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Navigating the Allergen Jungle

Jan03

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Advice Smackdown ArchivesI am a new-comer to your writing and I absolutely love it. Basically everything I know about pregnancy and parenting has come from here…I know, kind of pathetic…I am not currently pregnant and my husband and I are the only ones in his family that do not yet have kids. This year was the year to be with his family for the holidays and so all of my sisters-in-law – who have had children or will very soon – got to talking about some baby stuff and they couldn’t agree on anything really…what else is new?

One topic got pretty heated and I couldn’t find much online by way of any “credible” sources on it…so I’m asking you :) They could not agree on when you should give a child honey, peanut butter, and nuts in general. One said that is wasn’t until 2 years, another said 1 year, one even went as far as to say pregnant women shouldn’t eat nuts or peanut butter because it will affect the baby. I love nuts!! Pregnancy will be miserable without peanut butter! So…how much is true, what is not? Knowing before I get pregnant would be good because I don’t want to mess up the kid because of silly snacking habits and what not…

Thanks!
Peanut butter&Honey

Well, nuts are certainly becoming quite the hot topic around here, no? I promise this isn’t the beginning of a trend, mostly because after this question I’m pretty sure I’ll have completely used up every bit of my limited knowledge about nuts and nut allergies.

First of all: honey. Honey should never be given to a child under the age of one. It’s NOT an allergen, however. Honey can sometimes contain spores of a bacteria (clostridium botulinum). This bacteria is generally harmless to anyone over the age of 12 months because our digestive tract is mature and producing its own healthy microorganisms that can kill the bacteria. Under one year of age, however, a baby’s digestive tract is NOT mature enough, so those trace spores can develop into…botulism. Yum. Everything I have ever read tends to agree that 12 months is long enough to wait for honey — unless of course, you know your child has an underdeveloped digestive tract or compromised immune system for some reason. Prematurity, illness, something like that. If this is the case, your doctor will generally tell you when it’s okay to introduce honey. Otherwise, 12 months is the accepted standard for healthy, typically-developing children.

And now, NUTS. The reason you witnessed such vociferous disagreement about nut allergies is because…well, it’s one of those things that even the so-called “experts” aren’t entirely sure about, and there’s a LOT of conflicting information out there aimed at pregnant women and parents of infants. No one can adequately explain WHY there’s been a sudden rise in serious, life-threatening nut allergies in children, and that’s scary. (The best explanation I’ve read so far, by the way, was in The Unhealthy Truth, which posed the suggestion of genetic engineering mucking with the purity of our food supply and the reliability of food labeling, i.e. soy being cross-bred with cashews, thus a tree-nut allergic person could have a reaction after eating soy and not know why, or newborns getting accidentally exposed to nuts via genetically-modified formula. But again, this is just one of the many, many hypotheses floating around. The real unhealthy truth is we just don’t know.)

So quite often, parents go looking for ADVICE and end up getting what amounts to little more than reactionary scare tactics, or “experts” making guesses. There seems to be evidence that delaying a child’s exposure to peanuts and other tree nuts for at least a year might reduce their risk of developing a severe allergy…or it at least reduces the chance of them having a REALLY serious reaction, as even children who ARE allergic sometimes have milder reactions as they get older. But I’ve also read plenty of arguments AGAINST delaying nuts and nut products at all, claiming that early exposure to allergens can help build natural immunities and protections and blah blah blah. (Think the statistics that show that children who grow up with family pets tend to, on average, have fewer allergies to pet hair and dander later in life. Same theory, but while sneezing at the cat is one thing, anaphylactic shock over peanut-butter crackers is another. You won’t meet a lot of parents willing to sign their baby up for that particular focus group, you know?)

