Several medical journals published the new guidelines for the early introduction of peanut-containing foods to children as a strategy to prevent peanut allergy in January 2017. The guidelines were sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) and involved 25 organizations and agencies. They divide young children into three allergy risk categories.
Infants with severe eczema, egg allergy or both
For this group, the new advice is that doctors “strongly consider” evaluating the patient through an IgE antibody blood test or a skin-prick test. The results would determine whether peanut introduction should be done at home, while supervised in the doctor’s office, or with an oral food challenge in a specialized facility.
The guidelines recommend the testing and subsequent introduction in this high-risk group of infants be done between four and six months, as there is less of a likelihood of a positive test at this age. Speak to your child’s doctor at the four-month visit to discuss the best course of action.
Since peanut butter can be a choking hazard for a baby, it should be diluted, or use peanut puffs or mix peanut flour into a fruit puree. (There are also now branded early introduction products on the market.)
Despite the early age for introduction, infants should be eating solid foods. “Babies have to learn to eat solids,” says New York allergist Dr. Scott Sicherer, a member of the expert panel that reviewed evidence. “Some babies just aren’t ready to eat yet, so they might push food out or choke,” he notes. He says to start with a less risky food and gain success before moving on to the peanut-containing food.
Infants with mild to moderate eczema
This group would be at a slightly higher risk of developing peanut allergy as compared to the general population. The recommendations are that parents introduce peanut at about six months, if the child is already eating solids and is developmentally ready. While the LEAP study didn’t specifically research this category of kids, the expert panel concluded that early introduction of peanut could provide protection against developing this allergy.
These children should be able to have the first introduction at home, without testing first. In certain situations, the doctor might recommend testing or an in-office supervised feeding. Sicherer advises parents to speak to their doctor about the best course of action.
Infants with no eczema or food allergy
“This is an important group. This is trying to undo the misconception that you need to wait to introduce peanuts,” says Sicherer. The guidelines recommend introduction should be done at an age-appropriate time in accordance with family preferences.
In this last group, “peanuts shouldn’t be treated differently than any other foods,” says Sicherer.