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Dr. Hemant Sharma

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. Sharma: As your allergist may have explained, findings from the LEAP (Learning Early About Peanut Allergy) study provide compelling evidence that early introduction of peanut in a high-risk group of infants can be protective against the later development of peanut allergy. Dr. Gideon Lack and colleagues showed that regular consumption of peanut starting between 4 and 11 months reduced the odds of a peanut allergy at age 5 years by 70 to 80 percent.

Given your son’s negative skin test results to peanut and tree nuts, I agree that prompt introduction of these foods, one at a time, would be important next steps. The challenge, as you note, is how to do this safely in light of your husband’s and daughter’s allergies.

Depending on your daughter’s age and how likely she is to come into close contact with your son while he is eating the peanut and nuts, you may want to choose a time when she is regularly out of the home, such as while she is in school. Alternatively, you may decide to feed your son the peanut and nut products only when the two of you take a trip out of the home.

If you do feed it to him in the home, it would be advisable to keep him in a high-chair or confined location, so the allergen does not travel. Also, wipe all eating surfaces and wash all utensils with soap and water afterward to reduce the risk of cross-contact.

You could also time his bath afterward to ensure all peanut and nut residue has been removed from his skin.

I hope you will be able to find a routine that provides your son the benefit of introduction, while keeping your daughter and husband safe.

Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.

Also see Dr. Wade Watson’s opinion on this topic here.

Send your question to Dr. Hemant Sharma by email.
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