Basically, your family members are all just repeating what they have personally been told about nuts, and all of them were probably told that by people with the very best intentions who believed it to be true. (Or maybe they just read something scary on the Internet.) Most pediatricians advise waiting until at least your baby’s first birthday. Others say to wait longer, especially if you have a family history of food allergies. This was always what I was told — we are fortunate enough to have almost zero food allergies of any kind in our immediate family. (I was mildly allergic to tomatoes and strawberries as a kid and would get hives, but I outgrew them both by mid-elementary school.) Thus, our pediatrician told me to go ahead and try peanut butter after each of my boys’ 12-month check-ups. Which we did. Zero allergies. Noah practically LIVES on the stuff now. I spent a lot of time during Ezra’s first year fearing that Noah would smear peanut butter kisses on him or something, but Ezra, too, is just fine with nuts. Our pediatrician also told me to go ahead and switch to from formula to whole milk around 10 months, even though many experts say you should delay all dairy for a full year as well. Ezra started on scrambled eggs (yolks AND whites) around 10 months old, another allergen no-no. Yet eggs remain pretty much his favorite meal on earth to this day. Scrambled, cheese omelets, frittatas full of veggies and meats, huzzah for eggs.

Basically, welcome to parenthood: You get to listen to what This Expert says, which runs counter to what That Expert says, and then there’s This Doctor and then the Nurse Practitioner Who You Saw That One Time For An Ear Infection Who Said Something Completely Different…and eventually you learn to take ALL OF IT with a grain of salt and trust your own instincts about whose advice you’ll take in the end.

And the same goes for pregnancy. Extending the allergen exposure to pregnancy is a newer theory, and one that I personally have not read anything super-convincing about. Several peer-reviewed studies have found no link between peanut consumption during pregnancy and peanut allergies in the child, but again, because we just DON’T KNOW enough about the new strain of allergies, women with family histories of food allergies (or women who already have a child with a nut allergy) are sometimes advised to avoid peanut proteins during the third trimester and while breastfeeding. Personally, I did not do this, during pregnancy or nursing. I ate (and continue to eat) peanut butter and trail mixes with relish and delight. Obviously, I hope my third child will also escape having a food allergy. If s/he does develop one, well, I really won’t be able to say that my occasional habit of smearing peanut butter on matzo during pregnancy had anything to do with it, because I did the same thing with the other two.

(Note: I only eat and serve my children natural, organic peanut butter — none of the supermarket crap with a ton of sugar, GMOs, hydrogenated oils or mystery preservatives. Our peanut butter contains: Peanuts. Maybe some sea salt. The end. While I’m not saying this AT ALL makes a difference in the fact that Noah and Ezra aren’t allergic, I simply feel better knowing that if they did ever have a reaction to it, it would be easy to swiftly nail down the actual culprit instead of running down a long list of Frankenfood-type possibilities.)

Basically, find a doctor — an OB and a pediatrician — that you trust. Someone to help keep up with the latest research and recommendations for you. If that doctor says something drastically different than what your sister-in-law is preaching at Thanksgiving dinner, ask him or her about it. Do your own research, if you can do that without driving yourself insane. There are facts, theories, opinions and a bajillion shades of gray in between.

We’re lucky. Other families used the same exact allergen-introducing timeline and ended up with an allergy, despite no prior family history. Other families waited longer, and again, the results do not indicate any sort of guarantee. Some kids develop allergies, and others do not. We just don’t know why yet. We just keep doing the best we can with the barrage of conflicting information we have at the time.

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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22 Responses to “Navigating the Allergen Jungle”

  1. April Jan 03 at 6:49 pm Reply Reply

    There was actually an interesting study done of Jewish children in Israel and the UK that found that early introduction of peanut protein accounted for a ten-fold reduction in peanut allergy in infants. You can read the abstract here:
    http://www.ncbi.nlm.nih.gov/pubmed/19000582
    My partner ate nuts all through pregnancy and while breast feeding. We waited to introduce nuts to the boys until after 12 months to allow for maturity of the digestive tract (as Amy suggests above) and so far no nut allergy for either of our sons. Just our experience for what it’s worth.

  2. SarahB Jan 03 at 7:54 pm Reply Reply

    I hope pregnancy exposure is not an issue, as all I seem to be able to eat is peanut butter and jelly, cheese, yogurt, and eggs. Oh, and whole wheat toast, to throw gluten into the mix. 

