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Dr. Wade Watson

How to Introduce Peanuts or Nuts When a Sibling Has Allergies

Q. My husband and daughter have severe allergies to peanuts and tree nuts. Our youngest just had a skin test and does not have a peanut or tree nut allergy. Since he is at higher risk with our family history, the allergist recommended that I start to introduce peanuts and nuts into my son’s diet  to try to prevent an allergy. But how can I feed him these products on a regular basis, while keeping the rest of my family safe? 

Dr. Watson: With children at high risk for allergy who have negative skin tests, regular feeding (usually at least once a week) of peanut is important. There is new evidence that doing so may reduce the risk of a young child later developing a peanut allergy.

Your concern is understandable, but with some precautions, you can keep your husband and daughter safe while introducing your son to peanut. For instance, you could feed peanut butter to your son while your husband and daughter are not home.

You could avoid issues with smears by supervising the eating closely and keeping peanut butter to just one area of the kitchen. Once your son has finished, you can wash his hands and face with soap and water. You could immediately clean the utensils and also the countertops and any other affected surfaces. Depending on his age, nut butters can be fed in the same way.

Introducing any new allergenic food should be done with one food at a time to ensure that there are no reactions. If the at-home peanut introduction is too stressful, some of my parents’ parents take the non-allergic child to the grandparents’ home or a friend’s place to eat the allergenic food.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.

See also Dr. Hemant Sharma’s opinion on this question here.

Send your question to Dr. Wade Watson by email.
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