For severe eczema or egg allergy, discuss early peanut introduction with a clinician; never give whole peanuts
In high-risk infants starting at 4–11 months, regular peanut consumption led to 1.9% peanut allergy at age 5 versus 13.7% with avoidance among those initially skin-test negative. For weakly positive skin tests, rates were 10.6% versus 35.3%. Seek clinician assessment first. Whole peanuts can obstruct the airway and must not be given.
What it takes
Peanut butter costs a few tens of RMB in China, with small feeds several times weekly. Arrange a medical assessment before starting.
What you may gain
The UK LEAP randomized trial enrolled 640 infants aged 4–11 months with severe eczema, egg allergy or both, comparing regular peanut products with avoidance until 60 months. Among 530 initially skin-test-negative infants, allergy occurred in 13.7% of avoiders versus 1.9% of consumers, P<0.001. Among 98 weakly positive infants, rates were 35.3% versus 10.6%, P=0.004. Serious adverse events did not differ.
Context & considerations
Use thinned smooth peanut butter or peanut powder mixed into food, never whole nuts. China's health guidance warns that whole peanuts, nuts and jelly can cause aspiration and suffocation in infants/young children. Chapter 13, entry 26 discusses choking in adults and children over 1 year; its abdominal-thrust method is not an infant method. The LEAP findings apply to high-risk infants with severe eczema/egg allergy. Obtain clinical assessment rather than attempting an unsupervised home challenge: all trial infants were skin-tested, and reactions over 4 mm excluded them. Evidence for ordinary-risk infants is weaker. An EAT trial of 1,162 breastfed infants found intention-to-treat allergy rates of 5.6% versus 7.1%, not significant (P=0.32); only the adherent subset showed 2.4% versus 7.3%. That subset comparison can overstate efficacy; authors reported no demonstrated intention-to-treat efficacy but supported safety. The cited Chinese feeding material did not specify early introduction versus avoidance of allergenic foods, so this entry uses international trials. LEAP began from 4 months, whereas Chinese complementary-feeding guidance begins at 6 months; see entry 4. Let the clinician determine timing and method for a high-risk child.
Research & references
Du Toit G, Roberts G, Sayre PH, et al. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. https://doi.org/10.1056/NEJMoa1414850; General Office of China's National Health Commission (2020). Core Health-Education Information on Infant and Young Child Feeding. https://www.gov.cn/zhengce/zhengceku/2020-08/01/content_5531915.htm; Perkin MR et al. (2016). Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. New England Journal of Medicine, 374(18), 1733-1743. https://doi.org/10.1056/NEJMoa1514210 (EAT trial discussed below).