  3. Kate Jan 03 at 11:09 pm Reply Reply

    Amy’s right that there is a lot of conflicting information out there. When I was in the hospital my midwife gave me a handout that said (among other things) that I shouldn’t eat peanuts or tree nuts while breastfeeding. Since I’m a vegetarian I eat a lot of PB&J so this was quite distressing to me. I talked it over with my pediatrician ad he said that since there was no history of allergies in my bio family that I shouldn’t worry about it and 20 months later we have a healthy kid with no identified food allergies. 

    @April, that study is especially interesting because there is a growing body of evidence that delaying in introduction of foods beyond 6-8 months does increase the risk of allergies. 

    My personal opinion is that part of the problem is that we’re feeding babies formula which their little bodies can’t digest as well and then we’re compounding the problem by starting solids at 4 months (or even earlier) and this is damaging their bodies ability to properly respond to the potential allergens in food. 

  4. Kate Jan 03 at 11:09 pm Reply Reply

    Amy’s right that there is a lot of conflicting information out there. When I was in the hospital my midwife gave me a handout that said (among other things) that I shouldn’t eat peanuts or tree nuts while breastfeeding. Since I’m a vegetarian I eat a lot of PB&J so this was quite distressing to me. I talked it over with my pediatrician ad he said that since there was no history of allergies in my bio family that I shouldn’t worry about it and 20 months later we have a healthy kid with no identified food allergies. 

    @April, that study is especially interesting because there is a growing body of evidence that delaying the introduction of foods beyond 6-8 months does increase the risk of allergies. 

    My personal opinion is that part of the problem is that we’re feeding babies formula which their little bodies can’t digest as well and then we’re compounding the problem by starting solids at 4 months (or even earlier) and this is damaging their bodies ability to properly respond to the potential allergens in food. 

  5. Jennifer Jan 04 at 12:06 am Reply Reply

    I’m pursuing a bachelor’s of nursing in Canada, and the new recommendations I’ve actually heard are that you can feed your child whatever foods you want after 6 months (of course, start off with rice cereals/vegetables & progress upwards, yadda yadda yadda, but the basic message is that you don’t need to wait “longer” to introduce foods such as nuts, dairy, strawberries, eggs, shellfish, etc. — all foods they used to recommend you wait until 1, 2, even 3 years). The big recommendation they’re making now (and I know this isn’t possible for everyone) is to breastfeed exclusively for the first six months (and if your child is premature, you count your six months from their actual “due date”). Apparently the new studies are showing that this has more of an effect on reducing allergies than delaying the introduction of popular allergens.

    However, like Amy said, there’s lots of conflicting information, and with EVERY method there are going to be babies that still end up with allergies, and babies that don’t.

  6. Bonnie Jan 04 at 1:30 am Reply Reply

    There’s one VERY important point that Amy didn’t make about peanut butter, though. It is a very serious choking hazard and not recommended for children under two at the absolute youngest (although I’ve seen recommendations for as old as 4).

  7. Rachel Jan 04 at 2:41 am Reply Reply

    You just never can tell. My pregnancy was filled with peanuts, almonds, cashews, you name it– and my son was so happy in utero that he stayed there complication-free for 42 weeks.
    When I was breastfeeding, my son would projectile vomit if I ate anything with peanuts (or peanut oil). The first time he had rice cereal (theoretically just about the most innocuous baby food on the planet) was a pretty spectacular showing as well (just ask my in-laws, their porch, their kitchen, and their hammock. wow.) These days (at 21 months), he’s a true omnivore and has no problems at all with food allergies.

    Bonnie is right about big gobs of peanut butter being a choking hazard, but you shouldn’t let PBJ scare you.

