New Guidelines for Early Peanut Introduction to Prevent a Peanut Allergy

On Thursday, January 5, 2017, the National Institute of Allergy and Infections Diseases released formal and detailed guidelines about the early introduction of peanuts to infants in order to proactively prevent the development of a peanut allergy.  This announcement is a complete reversal from past advice of peanut avoidance for high risk infants until 3 years old.  The American Academy of Pediatrics endorses these guidelines and encourages parents to begin feeding their infants peanuts early.

The new guidelines is a result of the Learning Early About Peanut Allergy (LEAP) study that was published in 2015 in the New England Journal of Medicine.  The study divided over 600 high-risk children between the ages of 4 and 11 months old into two groups, and followed them until age 5.  The participants had to have severe eczema, an egg allergy, or both, with a negative or positive peanut skin prick test less than 4 mm in diameter.  The first group avoided peanuts.  The second group consumed peanut-containing snacks at least three times a week.  Of the children who avoided peanut, 17% developed the allergy by age 5.  Of the children who consumed peanut, only 3% developed a peanut allergy.  The result was definitive and confirms that early introduction of peanut to an infant is highly effective in preventing a peanut allergy from developing.

The new released guidelines are categorized into three groups:

• High Risk:  infants with severe eczema, egg allergy, or both
• Guidance:  introduce peanut as early as 4-6 months
• How/Where:  allergy testing with an allergist is strongly advised, with peanut introduction under physician supervision (see chart below)

• Moderate Risk:  infants with mild to moderate eczema
• Guidance:  introduce peanut around 6 months
• How/Where:  peanut introduction can be at home, although testing and physician-supervised feeding may be conducted at the request of the parent

• Low Risk:  no eczema, no food allergies, and no family history of allergies
• Guidance:  introduce peanut at any time
• How/Where:  peanut introduction at home

The NIH guidelines also advise parents to feed their infant peanuts for the first time only when he/she is healthy, and to ensure observation of the infant for at least two hours after peanut consumption to watch for signs of a reaction.  Signs of an allergic reaction may include:  hives, vomiting, coughing, wheezing, swelling (face, lip, or tongue), change in skin color, or lethargy.  In addition, recipe options are provided for the safe feeding of peanuts to infants, such as mixing peanut butter with warm water to thin it out, mixing peanut powder into baby food, or using Bamba peanut puff snacks.  It is also recommended to feed peanut-containing food at least three times a week.

Parents who have an high-risk infant (having either eczema, an egg allergy, or both) should contact an allergist before introducing peanut at home.  A parent who is concerned or nervous about introducing peanut to their infant may also contact an allergist for supervised feeding in the office.  A skin prick test or blood test may be conducted to assess the risk of peanut introduction to the child (see chart below).  Based on the results, an in-office introduction may be performed at the office under the supervision of the doctor, or it may be advised that the infant is allergic and should not be fed peanut.