Did I cause my child’s peanut allergy?

Did I cause my child’s peanut allergy?

I am asked by parents all the time whether or not they caused their child’s peanut allergy.  It is a very common concern.

A recently published study also caused a lot of parents to worry that they were at fault for their child’s peanut allergy.

If you have this worry, I will help you find the answer in the article below.

 

See if you caused your child's peanut allergy
Did I cause my child’s peanut allergy?

Could I have caused my child’s peanut allergy?

I worry every day whether or not I’m raising Emmett and Luke in a healthy way.  I’m sure you’re the same.  There’s nothing worse than worrying whether or not you CAUSED a problem with your child.

If you have a peanut-allergic child, there is enough information and misinformation out there that this is a very common fear:  that you CAUSED your child’s peanut allergy.

Lets address that worry once and for all and get you your answer.

 

There are two ways you might be worried you caused your child’s peanut allergy:

Most Common Fears

  1. You might be worried because you did (or didn’t) eat peanuts while pregnant or breastfeeding
  2. You were told to avoid peanuts or introduce them later and fear this caused the peanut allergy.

I will address both of these below.  But if you want an answer RIGHT NOW, just click the quiz below and I’ll figure it out for you automatically (it takes about 2 minutes!)

 

 

First, some facts about peanut allergy

  1. Food allergies happen in 6-8% of children.
  2. Peanut allergy happens in 1-3% of children.
    • This number is on the rise and has tripled over recent time
    • The cause of this increase is still uncertain
  3. The goal of this article is to try and be as evidence-based as possible

 

Question 1:  Were you told to avoid peanuts during breastfeeding and now your child has a peanut allergy?

 

Prior to about 2008, the American Academy of Pediatrics had recommended breastfeeding mothers to remove or reduce allergens such as peanuts in an attempt to reduce the risk of peanut allergy.

The results of that recommendation:

  • Studies showed that avoiding peanuts during breastfeeding did not reduce peanut allergy.
  • It also did not cause peanut allergy.

Summary: If you were avoiding peanuts during breastfeeding then you DID NOT cause your child’s peanut allergy.

 

 

Question 2:  Were you told to eat peanuts during breastfeeding and now your child has a peanut allergy?

The opposite of question 1 also happened quite a bit:  that you were told they SHOULD eat peanuts while breastfeeding.

This often raises the concern that you introduced your child to peanuts too early and by doing this, you caused your child’s peanut allergy.

  • There was a study from the UK that showed if mothers who introduced peanuts during breastfeeding might actually DECREASE the chance of their child having a peanut allergy.
  • There was no evidence that early introduction actually caused the peanut allergy.

Summary: In this case, if you were eating peanuts during breastfeeding then you DID NOT cause your child’s peanut allergy.

 

give child peanuts
Worried that early introduction of peanuts caused their allergy?

Question 3:  Did you give your child peanuts early in life and now you are worried that you gave them peanuts too soon? And that caused their peanut allergy?

I hear this a lot:  parents worry that their child wasn’t ready for peanuts yet (due to either a developing GI tract or some recent articles about “leaky gut”) and by giving them peanuts early, you might have caused the peanut allergy.

  • There is evidence that early introduction actually helps PREVENT peanut allergy.
  • There is no evidence that a developing GI tract or “leaky gut” causes peanut allergies.

Summary: So if you gave your child peanuts at an early age, you DID NOT cause their peanut allergy.

 

Almost done…

 

Question 4:  Were you told NOT to give your child peanuts (until 1 year, 2 years, etc)?  Or did you chose to wait to introduce peanuts?  And are now worried that avoiding peanuts caused their peanut allergy?

 

This is the most recent question that I’ve been getting, and it is a little more complicated to answer.  The recently published LEAP study suggested that eating peanuts in the first 4-11 months of life was effective at PREVENTING the development of peanut allergy.

 

The concern: that avoiding peanuts (or introducing them later in life) may have actually caused your child’s peanut allergy.

 

So your fear may be:

  • If giving peanuts could have prevented food allergy, then did not-giving it cause the food allergy?
  • Did I cause a problem by avoiding peanuts?

 

Well, lets break that study down with a few more questions based on the study itself:

Q4-1.  Was your child eating peanuts as a normal part of the diet and then had a reaction?

The LEAP study showed that introducing peanuts early might prevent allergies.  So if your child was already eating peanuts and still got an allergy, then there was nothing you could have done about it.

