Nearly 2 percent of U.S. children suffer from a peanut allergy, and the number of cases may have tripled in the last decade. Peanut allergy can be severe, is not often outgrown and has no cure or treatment beyond careful peanut avoidance. That said, we now know it may be possible to prevent peanut allergy from developing based on when peanut-containing foods are first given to a child.
Recommendations on when to first give an infant peanut-containing foods to help prevent peanut allergy have changed. We used to tell parents to wait until the child was age 3 if the child had a family history of allergy (one or both parents or a sibling). Then we recommended parents not delay introducing any food past 4 to 6 months, but we didn’t say exactly when parents should first give peanut-containing foods. Now, based on new research, we have updated our recommendations regarding the right time to first introduce peanut-containing foods.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
New guidelines released Thursday by the National Institutes of Allergy and Infectious Diseases recommend peanut-containing foods be introduced as early as 4 to 6 months of life. The new recommendation is based on three recent studies examining the best time to introduce peanut-containing foods to prevent peanut allergy. The most convincing of these studies was the Learning Early About Peanut (LEAP) trial from England. In it, infants with moderate-to-severe eczema (a type of skin rash) and/or egg allergy were randomly introduced to peanut-containing foods between 4 to 11 months, or told to deliberately avoid peanut-containing foods until age 5. Those who ate peanut-containing foods in the first year of life had an 80 percent lower risk of developing peanut allergy. This study showed early peanut introduction is very safe (most reactions that occurred were mild) and there were no negative effects on growth. Children fed peanut-containing foods early breast-fed as long as those who had delayed introduction.
Based on the results of the new studies, all of which showed early peanut introduction resulted in lower rates of peanut allergy, NIAID assembled a panel of experts to update the national recommendations on when peanut-containing foods should be introduced. The panel decided early peanut introduction seems to be a strong factor in preventing peanut allergy from developing and has issued the following three recommendations:
1. Infants with severe eczema, egg allergy or both should have introduction of age-appropriate peanut-containing foods as early as 4 to 6 months to reduce the risk of peanut allergy.
2. Infants with mild to moderate eczema should have introduction of age-appropriate peanut-containing foods around 6 months, in accordance with family preferences and cultural practices, to reduce the risk of peanut allergy.
3. Infants without eczema or any food allergy may have age-appropriate peanut-containing foods freely introduced in the diet, together with other solid foods in accordance with family preferences and cultural practices.
The recommendations have a few highlights. First, early peanut introduction is recommended for all infants, with special emphasis on children with severe eczema and/or egg allergy, who are at the highest risk to develop peanut allergy. Second, peanut-containing foods should not be a baby’s first food. Babies should all have started at least one or two other solid foods, so they do not gag or reject the texture of solid food, which could be mistaken for signs of a possible allergy. Third, babies should never be given the whole peanut — this is a choking hazard. The new recommendations make multiple suggestions for an appropriate form of peanut-containing foods for babies to try.
[See: 10 Healthy Meals You Can Make in 10 Minutes.]
The new recommendations also discuss where and how peanut-containing foods should be introduced. For babies without eczema or only mild or moderate eczema, peanut-containing foods can be introduced at home. However, babies with severe eczema and/or egg allergy should see their doctor before peanut-containing foods are introduced. The doctor may refer these infants to an allergist for further care or elect to run a peanut allergy blood test. Babies with negative blood tests are unlikely to be peanut allergic, and peanut-containing foods can be introduced at home.
Babies with positive blood tests should be referred to an allergist for further care. If referred, the allergist may perform peanut allergy skin testing. If the test produces no reaction or only a small hive (wheal), these babies can have peanut-containing foods introduced at home. If the test produces a moderate-sized hive (between 3 to 7 mm), these babies should have peanut-containing foods introduced at the allergist’s office, due to a small (but still unlikely) chance of a reaction on the first feeding. If the hive is large — 8 mm or larger — these children are likely already peanut allergic and will probably react if given peanut. Though some allergists may allow these babies to try peanut-containing foods in their office, most will consider them peanut allergic and not introduce peanut-containing foods.
[See: Top Reasons Children End Up in the Hospital.]
The new guidelines are an amazing opportunity to potentially help reduce the number of new cases of peanut allergy. It involves a big change in the way we think about when an infant is ready for peanut-containing foods. Parents and health care providers should be reassured that this change has been very carefully planned and is backed by high-quality, convincing research. While these new recommendations can benefit many infants, the benefit can only be accomplished with the cooperation of parents and health care providers. Let’s get to work!
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How to Introduce Peanut-Containing Foods to Your Infant to Avoid Allergy originally appeared on usnews.com
