Over the years, the medical community has debated about whether and when to introduce peanuts to infants as a way to prevent allergies from developing.
Today, the National Institute of Allergy and Infectious Diseases (NIAID) updated guidelines that define a child’s risk factor and specify when to introduce the legumes based on the risk.
In the recommendations, NIAID said foods that contain peanuts can be introduced to infants as early as 4 months of age and as much as three times a week.
Dr. David Stukus, a co-author of the guidelines, said previous notions to avoid peanuts until later in life were suggested because there was a lack of evidence on the best age to introduce peanut-containing foods.
“However, now we have excellent evidence that shows early introduction, prior to 11 months of age, can prevent the development of peanut allergy, particularly among infants at highest risk,” Stukus, a spokesperson for the American College of Allergy, Asthma and Immunology, told Healthline.
“The early introduction of peanut to the diet of children at high risk to develop peanut allergy, defined as severe eczema or egg allergy, has dramatically reduced their peanut allergy risk by 81 percent,” added Dr. Anna Nowak-Wegrzyn, an associate professor of pediatrics at the Icahn School of Medicine at Mount Sinai. “This intervention is incredibly promising and should be recommended widely.”
Details on new guidelines
The new guidelines were based on research from the Learning Early About Peanut allergy (LEAP) study.
Some of the recommendations are:
Infants at high risk have severe eczema and/or egg allergies. Foods containing peanuts can be introduced to a child as early as 4 to 6 months of age if a doctor deems it safe, and the child has begun to eat solid foods.
Moderate-risk infants, who have mild to moderate eczema and have started solid foods, do not need an evaluation. Peanut-containing foods can be introduced at home around 6 months of age.
Children with no eczema or egg allergy can start consuming peanut-containing foods at 6 months.
“It should be emphasized that initial introduction of peanut has to be followed by a regular ingestion at home, at least three times per week for long periods of time. In the LEAP study, the regular peanut intake was maintained for five years,” Nowak-Wegrzyn said. “Considering the burden and severity of lifelong peanut allergy, this effort is well worth making.”
A 2015 study in the New England Journal of Medicine found that infants 4 to 11 months of age who were at high risk for peanut allergies were 80 percent less likely to develop the allergy when they ate the equivalent of four teaspoons of peanut butter each week.
The percentage was a comparison to children who avoided peanuts all together.
While whole peanuts should not be on the menu, other peanut-containing foods — such as peanut butter, cereals, and cookies — can help introduce the legume to children.
Infants should already be eating other foods such as rice cereal, oatmeal, and yogurt to demonstrate that they are developmentally ready to introduce age appropriate peanut-containing foods, Stukus said.
Some caution recommended
“If your child is determined to be high-risk, the new guidelines recommend evaluation by an allergy specialist, which may involve peanut allergy testing, followed by trying peanut for the first time in the specialist’s office,” Dr. Matthew Greenhawt, chairman of the American College of Allergy, Asthma, and Immunology Food Allergy Committee, said in a statement.
Greenhawt noted that even if a child has a positive result, it does not necessarily mean the child is allergic.
On the flip side, if the child has a serious reaction to the skin test, the allergist may advise the parent to avoid peanuts all together due to a preexisting allergy.
“Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods,” Greenhawt said.
A serious concern
Peanut allergy is the most common food allergy and the leading cause of death from food allergies in the United States.
Although the overall mortality is low, the fear of life-threatening anaphylactic reactions is a concern.
For the majority of people with peanut allergies, the condition begins early in life and persists as a lifelong problem, noted Dr. Alkis Togias, chief of the Allergy, Asthma and Airway Biology Branch in NIAID’s Division of Allergy, Immunology, and Transplantation.
The only way to manage the allergy is to avoid peanuts and peanut-containing foods.
Treating anaphylaxis is part of the routine for children when they have an allergic reaction.
Food allergies are estimated to affect 4 to 6 percent of children and 4 percent of adults, the Centers for Disease Control and Prevention (CDC) reports.
Dr. Ruchi Gupta, a physician at the Ann & Robert H. Lurie Children's Hospital of Chicago, estimated that peanut allergies affect about 2 percent of children, adding that occurrence is on the rise.