Summary: You DID NOT cause your child’s peanut allergy.

 

Q4-2.  Was your child considered a “high risk” food allergy before they developed a peanut allergy?

If your child was a low risk, then it is unlikely that avoiding peanuts caused your child’s peanut allergy.

In the LEAP trial, only high-risk infants were included in the trial.  So what defines a child who is “high risk” for peanut allergy?

  1. Did your child have eczema (true atopic dermatitis and not dry skin eczema)?
    • If your child didn’t have atopic dermatitis, then they were “low risk” for peanut allergy
    •  Summary:  You DIDN’T cause their allergy
  2. Did your child have an egg allergy (or another food allergy) before the peanut allergy?
    • A food allergy means that when your child was exposed to egg, did they break out in hives, swelling, difficulty breathing or wheezing or other symptoms?  If you’re not sure, take a moment to read my Food Allergy vs. Food Intolerance post.
    • If there was no prior egg allergy (or other food allergy) then they were again not considered a “high risk.”
    • Summary:  You DID NOT cause their allergy.

 

According to the LEAP trial, if you had one of the two criteria (severe eczema OR a food allergy to egg) BUT NOT BOTH, then your child was “low risk” for peanut allergy.

Summary:  If you had one of the two and not both, then avoiding peanuts DID NOT cause the peanut allergy.

 

Q4-3.  Was your child told to avoid peanuts because of a previous allergy test value or had a high allergy test to peanuts?

 

I see kids in my allergy practice who have risk factors for food allergy so we do food skin tests.  Sometimes the result is high (>5mm skin test.)  In this case, we often advise to avoid peanuts based on the predictive value of high skin test results.

Remember, the question we are answering is whether or not you caused your child’s peanut allergy.

If you were told to avoid peanuts because of a skin test or allergy value, it was likely the correct medical decision.

 

The LEAP trial took children who were clinically high risk (moderate-severe eczema AND egg allergy) who ALSO had low allergy testing to peanuts.  This was the group the LEAP researchers felt might get benefit from early peanut exposure to help prevent peanut allergy.

Summary:  If you were told to avoid peanuts because of a high peanut allergy test value, then it was likely the correct medical decision. Unfortunately, there was nothing you could have done to prevent / change the course of your child’s peanut allergy.  You, however, DID NOT cause your child’s peanut allergy.

 

does early introduction of peanuts cause allergy?
What if your child was high risk, negative test AND avoided peanuts? Did THAT cause their allergy?

 

Question 5:  Was your child a “high risk” (moderate-severe eczema AND egg allergy) but negative/low peanut skin test and were told to avoid peanuts?

 

In this case, did avoiding peanuts cause a peanut allergy?  This answer is complicated.

      • The LEAP study:
        • High risk/low skin test EATING PEANUTS developed allergy in 2%-11% of kids
        • The avoidance group developed allergy in 14-35% of kids
      • This was the first study to suggest eating peanuts might help reduce risk, but still not for everyone!
        • This study has changed what we recommend for future patients
        • But I think more studies are needed to know exactly what we need to do to reduce peanut allergy.

Summary:  It is reasonable to say early introduction of peanuts might have REDUCED your risk, but I don’t think that it is reasonable to say you caused peanut allergy.

Again, risk reduction is different than cause creation.

 

Confused?  Take the quiz!

This is pretty complicated topic with a lot of different outcomes.  That is why I created the quiz to help ask you the questions and give you my best answer.

Still have questions?
Take the “Did I Cause My Child’s Peanut Allergy” Quiz

Final words

I hope that this helped the majority of you feel better, and relieved the fear that you caused your child’s peanut allergy.

I don’t see any scenario where you caused a food allergy.

Unfortunately, food allergies DO just happen.  What we have found from food allergy research is to appreciate the complexity of our immune system.

 

Now, I have tried to address the majority of the questions I have received from other patients and allergy friends.  If you still have questions feel free to contact me and I will help as much as I can.

 


Sources:

      1. LEAP study, published in New England Journal of Medicine, Feb 2015.
      2. Greer  FR, Sicherer  SH, Burks  AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology.  Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.
      3. Hourihane  JO, Aiken  R, Briggs  R,  et al.  The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanu allergy in United Kingdom children at school entry. J Allergy Clin Immunol. 2007;119(5):1197-1202.

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