Jennifer Kim, MD, Pediatric Allergist
NorthShore University Health system
Why are the new peanut exposure guidelines issued?
In 2015, findings from a landmark study – called the LEAP trial (Learning Early About Peanut Allergy) – showed that early introduction of peanut-containing foods to infants at high risk of developing peanut allergy was safe. In fact, early introduction led to an 81% relative reduction in development of peanut allergy. This was the first randomized trial to study early peanut introduction as a preventive strategy. Because of the significant effect shown, the NIH convened an expert panel to develop clinical guidelines.
My family doesn’t have a history of peanut allergies. Is it still important to follow these guidelines?
Peanut allergy is a growing problem, affecting about 2 percent of U.S. children who must avoid the wide array of peanut-containing foods or risk severe, even life-threatening, reactions. Prior studies have shown that 14% of all children with peanut allergy at age 12-18 months lacked known risk factors for peanut allergy. We believe early introduction may be protective even in children without risk factors. In fact, in Israel where peanut products are common introduced early in life, peanut allergy prevalence is low.
What age should a parent introduce peanuts?
If your baby has severe eczema, a kind of skin rash, or is allergic to eggs, introduction of peanut-containing foods as early as 4-6 months has been shown to reduce the risk of peanut allergy. These babies are at high risk for developing peanut allergy and were the kind of babies enrolled into the LEAP study. (In the LEAP study, all children were allergy tested prior to peanut introduction).
Talk to your doctor about seeing an allergist – but don’t put it off. Babies may get a test first to be sure peanuts are safe and that they’re not already allergic. Some may get a first taste in the doctor’s office while some parents may be told it’s OK to introduce the foods at home.
For other babies – those at low risk of allergy or those at moderate risk because of mild eczema – parents can introduce peanut-based foods at home around 6 months. Other solids should be introduced first – peanut should not be a first food.
Introduce peanut to your infant only when s/he is healthy. Don’t introduce them when your child is sick with a cold, vomiting, diarrhea, or other illness.
What should parents watch for?
Whole nuts are a choking hazard for under 5 years of age.
Offer a small portion – watered down peanut butter or Bamba (corn puff with peanut).
Mild symptoms can include a rash, swelling, or hives around the mouth or face. Reactions that need immediate medical care can include widespread hives, swelling of the lips, face or tongue, wheezing or difficulty breathing, repetitive coughing, or becoming tired or limp.
Gradually increase the amount to an age-appropriate serving size – speak to your doctor if you’re not sure.
If no severe signs, feed the age-appropriate peanut-containing food regularly – 3 times a week.
If my baby has a severe reaction, does that mean this strategy won’t work?
If s/he has a reaction, it means they have a peanut allergy; once they have the allergy the prevention strategy doesn’t apply.