November 11, 2016 / 5:10 PM / in a year

New guidelines: Introduce peanuts to infants early to prevent allergies

(Reuters Health) – Parents may be able to reduce the chance that their children will develop peanut allergies by introducing the food early on, as young as four to six months of age, experts now say.

The timing and method should depend on the infant’s risk of a peanut allergy, according to doctors who presented a preview of updated guidelines today in San Francisco at the annual meeting of the American College of Allergy, Asthma and Immunology.

“Guidance regarding when to introduce peanut into the diet of an infant is changing, based on new research that shows that early introduction around 4-6 months of life, after a few other foods have been introduced into the infant’s diet, is associated with a significantly reduced risk of such infants developing peanut allergy,” said Dr. Matthew Greenhawt, a pediatrician and co-director of the Food Challenge and Research Unit at Children’s Hospital Colorado in Aurora, Colorado, who coauthored the update.

“This is an amazing opportunity to help potentially reduce the number of cases of peanut allergy, but this can only be done with the cooperation of parents and healthcare providers,” Greenhawt told Reuters Health.

The basis for recommendations is the Learning Early about Peanut Allergy (LEAP) study. In that trial, infants at high risk for peanut allergies who were exposed to peanuts early were less likely to develop an allergy by the time they reached five years of age. The findings were published last year in The New England Journal of Medicine and reported by Reuters (reut.rs/2fqGZ6V).

The updated guidelines offer three approaches to peanut introduction depending on the infants’ risk of allergy, according to Greenhawt.

1. Infants with severe eczema, egg allergy or both are at high risk for peanut allergy. They should be exposed to peanuts as early as four to six months to reduce the risk of allergy. Beforehand, however, these infants should undergo a skin prick test. If the test yields no welt or a small welt of up to 2mm, parents can introduce peanuts at home. But if the test yields a welt of 3mm or larger, peanuts should be introduced in the doctor’s office - or not at all if the welt is large and an allergist recommends avoidance.

2. Infants with mild to moderate eczema who have already started solid foods should be exposed to peanuts at six months of age.

3. Infants without eczema or any food allergy are at low risk, and parents can introduce peanuts in an age-appropriate form at any time starting at age six months.

Of course, infants might choke on whole peanuts. So what are age-appropriate forms of peanut? Another coauthor of the new guidelines, Dr. Amal Assa’ad, a pediatrician and director of the FARE Food Allergy Center of Excellence at the Cincinnati Children’s Hospital Medical Center in Ohio, told Reuters Health, “Several appropriate forms of peanut-containing foods are creamy peanut butter that can be made softer or more liquefied by adding warm water and let it cool, or serving corn puffs containing peanut. For older infants, peanut butter can be added to apple sauce or other fruit purees.”

The updated guidelines will be published in January on the National Institute of Allergy and Infectious Diseases website; in the meantime, the site provides the current 2010 guidelines on peanut and other food allergies (bit.ly/2eKdsUd).

“As allergists, we’re very excited to see research being done to understand how children develop peanut allergy and how to treat it and how to prevent it,” said Dr. Stanley Fineman, an allergist at Atlanta Allergy and Asthma in Marietta, Georgia, who was not involved in updating the guidelines.

“The problem was that we didn’t have any good guidance about who to give it to early and who not to give it to early,” but these new guidelines will be helpful, Fineman said.

SOURCE: bit.ly/2ePxVKh American College of Allergy, Asthma and Immunology, online November 11, 2016.

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