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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Big News from the Peanut Allergy Gallery

So a big “wow” on the peanut allergy news, huh?  Major league “about face.”  Happens every now and again in medicine.  We’re a “keep on learning” kind of crew, and the collaborative research team with the National Institute of Health (NIH) at the hub has been working diligently and rigorously on this subject for awhile now.

I have a few allergist friends at the NIH so I knew these guidelines were brewing, but it’s still going to take a little adjustment for me to get used to the idea of giving 6 month old babies peanut powder after we’ve encouraged people for so long to delay giving it.  That being said, the numbers are pretty good and convincing, with early percentages as high as a 70% reduction in peanut allergy development in those infants who were exposed early. Can you say PARADIGM SHIFT?

Let’s think about it right, though.

If your baby is a “high risk” one—one with severe eczema or known egg allergy, then you really need to talk to your pediatrician and maybe even a pediatric allergy specialist about how and in what setting to introduce peanut proteins.  Make no mistake about it, the babies at higher risk are recommended to start at FOUR months of age getting peanut exposure (under physician supervision), with low and moderate risk infants starting the exposure at home at SIX months old.  Yep, I’m adjusting right now.  As we speak.

On the evening news, a physician talked about a key early “window” in the human body where it won’t recognize the peanut protein as something it should fight against, and that’s before age 12 months, so timing that introduction is important. I say we need to go with the data here and follow the new guidelines.

Here are some things you can do to embrace the peanut:

• Sprinkle a bit of peanut powder into your baby’s food
• Mix some creamy peanut butter in warm water (to dilute) and feed with a spoon
• Walk into any Five Guys restaurant and let your baby crawl on the floor (just kidding on this one!! but FYI, they do have peanuts all over that place)

Important reminder: High risk babies should start at 4 months. Low risk babies should start at 6 months. Regardless, speak with your baby’s pediatrician or allergist before doing this, and make a plan together.

When testing out peanuts…

Make sure you have a diphenhydramine (like Benadryl), or your prescribed epinephrine auto injector (like EpiPen) ready, just in case your child does indeed experience a problem. It is so important to make a plan with your pediatrician or allergist beforehand so that you know what to expect and what your action plan will be.

Signs that will indicate your child may need immediate help — AKA a call to 911 — include:

• Wheezing or tightening of the airway
• Lip swelling
• Eyelid swelling
• More than “just” hives

I worry a little that this whole change in approach will fuel the fire of distrust in some people regarding conventional medicine: how could we have been SO WRONG on this topic for so long (!), but I hope that more evolved minds recognize that with advances in scientific technique and methods, we will likely debunk more accepted practices in medicine just like the course was changed on this one.  It’s sort of the awesome part of being in medicine:  always learning, staying open-minded, questioning standard practice, thinking critically, acknowledging shortcomings and imperfections, and being accepting of change.  Taking joy in the small wins and the big ones, and putting our sharpest minds and best intentions forward every day to try to improve the health of human kind and, specifically in pediatrics, our next generation.  And this new recommendation has the potential to do just that.  Very exciting!

Feelin’ academic? Check out the full study here.

Graph on Severe eczema or egg allergy or both

Source: American College of Allergy, Asthma & Immunology

Keep reading! What to Watch in 2017

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