  8. Helen Jan 04 at 7:44 am Reply Reply

    Here is a page that links to the studies that indicate that there is no evidence-based reason to delay particular foods until after 6 months. In fact, as Kate said above, it is beginning to look like delaying foods might increase allergies. 
    http://www.wholesomebabyfood.com/news/?p=1150

    Here in Australia, the Australasian Society of Clinical Immunology and Allergy basically says that *after 4 months* you can feed babies whatever, even supposedly “allergenic” foods like fish and eggs. However, our various State Health Departments are lagging behind in evaluating the research, so it’s hard to get anything but vague hand-wavy umms and ahhs from doctors and local child health nurses…
    http://www.allergy.org.au/content/view/350/287/

  9. Olivia Jan 04 at 8:49 am Reply Reply

    At my daughter’s 12 month check up I was asked what some of her favorite foods were and when I got to peanutbutter the nurse gasped. I asked why and she said the possibility of choking was the biggest issue. I don’t know, I think if is served in small amounts like any food for a baby/toddler it should be okay.

    As for developing allergies, my anecdotal data points more to a family history of allergies. I know that’s not true in every case, but you have a history of allergies then maybe you should proceed with more caution than those without.

  10. Amalah
    Amalah Jan 04 at 9:39 am Reply Reply

    The choking thing re: peanut butter being an EXTRA BIG SCARY THING is weird to me, because…common sense would tell you that, like ANY food you feed your young toddler, you follow a couple basic precautions. Creamy, not chunky. Small amounts, spread very thinly on easily gummed bread or cracker. Never feed unsupervised.

    Like I said, our pede gave us the okay for PB at 12 months, at the same visit where he went over choking precautions in general in pretty great detail. ANYTHING that’s not a carb (that can be broken down via saliva alone) is a choking hazard and requires extra care, PB, cheese, fruits and veggies. 

  11. Kim Jan 04 at 12:00 pm Reply Reply

    With my first, I was all about Yaris’s Super Baby Foods, and followed that food schedule. But that baby let me spoonfeed her, and I could plan around her food. My second hated being spoonfed, and was self feeding by 7 months. She wanted to do it herself, and she wanted what everyone else was having, by golly, hand over that blueberry/tomato sauced pasta/pbj. I’d seen the British research, so I went with it, and so far so good. She just turned a year and she’s had everything on the list other than honey. She’s spit stuff back out, mostly when she overstuffs, but she’s never choked. What’s interesting to me is that her sister had far more food related diaper rashes (watermelon, citrus, tomatos- all fine now) than the little one. She eats it all, no worries. No history of food allergies over here, though.

  12. Kim Jan 04 at 12:13 pm Reply Reply

    Came back because I realized I sounded very la-di-da about the whole thing, and oh my stars, not the case. Trepidation, big heavy trepidation, was involved. But I did do my research, and I found a Baby Led Weaning discussion board in Britain so I could ask questions, and I trusted my baby and myself. Never asked my pede because it was so clearly working for us that I knew I wouldn’t change anything even if he didn’t agree with it. (The PA at her 9-month said, oh good, self feeding is best, so I suppose I could have.) Mileage definitely varies.

  13. Julie Jan 04 at 12:54 pm Reply Reply

    I’ve also seen the recommendations in recent months switching to “feed whatever you want as long as you don’t have a family history of allergies” once the kid is between 6 months to a year and ready for that level of solid foods. Though peanut butter is recommended to be used in baked goods, etc as opposed to giving a giant chunk because of the chocking hazard. The same with large pieces of nuts.

    The main reasoning I’ve heard behind waiting to introduce allergens if you have a family history of food allergies has nothing to do with it reducing the likelihood of an allregic reaction, BTW. It’s because it’s much easier to intubate a 2 year old than an infant if they do go into a severe allergic reaction.

  14. Holly Jan 04 at 12:58 pm Reply Reply

    I’m a scientist, and in the research world we talk about something called “The Hygiene Hypothesis”. What this is is basically in the modern developed world, we’re too clean – with all the hand sanitizer and antibacterial soaps and freaking out about cleanliness, our kids immune systems are not challenged. Then the immune system gets bored, and decides to target food allergens instead.

    There is also some thinking that exposing an underdevelped GI tract to too many new things at once can also cause it to rebel. That’s why the exclusive breastfeeding for 6 months – no rice cereal, etc. That way, hopefully the GI tract can ‘toughen’ up and get ready to handle new foods/insults.

