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New guidelines from the National Institutes of Allergy and Infectious Diseases provide insight


By Matthew Greenhawt, M.D.

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.
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.

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