effort we can to reduce our baby’s risk and to know the signs of peanut allergy in baby. If you’d like more information on early introduction, check out Food Allergy Canada’s Early Infant Feeding Guidelines FAQs.

I would love to hear from you, when did you introduce peanuts to your baby? Do you or anyone you know have a peanut allergy? How did your baby tolerate their first peanut snack?

Leave me a comment below with your thoughts!

MORE BLOG POSTS YOU MIGHT LIKE

If you liked this blog post discussing the signs of peanut allergy in baby, then you might also enjoy more blog posts on feeding infants and allergies:

• Is Soy Formula Bad for Babies that are Vegan or Allergic to Dairy?
• Why Are Food Allergies in Kids on the Rise? | Allergy Prevention Tips
• Are Food Sensitivity Tests BS or Legit? A Dietitian’s Perspective
• How and When to Introduce Food Allergens to Babies with Baby Led Weaning or Spoon-Feeding
• Do Babies Need Cow’s Milk? | Is Raising an Infant Vegan Safe and Healthy?