  15. Amy M. Jan 04 at 1:25 pm Reply Reply

    I lived on pb and j and cream of wheat during pregnancy. No issues here.

  16. Cindy Jan 04 at 2:13 pm Reply Reply

    Our family has no nut allergies. My son who is 15 can eat all the peanut butter he wants. But cashews will give him a stomach ache and vomit, pistacios make his throat swell , (just found this out recently at midnight one night.) Pecans don’t seem to do anything. So who knows!

  17. Cindy Jan 04 at 2:13 pm Reply Reply

    Our family has no nut allergies. My son who is 15 can eat all the peanut butter he wants. But cashews will give him a stomach ache and vomit, pistacios make his throat swell , (just found this out recently at midnight one night.) Pecans don’t seem to do anything. So who knows!

  18. Ms. K Jan 04 at 3:07 pm Reply Reply

    I, too, was advised to exclusively breastfeed for 6 months. The scientific rationale is that babies’ intestines are built to absorb large, complicated molecules directly into their bloodstreams in the first six months – this is so that they can take advantage of all the antibodies in mom’s breast milk. But the “open” intestinal tract can also absorb large, scary allergy-inducing molecules like those from nuts, shellfish, whatever. So avoid non-breast milk during that time period to avoid exposing the child to big, scary molecules that could trigger allergies in the susceptible.

    Babies’ intestines “close up” between 4-6months as the baby’s own immune systems matures. Then the child can handle solid foods, etc.

    That’s the theory, anyway. In my exceptionally allergy-prone family it seems to have borne out well. All of my mom and her sisters have scary allergies…and they were all formula fed according to 1940s standards. My mom and some of her sisters exclusively breastfed all their kids for at least six months…none of those kids have food allergies. The kids who, for whatever reason, were formula fed DO have life-threatening food allergies.

    Then again, this sample size was just in a single family and is pretty damn small. But I sure as hell am exclusively breastfeeding my kids for at least six months. Better safe than sorry.

  19. Emily Jan 05 at 9:27 am Reply Reply

    Feeling compelled to say it, just because this point hasn’t been made yet – formula-fed babies also generally avoid having life-threatening allergies. Thank god. 

  20. gretchen Jan 05 at 12:00 pm Reply Reply

    My doctor told me to keep one thing in mind when introducing a potential allergen: NO ONE HAS AN ALLERGIC REACTION THE FIRST TIME THEY TRY SOMETHING. (Keep in mind that babies are exposed to all sorts of things utero. Tree nuts and peanut stuff is in EVERYTHING.)

    If you have a family history or suspect an allergy, don’t ring the all clear until there have been a few exposures.

  21. Enna Jan 06 at 4:55 pm Reply Reply

    That last post (NO ONE HAS AN ALLERGIC REACTION THE FIRST TIME THEY TRY SOMETHING…completely true) is the reason NEVER to introduce eggs early. Many vaccines are grown in eggs. So wait until after a child has their first round of vaccines to introduce eggs, so IF the child IS allergic to eggs, he or she will not have an allergic reaction to the vaccines (because, see, the vaccine will be the first exposure to the eggs and there won’t be a reaction). (People who do not vaccinate should probably never give their kids eggs ever, so they can safely give the kid a rabies vaccine or a tetanus vaccine if it is ever necessary.)

    I have some friends who are doctors and two who are scientists, and they say the number one theory for a rise in allergies is that there are no more parasites. People infected with hookworms do not have allergic reactions – in fact, hookworms have “cured” lifelong chronic allergies in people. We have a whole part of our immune system designed to fight worms and bugs, and in their absence, that part of the immune system often goes haywire. Weird, huh? The problem is, parasites are disgusting and create their own health problems. So it is a real quandary for the medical establishment.

  22. Papagayita Jan 11 at 3:46 am Reply Reply

    Heartening news in this NYT article about food allergies including the results that skin prick tests and blood tests for antibodies can produce misleading results.
     “Have a Food Allergy? It’s Time to Recheck” http://www.nytimes.com/2011/01/11/health/11brody.html?ref=health

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