Once upon a time, schoolchildren all over the land brought peanut butter and jelly sandwiches to school and lived happily ever after.
With the rate of peanut allergies quadrupling in the last 13 years, those days now seem like just a fairy tale.
Thursday, the federal government reversed course on its previous recommendations regarding when children should start eating peanut products. Rather than avoiding them throughout infancy, the National Institute of Allergy and Infectious Diseases now recommends that most babies eat peanut products early and often.
"It's a real change for everybody," said Scott Tyson, a pediatrician with Pediatrics South in Mount Lebanon, Pa. "It's a complete flip."
The change came about because of a highly regarded study released in 2015 known as the Learning Early about Peanut Allergy, or LEAP, trial, which found an 81 percent reduction in the development of a peanut allergy by age 5 among high-risk babies that were fed peanut products between 4 and 11 months, versus a control group of children that avoided peanut products.
Prior to that, the conventional wisdom had been to delay the introduction of peanuts, with the American Academy of Pediatrics recommending in 2000 to wait until children turned 3. But a national survey in 2010 estimated that 2 percent of children have a peanut allergy, up from 0.4 percent of children in 1999.
"The question is, because we were avoiding it so much did we produce a population of kids who had peanut allergies?" said Tyson. "We may have really been our own worst enemy."
Infants should never eat whole peanuts because they are a choking hazard, though they can consume them through smooth peanut butter mixed with water or purees, peanut powder or Bamba, an Israeli snack food typically given to infants.
The federal recommendations released Thursday divide babies into three groups, based on risk level.
Children with the greatest risk _ those with severe eczema and/or a known egg allergy _ should be tested for a reaction to peanuts via skin or blood test. If the reaction demonstrates a low risk of an allergy, the child should be introduced to peanut products between 4 and 6 months old either at home or in a medical setting. If the risk of a reaction is moderate to high, the child should be given the peanut products in a doctor's office or specialty facility. If there is evidence that the infant is already allergic to peanuts, he or she should not receive peanuts.
The second risk group _ those with mild to moderate eczema _ should start eating peanut products around 6 months old. And the third group _ those without eczema or allergies _ should have peanut products "freely introduced in the diet together with other solid foods."
While the advice is a change from the government's previous recommendations, many pediatricians and allergists have been recommending that babies be introduced to foods containing peanuts since the LEAP study was published. Even before that, the American Academy of Pediatrics and other groups began softening their recommendations to delay allergens.
"Our practice has been recommending this for a while but it's official today," said Sarah Kohl, a pediatrician at Pediatric Alliance in Chartiers/McMurray. "This is a completely opposite recommendation so parents can be confused, but they are incredibly understanding. What parents want are kids who don't have peanut allergies and if there's a way to reduce it, they're on board."
Allergists at Children's Hospital of Pittsburgh of UPMC have also already incorporated these recommendations into their practice. After the LEAP report, they developed an "infant peanut challenge" protocol in which they feed high-risk babies small amounts of the Bamba snack and watch for a reaction.
"We've really modified our practice based on that study," said Todd Green, director of the Food Allergy Center at Children's Hospital. "You had this study that was pretty powerful but it didn't really tell people what to do. There are still lots of questions."
