The Peanut Shift: What Every Parent Should Know Now

New research shows steep drop in peanut allergies thanks to new behavior

In 2017, Trader Joe’s stores began selling a crunchy peanut butter snack perfect for the smallest hands to grasp and enjoy. Placing Bamba snacks at kids’ eye level ever since then is no accident. It’s a direct result of a major update to pediatricians’ advice to parents aimed at preventing allergies.

Today, introducing kids to peanut butter at a very young age has significantly reduced peanut allergies, according to a new study from the Children’s Hospital of Philadelphia (CHOP). Researchers analyzed health data from almost 125,000 children born before and after the latest guidelines, finding that allergy prevalence decreased among those born after the guidelines were updated.

Melissa Gans, M.D., an allergist and pediatric immunologist at the University of Miami Health System, weighs in on what parents need to know to help reduce the likelihood and severity of food allergies.

From total abstinence to encouraging tots to eat peanut butter

For decades, parents were told to wait until age 3 before giving children foods that had been known to cause anaphylactic food allergies. There’s nothing like imagining your child’s throat dangerously closing from nuts to keep parents vigilantly adhering to pediatric guidelines. This well-meaning advice to protect vulnerable kids actually led to an increase in allergies.

“The idea to wait to introduce the allergens until later didn’t come from any strong evidence. The medical community thought that waiting to introduce allergens was actually decreasing the risk of developing food allergies,” says Dr. Gans.

The previous advice didn’t apply only to peanuts. Parents were often told to wait until age 1 before offering foods like eggs. “The MMR vaccine, which is typically given out at one year, contains a trace amount of egg protein, so parents were told not to offer any egg until babies get the MMR,” says Dr. Gans.

Then, new research published in 2015 led the American Academy of Pediatrics (AAP) to advise parents to introduce peanuts to babies as early as four months. The study was the result of earlier research widely known as the “Bamba Study.” The research demonstrated that Jewish children in England had a 10-fold prevalence of peanut allergies compared to Israeli children, who commonly gummed on Bamba as a first food. British children avoided nuts.

More studies yielded similar findings, and in 2017, the National Institute of Allergy and Infectious Diseases, a division of the National Institutes of Health, began recommending early peanut exposure. That was when Bamba began popping up in stores across the United States. Parents shed their fear of peanut allergies and began offering peanut butter and other peanut snacks to their babies.

How to introduce peanuts to babies

Despite abundant evidence that offering peanuts early is better for kids, parents are still right to feel intimidated. Consuming peanut butter from a very young age doesn’t guarantee a child won’t develop a peanut allergy. Still, Dr. Gans recommends not waiting before carefully offering peanuts, along with eggs and dairy products, for the first time.

“There’s no reason to wait to introduce peanuts, even for babies with eczema or a sibling with a peanut allergy,” says Dr. Gans.

As a pediatric immunologist in one of the few Food Allergy Research Education Center of Excellence (FARE) in Florida, Dr. Gans offers step-by-step instructions grounded in clinical practice:

1. Start with your pediatrician

Before introducing any solids, confirm your baby is developmentally ready, typically around 4 to 6 months.

2. Begin with non-allergenic foods first

Start with simple foods like oatmeal, rice cereal, bananas or avocado to help your baby with eating solids.

3. Introduce one allergen at a time

Avoid introducing multiple new allergens on the same day, like dairy, eggs and peanuts.

4. Choose a safe peanut form

Whole peanuts and even thick peanut butter are choking hazards for babies. Instead, try thinning peanut butter with water or mixing a little peanut powder into puree, cereal or mashed banana.

5. Start small and go slow

Offer a very small amount, about the size of a pea. Wait a few minutes and watch for any reaction before continuing to feed more.

6. Watch closely for symptoms

Early signs of an allergic reaction may include:

• Rash or hives
• Vomiting
• Coughing

If symptoms occur, stop feeding immediately and seek medical care. Severe symptoms require emergency attention.

Once you safely introduce peanuts to your baby, consistency matters. “Once you introduce it, keep it in the diet at least three times per week to maintain tolerance,” says Dr. Gans.

Expanding treatment options for peanut allergy

For those families who are navigating a peanut allergy diagnosis, a growing range of treatment options can reduce risk and build tolerance. About 20% to 30% of kids diagnosed with peanut allergy at a young age naturally outgrow a peanut allergy. Periodic testing and supervised food challenges can help determine whether the allergy is still active.

At UHealth, care is tailored to each child’s needs, allergy severity and family goals. Some families still choose careful avoidance with regular monitoring.

But for many families, newer therapies offer more proactive paths forward.

Medications to reduce reaction risk

One option for peanut allergies is omalizumab, an FDA-approved injectable therapy for peanut allergy in children at least 1 year of age. Given every 2 to 4 weeks, it works by targeting IgE, the antibody involved in allergic reactions to foods like peanuts, eggs, and milk.

Patients on the medication may tolerate higher amounts of peanut or have less severe reactions with accidental exposure. “It’s like an insurance policy, but it’s not a cure. Protection depends on continuing treatment,” says Dr. Gans.

Oral immunotherapy builds tolerance

Dr. Gans treats many children with oral immunotherapy (OIT) or sublingual immunotherapy (SLIT), where kids ingest a very small, controlled amount of peanut protein daily and gradually increase the dose under medical supervision. Dr. Gans also does food immunotherapy for other food allergies like tree nuts, sesame, milk and egg.

“We start with very small amounts and build up, so it’s a big commitment; but it is tremendously effective in either curing the food allergy or building a tolerance to prevent severe reactions,” says Dr. Gans.

Emerging peanut allergy treatment in Miami

UHealth researchers, including Dr. Gans, are also advancing newer, less invasive approaches, such as the peanut patch, also known as epicutaneous immunotherapy (EPIT).

Dr. Gans and UHealth researchers were one part of the peanut patch clinical trial. This investigational treatment delivers small amounts of peanut protein through a daily skin patch, typically worn on the back. The goal is to train the immune system to tolerate gradual exposure to peanuts.

Clinical trial results have been encouraging, especially for younger children. “About 30% of patients on the patch, between the ages of 1 and 4, are more likely to tolerate a higher dose of peanut protein compared to placebo after one year of the patch,” says Dr. Gans, based on Phase III data.

The patch isn’t FDA-approved yet, and full study results are still being published. However, it reflects a broader shift toward more flexible, patient-friendly treatment options for peanut allergies.

Today, measures to keep kids safe from peanut allergies are becoming increasingly promising. Parents of children with peanut allergies have more promising options than ever, especially at a FARE center like UHealth.

Written by Wendy Margolin. Medically reviewed by Melissa Gans, M.D.

Tags: Dr. Melissa Gans, early peanut introduction babies, pediatric allergist Miami, reducing food allergy risk infants, when to introduce peanuts to baby