When Nicole Lepke’s son was born, she listened to her pediatrician and kept peanuts away until the age of 2, but the toddler still developed a severe peanut allergy when he finally tried them.
Now, 12 years later, health experts have reversed their advice on peanuts, urging parents to begin feeding foods containing peanut powder or extract during infancy in hopes of reducing a child’s risk for allergy.
The about-face on peanuts has stunned parents around the country who are coping with the challenges of severe peanut allergies. Like many parents, Ms. Lepke is now plagued with guilt. By restricting peanuts early, did she inadvertently cause the very allergy she was trying to prevent?
“There is this constant guilt that you have as a parent,” said Ms. Lepke, a mother of three who lives outside Milwaukee. “And then if the recommendation changes the next year, you feel it even more.”
Since the new guidelines were announced last week, many parents, alarmed by the recommendation that peanut-containing foods be deliberately fed to infants, have lashed out at the medical community in social media posts.
A new parent who gives peanuts to a baby “could be sentencing them to death,” said Peggy Cottle, of Dayton, Ohio, who has a child with a peanut allergy.
Ms. Cottle said that it often seems like every year a new study comes out that negates an earlier study. “There is no definitive proof on what causes food allergies,” she said.
Jennifer Urso Doggart, a mother of four from Jefferson, Ohio, said she feared babies would be used as “guinea pigs” to test the new allergy prevention guideline.
“You follow advice and then find out years later that it was the wrong advice,” Ms. Doggart posted on the Facebook page of kidswithfoodallergies.org.“‘Oh no. Wait. We were mistaken. It’s actually the opposite thing you should be doing!’”
But others reacted with sadness, wondering whether better information earlier on might have prevented their children’s allergies. “It is a bit disheartening and frustrating,” Heather Eslinger, a physical therapist in Colorado Springs whose children have nut allergies, said in an interview. “It is hard to accept that things may have been different had we known then what we know now.”
While national health officials have a track record of reversing medical advice from time to time — menopause hormones and trans fats are two examples — few topics are as fraught as food allergies. For starters, food allergies disproportionately affect children, and the risk of making the wrong decision about a food is immediate and potentially deadly. As a result, parents are particularly fearful about following the advice.
“I gave my 5-month-old a bit of my toast and peanut butter and we ended up in the emergency room,” said Lori Dombek, 58, a web developer in Gorham, Me., whose son is now 22. “Peanut allergies are nothing to fool with.”
But scientists say the new guidelines are based on the latest science. A large clinical trial studied hundreds of British children at risk for peanut allergies, giving them either peanut-containing food regularly from infancy or withholding all foods with peanuts.
By the age of 5, the trial found, those who had been given peanut-containing food early in life had an 80 percent reduced risk of developing a peanut allergy.
“The trial’s results were very very unambiguous,” said Dr. Matthew Greenhawt, chairman of the American College of Allergy, Asthma and Immunology’s food allergy committee and one of the authors of the new guidelines. The fact that the guidelines changed over time makes them more credible, not less, he said.
“You want them to change over time if there is better data available that can make a more informed statement — that’s progress,” Dr. Greenhawt said. “That’s why taxpayer dollars fund N.I.H. research – to push the envelope, to build a better mousetrap, to find a better answer to a question.”
The shift in recommendations was not as abrupt as some may think, experts said. As recently as 2000, the American Academy of Pediatrics told parents to withhold peanuts from children at high risk for allergies until the age of 3. But in 2008, the academy backed away from the recommendation, said Dr. Scott H. Sicherer, a spokesman for the academy and one of the authors of the new guidelines. Although the recommendation against withholding nuts from children under 3 was rescinded, that message didn’t catch on.
By 2008, the message was “You don’t need to avoid peanuts till age 3, feed the baby as you wish, there’s no evidence that delaying is going to be helpful,” Dr. Sicherer said. But by then, “It was stuck in people’s minds and wasn’t easily forgotten — it had become the gospel.”
Dr. Sicherer said he understands the resistance to the new message, and the fear that the advice might change again. In addition, he noted that giving your children peanut foods at a young age doesn’t guarantee they will be allergy-free. “It’s not foolproof. Even in the study, some still developed an allergy or had it when they started,” he said.
The new policy also leaves a lot of unanswered questions about allergies and other foods. When should other allergenic foods like eggs, dairy, fish and shellfish be introduced to young children? And what about eating peanuts during pregnancy and lactation? Experts said research about introducing other allergenic foods is ongoing, and that studies on eating peanuts during pregnancy and while breast-feeding are weaker observational studies, and the results are mixed.
There are social implications as well. Parents of children with allergies often feel that they are subtly accused of causing allergies by being overprotective or of being neurotic and exaggerating the risks. They worry that the new guidelines will encourage those stigmas. Doctors say no one should be blamed for peanut allergies or feel guilty about them. “There is no peanut-allergic child right now who is peanut allergic because of something their mother or father did,” Dr. Greenhawt said. “It’s not their fault. This is something that was there.”
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