New Peanut Allergy Guidelines: A Balanced View
Friends, tonight I’m publishing ‘the other side’ or ‘the balanced view’ of this whole new early exposure to peanuts gig. We’ve talked before about how medicine isn’t perfect, and no doubt with these new guidelines WE WILL SEE some truly allergic children having reactions at an early age at the time of first exposure. This should neither anger nor horrify nor surprise us, other than feeling disappointment for the unfortunate baby who is truly allergic and gets a reaction. A colleague of mine, Dr. Kristen Brumleve, had an intense clinical experience with a patient whose parents did all the right things and their baby had a reaction anyway. Sometimes that’s how it goes with humanity in this universe, and in the spirit of understanding all possible outcomes, her story needs to be told:
DR. BRUMLEVE WRITES…
I woke up and called my parents on January 5th to wish them a Happy 43rd Wedding Anniversary and rather than thanking me, my mother chimed in “Have you seen this whole peanut news?” I had, and as medicine occasionally has big breakthroughs like this, I just laughed at her exclamation and didn’t give it too much thought at the time, and moved on to the next part of the conversation. Just a few days later I was on shift here at PM Pediatrics when a baby under 12 months old was brought in by both parents in anaphylaxis (life-threatening allergic reaction – you don’t mess around with this one) heading towards shock from ‘early’ introduction of peanuts.
The baby had the classic signs of anaphylaxis. Dusky in color with fluid-filled lips, nearly swollen shut. Hives all over his torso and had vomited en route to the office. I could hear him gasping for air from across the room and upon evaluation with my stethoscope, his lungs were barely moving air. Like I said, you don’t mess around with anaphylaxis, so the code cart popped open, syringes of epinephrine (adrenaline) were filled (twice, I might add), and oxygen with breathing treatments were initiated. Due to its severity, 911 was called for transport to the closest hospital Emergency Department, and in the meantime, I gave a dose of intramuscular steroids. In 14 minutes, the baby had left PM Pediatrics in an ambulance as quickly as he had entered and I sent FDNY after the father in the ambulance to find out my patient’s name. What a blur.
A day after the chaos, I got to follow up with the baby’s dad who noted the patient was home and doing well. Thankful for our care, he revealed that both parents had read the NYT article, “Feed Your Kids Peanuts, Early and Often, New Guidelines Urge” and both parents took the correct precautions in discussing early peanut introduction to their low risk son with his Pediatrician.
As we are well aware, it’s impossible to predict this type of allergic reaction, and it appears that these parents did everything by the book. As Dr. Johns has clarified in her blog, the recommendation is that High Risk babies start a peanut trial at 4 months and Low Risk babies start at 6 months under the care of their Pediatrician +/- Allergist with diphenhydramine (Benadryl) on hand at home for infants 6 months and over. I would like to take this opportunity to reiterate the importance of ‘hoping for the best BUT preparing for the worst.’ Science is something we can trust, but it still does not give 100% guarantees. Get a game plan before you start.
If you suspect your child is having an allergic reaction with swelling, hives, and/or difficulty breathing, do not prolong intervention by calling your pediatrician for advice on what to do. Please head to your closest Urgent Care, ER, or call 911.
FINAL WORD: SHOULD I STILL GIVE MY INFANT PEANUTS?
YES. Under the supervision of your child’s pediatrician and/or allergist, you should absolutely be doing this. This story is in no way meant to scare you out of trying out peanuts. In fact, I encourage everyone to follow the guidelines. If you’re nervous, call your doctor and partner up. Work together. The study — which was conducted by an expert panel of physicians, scientists, and allergy advocates, and was sponsored by the National Institute of Allergy and Infectious Diseases — had a 70-80% success rate and following these guidelines gives us chance to prevent peanut allergies from ever happening. It’s already worked for a number of young children, and hopefully will for many more to come.
Feelin’ academic? Check out the full study here.