Peanut Allergies and Breastfeeding

The Facts of Nut Allergies and Nursing

How Serious is Peanut Allergy?

Peanut allergy is not as rare as you might think. A pediatric food allergy specialist at the Mount Sinai School of Medicine in New York, says that about one in 150 children are affected by peanut allergy, and that number is rising. Peanut allergy is more common in families with a history of peanut allergy or allergies in general. Unlike many other food allergies, children don't usually outgrow their reaction to peanuts. It is a particularly scary allergy, because reactions are often severe, and accidental ingestion of peanuts is fairly common – traces of peanuts can be found in ice cream, cereal, baby formula, candy, donuts and many other foods. Just check for labels that say "may contain traces of peanuts."

How Can Peanut Allergy Be Avoided?

Many food allergies can be avoided or lessened in severity by delaying the introduction of high-risk foods. The American Academy of Pediatrics recommends waiting until children are a year old to introduce dairy products, 2 years for eggs and 3 years for peanuts, nuts and fish. So it would seem that the simple answer to reducing peanut allergy is to keep the peanut butter and jam sandwiches out of your child's diet for a few years.

However, there is a growing concern that breastfeeding mothers may be sensitizing their infants to peanuts. Research by allergists at St. Michael's Hospital in Toronto, Canada, discovered that when moms eat peanuts, within two hours, peanut proteins can often be found in their breast milk, including the two peanut proteins which are most likely to cause an allergic reaction. While not all babies will develop allergies from this exposure, the concern is that high-risk infants (those with a family history of allergies) might react to this early exposure to peanuts, perhaps developing the allergy or a more severe allergy than they might have gotten otherwise.

Should breastfeeding moms, particularly those with a family history of allergies, avoid peanuts? "I do not believe that we have a clear knowledge of the impact of breastfeeding on peanut allergy," Dr. Sicherer says. "It has been supposed that when a breastfeeding mother ingests peanut, since some may pass through the milk to the infant, that this may 'cause' the allergy. There is some circumstantial evidence that this may be the case. On the other hand, a careful reading of the available literature does not convincingly show a relationship."

In other words, he's not convinced that avoiding peanuts while breastfeeding will reduce the chances of your baby having a peanut allergy.

In other countries, governments and the medical establishment have taken a stronger stance. While the evidence is not conclusive that breast milk containing peanut proteins can lead to allergies, several countries have clear recommendations in place for breastfeeding women. For example, the governments of both Britain and New Zealand recommend that women with a family history of allergy (asthma, hay fever, eczema) avoid peanuts while both pregnant and breastfeeding.

What Moms Have to Say

Tritia Sam of Farmington, Ark., has three boys. The oldest has peanut allergy. "From the time he was conceived, all the way through pregnancy and nursing, I got in the habit of eating a late night snack of toast with peanut butter and jelly," she says. "That was what I'd eat to take my vitamin before bed. Never missed a night. And, often I would eat it other times of the day for the protein."

From the time Sam's son was born, he had what she was told was very bad eczema. Much to her surprise, she says, "The week after I weaned him, the spots, the ooze, the pus – all of it – was gone." She didn't think about it until he had his first peanut butter cookie and broke out from head to toe. Her youngest two sons, also fed on her steady prenatal and nursing diet of peanut butter and jelly on toast, seem fine.

Darlene Johnson of North Augusta, S.C., has a similar story. "My son is 16 months old," she says. "We found out that he had a peanut allergy about six months ago. I gave him his first peanut butter sandwich, and he broke out in hives on his face where the peanut butter touched him."

Looking back, Johnson remembers that her son was very gassy and spit up a lot as a small baby. Only now does she wonder if that was due to the peanuts in her diet. "I have always really liked peanut butter and thought it was a healthy protein source," she says. "I never thought of it as an allergy source for my baby!"

Sam and Johnson both wish they had been better informed by their doctors. "I feel angry at my OB doctor," Johnson says. "I was given plenty of information on certain foods to avoid, like some types of fish, but never was there any information given about peanuts. I think this should definitely be included in the information sheets they hand out."

Sam agrees. She asked her doctor many times if her son's "eczema" could possibly be related to anything she was eating, and he always said no.

What to Do?

As I sit here 3 months pregnant, with a family history of peanut allergy, what am I going to do? My doctor doesn't think it will make any difference if I avoid peanuts during my pregnancy and breastfeeding. He's waiting for more solid evidence before he counsels his patients in any particular direction.

For me, however, the evidence is clear enough. I've had enough exposure to kids with peanut allergy to convince me that anything I can do that might reduce the risk of my baby having peanut allergy is worth a try. So I have given up my beloved peanut butter for a couple of years.