For millions of children who have peanut allergies, mealtimes can be deadly. And for years, doctors have advised parents to keep peanut products away from children thought to be at high risk.
But new guidelines issued Thursday state that infants should be introduced to peanut products as early as 4 months old if they appear to be at high risk of developing food allergies.
A panel of experts convened by the National Institute of Allergy and Infectious Diseases says that introducing peanuts early in life can actually help prevent the development of peanut allergies.
The new recommendations encourage parents to prevent food allergies by following a schedule of early introduction of certain allergenic foods, explained Dr. Hugh Sampson, director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Hospital in New York and a member of the NAIAD panel. The NAIAD’s 2010 guidelines had stated only that that there was no sufficient data to support the withholding of allergenic foods in order to prevent allergies.
“The big difference with these guidelines is that they’re not saying there is no reason not to give it. It’s now saying give it,” said Sampson. “So this is a proactive statement, as opposed to a more passive [approach].”
Severe peanut allergies can cause anaphylaxis, in which the throat swells, constricting breathing. People with less severe peanut allergies can experience wheezing, shortness of breath, digestive problems, skin rashes or hives in the mouth and throat.
How to introduce peanut products to babies
If a baby has severe eczema, an egg allergy or both, these conditions increase the risk of a peanut allergy. For these high-risk infants, peanut product introduction should take place from 4 to 6 months of age — not with whole peanuts, which can be a choking hazard, but perhaps with diluted peanut butter.
Babies with mild to moderate eczema but no egg allergy should start being introduced to peanut products at 6 months if this fits in with the family’s normal diet. In other words, parents shouldn’t feel compelled to introduce peanuts at this age.
The guidelines state that for both of these high-risk scenarios, parents should see if babies are developmentally ready to eat solid foods by introducing something else first. Then, when babies show confidence in eating solid foods, parents should check with the pediatrician first before introducing a peanut food. A pediatrician may suggest testing for peanut allergies before the first introduction or may have specific instructions for the introduction. A baby’s first taste of peanut can even take place at the doctor’s office.
If the baby shows no sign of eczema or egg allergy and thus appears to be at no heightened risk of developing a peanut allergy, peanut products should be incorporated into their diet in keeping with the family’s normal dietary preferences, in an age-appropriate way.
Compelling data prompted the change
The recommendations are based on an NIAID-funded, five-year clinical trial called Learning Early About Peanut Allergy, or LEAP. The trial randomly divided more than 600 infants into two groups: a control group that avoided eating peanut products until they were 5 years old and an experimental group that was introduced to peanut foods early in life on a regular basis. Scientists found that eating peanuts early in life was safe and reduced the risk of developing a peanut allergy by 81 percent compared with the control group.
“The data was so compelling on the preventive effect of early introduction that it was felt that the guidelines needed to be revised,” said Sampson of the LEAP study results.
Childhood peanut allergies in the U.S. have increased dramatically over the last decade: In 1997, 0.4 percent of children reported an allergy to peanuts, and by 2008 that number was 1.4 percent, or more than 3 million people.
To reduce the number of people with peanut allergies, Dr. Sujan Patel, an allergist immunologist at New York University Langone Medical Center, has been advising parents to introduce allergenic foods early to their children for several years now. He says he is glad that the guidelines have caught up with the practice, common among immunologists.
Allergies to peanuts and other foods could have risen because parents were introducing certain foods to their children later, because of official guidance or perhaps out of fear of triggering a life-threatening allergic reaction, Patel explained. But the results of the LEAP study, published in 2015, show that this approach may actually be setting the stage for severe food allergies in the future.
“We’re trying to combat the development of peanut allergy with early introduction, based on these studies,” said Patel, who was not involved in the creation of the new guidelines. “With the overall increase of prevalence of food allergies, I feel that a lot of parents are now nervous to introduce highly allergenic foods at a young age because they feel like the child might be in danger.”
Other factors that may have contributed to the rise in food allergies include outdated advice from family doctors and pediatricians, or perhaps a reluctance to introduce any solid food at all before 6 months, in favor of exclusive breastfeeding.
Patel and Sampson hope that the new recommendations will stem the increase of peanut allergies in children.
“We’re looking to reduce the prevalence of peanut allergy among the population,” said Patel.
For instructions on how to introduce peanut products to your child, check out this video produced by the American College of Allergy, Asthma and Immunology.