For children with severe eczema or egg allergy, don’t avoid peanuts — introduce them early under medical guidance, but never feed whole peanuts.

12. For children with severe eczema or egg allergy, don’t avoid peanuts — introduce them early under medical guidance, but never feed whole peanuts.

Cost: A jar of peanut butter costs just a few dozen yuan. Feeding it a few times a week is easy to fit into a routine. Before starting, though, a doctor’s evaluation is required.

In plain terms: In a randomized trial of 640 high‑risk infants, those who ate peanuts regularly from 4 to 11 months of age had a peanut allergy rate of only 1.9% by age 5, compared with 13.7% in the group that completely avoided peanuts. Among children already showing a weak positive skin test at enrollment, the rates were 10.6% versus 35.3%. Avoiding peanuts actually raises the risk of allergy. However, whole peanuts must never be given, as they can block the airway. A total of 530 infants had negative skin tests at entry, while 98 had weakly positive results.

Benefit: The LEAP trial involved 640 infants aged 4–11 months with severe eczema, egg allergy, or both. One group ate peanut products regularly while the other avoided them entirely; at 60 months, only 1.9% of the eaters had a peanut allergy versus 13.7% of avoiders (P<0.001). Among 98 children with a weak positive skin test at entry, 10.6% of eaters were allergic versus 35.3% of avoiders (P=0.004). No serious adverse events differed between groups.

Evidence grade: A

Sources: 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>; National Health Commission of China (NHC) General Office (2020). Core information on infant and young child feeding health education. <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> (The general infant trial EAT in the remarks)

Notes: Peanuts must be given only as thinned peanut butter or powdered form mixed into food — never as whole nuts. The Health Commission clearly states: “Whole peanuts, nuts, jelly, and similar foods can be inhaled into the airway and cause choking; infants should avoid them.” For choking first aid, see Section 13, Item 26. This guidance applies only to high‑risk children with severe eczema or egg allergy. A medical assessment is mandatory before introduction; in the LEAP trial, children with a skin‑test reaction greater than 4 mm were excluded. Another study of 1,162 breastfed infants found no significant difference in overall food allergy rates between early‑introduction and standard groups, though a subset showed a clear benefit: 5.6% versus 7.1% (P=0.32) and 2.4% versus 7.3% respectively. Evidence for typical infants is far weaker. Early introduction appears safe, but Chinese official guidelines currently give no recommendation on this point; therefore this advice follows international trial evidence. Keep in mind that LEAP started at 4 months while Chinese practice recommends waiting until 6 months for solids — consult a doctor on timing and method for high‑risk children.