New guidelines show how to introduce peanut-containing foods to reduce allergy risk

January 5, 2017

The wait is over for parents who've been wanting to know how and when to introduce peanut-containing foods to their infants to prevent peanut allergy. New, updated guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), published today, define high, moderate and low-risk infants for developing peanut allergy, and how to proceed with introduction based on risk.

"This update to the peanut offers a lot of promise," says allergist Stephen Tilles, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI). "Peanut allergy has literally become an epidemic in recent years, and now we have a clear roadmap to prevent many new cases moving forward. The Learning Early About Peanut allergy (LEAP) study, the study that paved the way for the updated guidelines, has had a dramatic impact on day-to-day patient care. In fact, during my career as an allergist I cannot think of a single publication with more of an impact."

According to the new 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 who have already started solid foods, after determining that it is safe to do so.

"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," says allergist Matthew Greenhawt, MD, MBA, MSc, ACAAI Food Allergy Committee chair, and a co-author of the guidelines. "If a child is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we still don't know if they're truly allergic. 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 have a peanut sensitivity aren't necessarily allergic. "In fact in the LEAP study, infants sensitized to peanuts showed the most benefit from early introduction of peanut-containing foods," says Dr. Greenhawt. The updated guidelines recommend that Infants with a positive peanut skin test have peanut fed to them the first time in the specialist's office. Some infants may have a large reaction to the skin test (8 mm or larger) which could indicate they are already peanut allergic. "An allergist may decide not to have the child try peanut at all if they have a very large reaction to the skin test. Instead, they might advise that the child avoid peanuts completely due to the strong chance of a pre-existing peanut allergy. Other allergists may still proceed with a peanut challenge after explaining the risks and benefits to the parents."

Moderate risk children - those with mild to moderate eczema who have already started solid foods - do not need an evaluation. These infants can have peanut-containing foods introduced at home by their parents starting around six months of age. Parents can always consult with their primary health care provider if they have questions on how to proceed. Low risk children with no eczema or egg allergy can be introduced to peanut-containing foods according to the family's preference, also around 6 months.

The new guidelines offer several peanut-containing suggestions as well as methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. It is extremely important 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 guidelines are an important step toward changing how people view food allergy prevention, particularly for peanut allergy," says Dr. Tilles. "They offer a way for parents to introduce peanut-containing foods to reduce the risk of developing ."

The guidelines are simultaneously being published in Annals of Allergy, Asthma and Immunology, the ACAAI's scientific publication, and several other scientific journals.

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

More information: DOI: 10.1016/j.anai.2016.10.004

Related Stories

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

November 11, 2016
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, ...

Expert panel issues clinical guidelines to prevent peanut allergy

January 5, 2017
An expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, issued clinical guidelines today to aid health care providers in early introduction ...

Study explores factors linked to successful peanut OFC

December 5, 2016
(HealthDay)—Early peanut introduction is associated with increased probability of a successful oral food challenge (OFC), with higher odds for introduction between 6 to 11 versus 4 to 6 months, according to a study published ...

Anaphylaxis risk up for siblings of peanut allergic children

June 14, 2016
(HealthDay)—The risk of anaphylaxis is increased upon peanut introduction in siblings of children with peanut allergy, according to a study published online June 13 in Allergy.

Doctors recommend early exposure to prevent peanut allergies

August 25, 2015
A pediatricians' group is recommending that infants at high risk of peanut allergies be given foods containing peanuts before they turn 1.

Gene-environment connection seen in peanut allergy study

December 15, 2014
(HealthDay)—Infants of a particular generation born in Australia to Asian-born parents appeared to have an increased risk of peanut allergy compared with those of Australian-born parents, according to research published ...

Recommended for you

Genetic immune deficiency could hold key to severe childhood infections

July 18, 2017
A gene mutation making young children extremely vulnerable to common viruses may represent a new type of immunodeficiency, according to a University of Queensland researcher.

What are the best ways to diagnose and manage asthma?

July 18, 2017
What are the best ways to diagnose and manage asthma in adults? This can be tricky because asthma can stem from several causes and treatment often depends on what is triggering the asthma.

Large multi-ethnic study identifies many new genetic markers for lupus

July 17, 2017
Scientists from an international consortium have identified a large number of new genetic markers that predispose individuals to lupus.

Study finds molecular explanation for struggles of obese asthmatics

July 17, 2017
A large, bouquet-shaped molecule called surfactant protein A, or SP-A, may explain why obese asthma patients have harder-to-treat symptoms than their lean and overweight counterparts, according to a new study led by scientists ...

Team identifies potential cause for lupus

July 14, 2017
Leading rheumatologist and Feinstein Institute for Medical Research Professor Betty Diamond, MD, may have identified a protein as a cause for the adverse reaction of the immune system in patients suffering from lupus. A better ...

Immunosuppression underlies resistance to anti-angiogenic therapy

July 14, 2017
A Massachusetts General Hospital (MGH) research team has identified a novel mechanism behind resistance to angiogenesis inhibitors - drugs that fight cancer by suppressing the formation of new blood vessels. In their report ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.