**Not a medical professional. As always, please discuss specific recommendations for your child with your doctor. The below is to inform you of pediatric guideline changes and their purpose.**
Earlier this month, experts from the National Institute of Allergy and Infectious Disease (NIAID) issued new recommendations to help families prevent peanut allergies.
While there are a lot of intricacies involved in the research and its findings, the results are clear: early introduction of peanuts can help prevent the development of a peanut allergy. And, that’s big news!
Peanut allergies (and food allergies in general) are a growing problem. The rate of food allergy has doubled in the last 10 years alone. And, only 1 of every 4 children allergic to peanuts will outgrow their allergy.
Prior to 2000, doctors didn’t give new parents much advice about feeding their infants allergenic foods (such as milk, eggs, peanuts, fish, etc). Beginning around 2000, the general consensus was that delayed introduction might help developing immune systems handle these proteins more efficiently. In 2008, doctors didn’t really give parents a strong direction either way. However, that same year, researchers compared the rate of peanut allergy among Jewish kids in the UK (where they delay introduction), to those in Israel (where they feed a peanut-based snack as some of their babies’ first foods) and were stunned to see the difference. Children in Israel had a far smaller rate of peanut allergy than their counterparts in the United Kingdom. It became clear doctors and researchers needed to revisit their guidance.
Thus, began the 5 year LEAP study (Learning Early about Peanut Allergy), one of the most successful allergy trials that has been conducted to date. It took children with severe eczema or egg allergy and broke them into two groups: one group was fed peanuts early and one avoided them. Published in the New England Journal of Medicine, the study revealed that early introduction of peanut reduced the incidence of developing a peanut allergy by up to 80% and had lasting effects.
Based on their findings, the NIAID broke down their recommendations into three categories:
If the baby has an egg allergy (which is inexplicably related to peanut allergy) or has severe eczema (a persistent, scaly rash associated with allergy), speak with your doctor or a specialist about testing for peanut allergy. And, speak with her/him about best ways to proceed with introduction.
In their own words, the NIAID states:
“Guideline 1 recommends that if your infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), he or she should have peanut-containing foods introduced into the diet as early as 4 to 6 months of age. This will reduce the risk of developing peanut allergy.
Check with your infant’s healthcare provider before feeding your infant peanut-containing foods. He or she may choose to perform an allergy blood test or send your infant to a specialist for other tests, such as a skin prick test. The results of these tests will help to determine if peanut should be introduced into your infant’s diet and, if so, the safest way to introduce it. If your infant’s test results indicate that it is safe to introduce peanut-containing foods, the healthcare provider may recommend that you introduce peanut-containing foods to your infant at home. Or, if you prefer, the first feeding may be done in the healthcare provider’s office under supervision. On the other hand, testing may indicate that peanut should be carefully introduced at a specialist’s facility or not introduced at all because your child may already have developed an allergy to peanut.
Follow your healthcare provider’s instructions for introducing peanut-containing foods to your infant.”
If your child has mild to moderate eczema, peanut-containing products can be introduced beginning at 6 months of age. Check with your doctor or specialist to confirm that his/her case of eczema is considered mild to moderate and discuss introduction.
“Guideline 2 suggests that if your infant has mild to moderate eczema, he or she may have peanut-containing foods introduced into the diet around 6 months of age to reduce the risk of developing peanut allergy. However, this should be done with your family’s dietary preferences in mind. If peanut-containing foods are not a regular part of your family’s diet (and your infant does not have severe eczema, egg allergy, or both), do not feel compelled to introduce peanut at such an early stage.
Your child’s healthcare provider can tell you whether your child’s eczema is mild to moderate. You may then choose to introduce peanut-containing foods at home. However, if you or your healthcare provider prefer, the first feeding can be done in the provider’s office under supervision.”
If your child does not have an egg allergy OR eczema, you may freely introduce peanuts with other solid foods.
The flow chart and summary from Science News, spells it out clearly if you need a visual.
How DO you introduce peanuts to an infant? Do I need to look out for anything special?
- First feeds should be offered after you have tried other first foods (such as rice cereal) so that the baby learns to suck and swallow these news textures and to ensure that your baby tolerates these typical foods.
- DO NOT feed babies whole peanuts as they pose a choking hazard. Babies lack both the teeth and the development to properly manage peanuts.
- Once introduced, watch for 10 minutes and up to 2 hours for signs of a reaction. In a baby, you might see: hives, cough or gasping, vomiting, you might notice they are more cuddly and needy. If you suspect a reaction, seek immediate medical attention.
- Once tolerated, aim for regular ingestion. The recommended frequency is 2g of peanut protein three times a week.
What does 2g of peanut protein look like?
In Israel, parents feed their children a snack called Bamba – a dissolvable, airy snack that contains peanut protein. Shaped like a Cheese Doodle, 2/3 bag of Bamba equals 2g of peanut protein. To begin, you can crush the Bamba and mix it with water to feed.
If you’d like to use peanut butter, 2g of peanut protein is equal to 2 tsp or 1 household spoon (as in, from your utensil drawer). Mix SMOOTH peanut butter with hot water and COOL. You can then mix it with fruit or vegetable puree before serving.
Two grams of peanut flour or protein is equal to 2 tsp. Again, these can be mixed with fruit or vegetable purees.
(Peanut containing cereals were not specifically recommended because of the varying levels of peanut protein as well as sugar and sodium content by brand.)
A few notes:
For those of you, like me, whose children are already allergic. This is not instruction to begin feeding them peanuts. DO NOT!
And for those of you, like me, who read these guidelines and felt guilty about eating peanuts during pregnancy and breastfeeding… or NOT eating peanuts during pregnancy and breastfeeding… or delaying introduction (as we were instructed at that time):
You did not cause your child’s food allergy. There IS no single cause of food allergies. As Dr. Matthew Greenhawt of Children’s Hospital Colorado kindly offered, “This was nobody’s fault. You followed the best data at the time. Your avoidance didn’t cause [your child’s] peanut allergy.” I’ll be honest, I welled with tears hearing this from an allergist.
This exciting news represents a paradigm shift in the prevention of food allergies. Here’s hoping that future generations won’t be plagued by the same number and severity of cases!
Download NIAID’s full recommendation report here: Addendum Guidelines for the Prevention of Peanut Allergy in the United States.