Q&A: What parents need to know about early introduction of peanuts for allergy prevention
The National Peanut Board
March 28, 2017
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This post is sponsored by the National Peanut Board.

The newest clinical data show that early introduction of peanut foods to children can decrease the risk of developing peanut allergy, and a panel sponsored by the National Institute of Allergy and Infectious Diseases recently issued new guidelines for early introduction of peanuts to infants. SmartBrief interviewed allergy and immunology expert Dr. Shahzad Mustafa and consultant and registered dietitian nutritionist for the National Peanut Board Sherry Coleman Collins about how parents and healthcare professionals can adhere to these new guidelines when introducing peanut foods to children.

Collins
Collins

Mustafa
Mustafa

A panel sponsored by the National Institute of Allergy and Infectious Diseases issued new clinical guidelines in January for early introduction of peanuts to infants to prevent the development of peanut allergy. How do these guidelines supplement the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States?

Mustafa: These guidelines present updated recommendations for the early introduction of peanuts to infants. The update is based on a recent landmark clinical trial and other emerging clinical data that has shown that early introduction of peanut foods can decrease the risk of developing peanut allergy. These guidelines now present parents with specific recommendations on when and how to best introduce peanut into the infant’s diet. Additional research will hopefully provide similar knowledge about other potentially allergenic foods.

Collins: In 2000, the American Academy of Pediatrics recommended waiting to introduce many potentially allergenic foods, including peanuts, but in 2008 they said there was no reason to wait as a means to prevent allergies. However, this message got muddled and many parents -- and healthcare providers -- weren’t sure what to do. As a result, many waited when they probably shouldn’t have. These new guidelines clearly state that, in accordance with their risk, peanut foods should be given to infants to help prevent peanut allergies.

How much less likely are children to develop a peanut allergy if they are introduced to peanuts as an infant?

Mustafa: In infants at high risk for peanut allergy (defined as severe eczema or egg allergy), early introduction of peanuts into the diet decreases the risk of peanut allergy by more than 80%. The risk reduction is less but likely still significant for the general population of children who are not defined as “high risk” for developing peanut allergy.

Collins: The benefits are clear that many, many children will be spared from developing a peanut allergy when recommendations for early introduction are followed. This is good news for those at high risk, but also for those who don’t have known risk factors, since those represent the greatest numbers of children who will develop peanut allergies.

The new guidelines recommend three plans for introducing peanuts to infants based on clinical features reflecting the risk of having or developing peanut allergy. How can healthcare providers and parents determine the category in which a child belongs?

Mustafa: The new guidelines can be summarized as follows:

  • Children at low risk for peanut allergy, as defined by no history of eczema or egg allergy, can be given peanuts at home whenever the parents wish, but ideally around 6 months of age. This applies to the majority of children in the US. Remember that children this young should never be given whole peanuts due to the risk of choking, so instead should be given thinned peanut butter, peanut powder mixed into other tolerated foods, or peanut-based snacks like Bamba.
  • Children at moderate risk for developing peanut allergy, as defined by those with mild to moderate eczema, can also be given peanuts at home, without the help of their pediatrician or allergist.
  • Children at high risk for peanut allergy, as defined by those with egg allergy or severe eczema, should begin eating peanut foods around 4-6 months of age. These infants should first have an evaluation by their healthcare provider, who may recommend IgE testing (skin prick testing or blood work). Based on the results of IgE testing, the pediatrician or allergist can decide the best way to introduce peanut into the diet of these high risk infants.

Collins: For those parents with questions or unsure of the risk status of their infants, we recommend discussing their situation with their pediatrician. It’s also important to remember that more than 99% of Americans are not allergic to peanuts, so chances are good that their baby will not develop an allergy to peanuts.

The guidelines recommend introducing peanuts to children between 4 and 6 months of age, depending on risk. What are some peanut-containing foods healthcare providers and parents can use to introduce peanuts into a child's diet?

Mustafa: When introducing peanut into the diet of an infant, parents must be cognizant of age-appropriate foods that do not pose a choking hazard. The following are options for the safe introduction of peanut into the infant’s diet:

  • Peanut butter thinned with warm water
  • Peanut butter or peanut powder mixed in with baby food such as cereal, apple sauce, yogurt, etc.
  • Peanut powder mixed in with pureed foods like fruits and vegetables
  • Infant-appropriate peanut-based snacks like Bamba or teething biscuits

Collins: For the early introduction, just two teaspoons of peanut butter or peanut powder (also called powdered peanut butter or peanut flour) is enough to begin introduction. High risk infants should have peanut foods three times per week in this amount, according to the guidelines. Otherwise, it can be given in accordance with the family’s normal eating habits. All good news for peanut loving families!

Dr.  Shahzad Mustafa is a member of the American Academy of Allergy, Asthma & Immunology adverse reactions to foods committee as well as the AAAAI mast cell disorders committees. He is heavily involved with the allergy/immunology training program at the University of Rochester, where he is clinical assistant professor of medicine.

Sherry Coleman Collins is a metro-Atlanta based registered dietitian nutritionist and consultant for the National Peanut Board. She leads the Board’s efforts to provide reliable, science-based information about peanuts and peanut allergies. You can follow her at @PeanutRD on Twitter and Instagram

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