New Guidelines Aim to Lower the Risk of Peanut Allergy

Peanut allergy is much more prevalent than you might think. Learn more about what these new guidelines mean for potential allergy prevention, courtesy of our friends at Children's Hospital Los Angeles.

In the U.S., food allergies affect 1 in 13 children. Among food allergies, peanut allergy is the leading cause of anaphylaxis. It is life threatening, and the economic and psychosocial burdens that come with it make life much more difficult for patients and their families. As the prevalence of peanut allergy appears to be rising and is rarely outgrown with age, scientists are trying to find out why the rates for peanut allergy are rising, and how to lower the risk of developing peanut allergy in infants and children.

The National Institute of Allergy and Infectious Diseases (NIAID) has facilitated new guidelines that detail the introduction of peanut-containing foods during infancy. These guidelines are based on the 2015 research findings from the landmark LEAP and EAT clinical trials, which revealed reduction of developing of peanut allergy by a startling 81 percent.

NIAID’s guidelines for introducing peanut-containing foods to infants depends on various levels of risk for developing peanut allergy. Talk to your pediatrician or allergist if your infant is at risk for developing peanut allergy to determine what steps to take, or if you are not sure which guideline best applies to your child.

For infants at high risk for developing peanut allergy with severe eczema, egg allergy or both.

Offer peanut-containing foods as early at 4 to 6 months of age to reduce the risk of developing peanut allergy. First check with your infant’s pediatrician or allergist to make sure that it is safe to offer peanut-containing foods, to make sure the infant is not already allergic and won’t have a severe allergic reaction. Your doctors may want to perform an allergy blood or skin test to determine safety of the peanut introduction. Your doctors will recommend an amount of peanut to be given weekly along with instructions for safely administering the peanut (it may be safe to introduce the peanut-containing food at home, or it may be recommended to introduce the peanut in a doctor’s office under supervision.) It is important to continue offering peanut in correct amounts to maintain a durable tolerance that continues to protect against peanut allergy. The LEAP trial provided peanut to the participants until 5 years of age.

For infants with mild to moderate eczema.

Peanut-containing foods can be introduced into the diet around 6 months of age to reduce the risk of developing peanut allergy. The introduction of peanuts can be done with a family’s dietary preferences and cultural affiliations in mind, and the timing can be more flexible than for infants at high risk. Talk to your child’s doctor to determine whether the first feeding should be at home or can be done in the provider’s office.

For infants with no eczema and no food allergy.

Peanut-containing foods can be freely introduced into the baby’s diet at home in an age-appropriate progression along with other solid foods. The previous American Academy of Pediatrics (AAP) recommendations apply from 2008 for complementary feeding, which do not restrict potential food allergens after 4 to 6 months of age as long as the infant is developmentally ready to start solid foods.

What parents and caregivers need to know.

• Due to the shape and size of a whole peanut, it is a choking hazard and should never be given to infants and small children.
• Because whole peanuts are a choking hazard, and peanut butter is sticky, the NIAID guidelines contain detailed information for offering peanut in a form that is safe for infants. If you choose to offer peanut to your baby, talk to your pediatrician, allergist or dietitian for more information on how to do so safely.
• For all infants, introduce other solid foods before introducing peanut-containing foods to ensure that the infant is developmentally ready—this means that the infant can sit up by him or herself, has good head control, and is interested and eager to try food.
• For all infants with food allergies, following up with your allergist and dietitian is important to monitor growth and ensure that babies are receiving all the nutrients they need while on a restricted diet.

Jonathan Tam, MD, medical director of the Gores Family Allergy Center at CHLA says, “The new guidelines highlight two important messages to parents. First, all parents should not hesitate to introduce foods to children as soon as they are ready to eat; second, the introduction of peanut should be done early and purposefully especially in children at high risk for developing food allergy. The highest risk children may need the help of their doctor or even a specialist, but should be encouraged with the right precautions.”

~Jill Madison, MS, RD, CLC, Clinical Dietitian II

Jill completed her dietetic internship with UCEDD and is currently an outpatient RD in CHLA's AltaMed Clinic and the Food Allergy Center.