Introducing peanuts early to help prevent peanut allergy

In January 2017, food allergy experts issued updated guidelines recommending most infants be fed peanut proteins starting at around 6 months of age.  Emerging research suggests peanut exposure starting at an early age may help reduce the risk of developing a peanut allergy.

The new guidelines divide infants into three groups, depending on whether they already have risk factors such as eczema (atopic dermatitis) or a known food allergy to egg.

Low-risk group:  Infants with no known eczema or food allergies.  When your infant is around 6 months old, you may introduce peanut proteins (for example, 2 teaspoons of thinned creamy peanut butter, or 21 pieces of Bamba peanut puffs) at home and without allergy testing.  Thinning peanut butter with warm water, soup or fruit puree can help reduce the risk of choking.  Avoid whole peanuts or peanut pieces.  If your child tolerates peanut, then continue serving foods that contain peanut protein as part of your family’s usual routine.

Intermediate-risk group:  Infants with mild to moderate eczema, and no known egg allergy.  Your infant may also try peanut at home (avoid choking hazards), and without allergy testing.  However, depending on your preference, or that of your child’s physician, your infant can be tested for peanut allergy before trying peanut.  When your child does try peanut for the first time, you may opt for a supervised setting, such as an allergist’s office.

High-risk group:  Infants with severe eczema and/or a known egg allergy.  See your child’s physician or an allergy specialist before introducing peanut.  Infants in this group should receive an allergy test (a blood test or a skin test) to determine if it’s safe to try foods that contain peanut.

Wait, isn’t this totally different than before?

Yes!  Starting in 2000, food allergy experts had recommended no peanut for high-risk infants until age 3.  In reality, those recommendations were not based on solid research, and the rate of peanut allergy continued to rise.  In 2008 the same experts said it was no longer necessary to delay introducing peanut, though they stopped short of recommending early peanut introduction until now.

The 2017 guideline update has a lot to do with the Learning Early About Peanut, or LEAP, study published in 2015.  Researchers found that high-risk infants who were fed peanut protein at an early age (and kept eating it on a regular basis) had a significantly lower rate of peanut allergy by their fifth birthday.  The study excluded infants who had already developed peanut allergy, and could not eat peanut.

What’s next?

The newest peanut guidelines show it’s important to question assumptions and to stay tuned! New research is constantly adding to our understanding of food allergies.  For example, research is still under way to see if early introduction to other allergenic foods (dairy, egg, wheat, soy, tree nuts, seafood) helps reduce the risk of an allergy to those foods.

Current peanut allergy management

Peanut and other food allergies have been on the rise over the past few decades.  Experts are unsure why, although there are probably several factors.  Peanut allergies are especially common in infants and toddlers who first develop eczema and egg allergy.  Peanut allergy is usually lifelong: Only about 20 percent of children will outgrow a peanut allergy.

Current peanut allergy management includes receiving an accurate diagnosis, avoiding peanuts at all times and being prepared in the event of a potentially life-threatening reaction.  All patients with peanut, tree nut, seed and seafood allergies should keep an “epinephrine auto-injector” on hand at all times.  These include Auvi-Q, EpiPen, Adrenaclick or generic products.   Currently there are no FDA-approved treatments for food allergies.  Research is under way to find ways to treat or desensitize patients with food allergies.

The 2017 peanut recommendations are summarized here for parents and caregivers.

The complete original article is also available to read online.  A reference is listed below¹.

If your infant has eczema, an egg allergy, or both, consider seeing an allergist before trying peanut protein at home.  An evaluation may include a skin or blood test, and potentially trying peanut protein for the first time in the office.

¹ Togias et al.  Addendum guidelines for the prevention of peanut allergy in the US:  Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel.  J Allergy Clin Immunol.  January 2017;139;1:24-44