When and how to introduce peanut-containing foods to reduce allergy risk

November 11, 2016, American College of Allergy, Asthma, and Immunology

Parents may be confused with how and when to introduce peanut-containing foods to their infants. Presentations at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting will offer guidance, based on soon to be released guidelines, on how to approach this topic without going "nuts."

"The first step is determining if your child is at high-risk for peanut allergy," says Amal Assa'ad, MD, chair of the ACAAI Food Allergy Committee and a co-author of the guidelines. "Before introducing peanut-containing foods to a high-risk infant, the infant should be seen by their primary health care provider who will determine if referral to an allergist for testing and/or in-office introduction is needed."

According to the guidelines, an infant at high risk of developing peanut allergy is one with severe eczema and/or . The guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants, after determining that it is safe to do so.

"If your child is determined to be at risk, and then is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we don't yet know if they're truly allergic," says allergist Matthew Greenhawt, MD, MBA, MSc, ACAAI Fellow, incoming ACAAI Food Allergy Committee chair, and a co-author of the guidelines. "Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods."

A positive test alone is a poor indicator of allergy, and studies have shown infants who are peanut-sensitized aren't necessarily allergic. "Infants sensitized to peanuts showed the most benefit from early introduction of peanut-containing foods in the Learning Early About Peanut allergy (LEAP) study," says Dr. Greenhawt. "Some allergists caring for a child who has a large positive skin test may decide not to do an in-office challenge. Instead, they might advise that the child avoid peanuts completely due to the strong chance of a pre-existing peanut allergy. Other allergists may proceed with a peanut challenge after explaining the risks to the parents."

Children with mild to moderate eczema who have already started solid foods do not need an evaluation, and can have peanut-containing foods introduced at home by their parents at around 6 months of age. Children with no eczema or egg allergy can be introduced to peanut-containing foods at home as well, according to the family's preference.

Credit: American College of Allergy, Asthma and Immunology

The new guidelines offer several methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. It is extremely important that parents understand the choking hazard posed by whole peanuts and to not give whole peanuts to infants. Peanut-containing foods should not be the first solid food your infant tries, and an introduction should be made only when your child is healthy. Do not do the first feeding if he or she has a cold, vomiting, diarrhea or other illness.

"The soon to be released updated guidelines on preventing peanut allergy are sponsored by the National Institute of Allergy and Infectious Diseases," says Dr. Greenhawt. "The guidelines are an important step toward changing how people view prevention, particularly for peanut allergy. They also offer a way for parents to introduce peanut-containing foods to reduce the risk of developing peanut allergy."

The guideline authors, an expert panel of allergy researchers, physicians, nurses and lay organization representatives from many fields, reviewed existing evidence and made comprehensive recommendations.

The authors recognized early introduction of peanut-containing foods may seem to depart from recommendations for exclusive breastfeeding through six months. One recent study showed introduction of peanuts did not affect the length or frequency of breastfeeding, and did not negatively influence growth or nutrition.

"This is a very exciting development for those of us who have been treating an increasing number of kids with in the past 25 years," says Dr. Assa'ad. "To be able to offer parents a way of reducing the risk of their children developing peanut allergies is remarkable and of real importance."

ACAAI has created the video "Peanuts and your baby: How to introduce the two" as an introduction to the topic.

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