08 February 2017
For years, expert opinion held that the best way to prevent food allergy, especially peanut allergy, was avoidance of these foods until age 3.
However, a landmark study published in 2015 (the LEAP study) disputed this long-held belief and instead, demonstrated that children at risk for peanut allergy in fact had a much lower incidence of allergy (1.9% vs 13.7%) by age 5 if they were fed peanuts regularly by age 6 months, compared to children who avoided peanuts.
New peanut allergy data, new guidelines
In recognition of this data from the LEAP study, an expert panel recently released new guidelines directed at preventing the development of peanut allergies in children.
The panel separated infants with food allergies into three (3) groups:
- Infants with severe eczema, egg allergy or both should be tested for peanut sensitivity by either blood or skin testing. The new guidelines specify that infants who exhibit levels that suggest early peanut sensitivity and risk should be fed peanuts between ages 4-6 months. If the test results are low/negative, feeding peanuts can start at home (between ages 4-6 months). If the blood or skin tests show increased reactivity, then feeding peanuts should proceed under the guidance of a physician trained in treating allergic reactions (i.e. a trained allergist). Feeding instructions are included in the guidelines (i.e., whole peanuts can cause choking in infants and never should be used). There are instructions regarding thinning peanut butter with hot water, using peanut flower or Bamba, a peanut snack.
- Infants with mild to moderate eczema without egg allergy should start eating peanut products by six (6) months of age. The guidelines do not mandate physician supervised feeding. Instead, they suggest in-office supervised feeding, per parent and provider preference.
- Infants without either eczema or food allergy should have peanuts introduced with other solid foods, per family (and cultural) preferences.
The guidelines did express concern regarding peanut introduction to children who have a sibling with confirmed peanut allergy. They also cautioned that children in group 2 could have peanut allergy and thus should be managed by an allergist.
The goal of the new guidelines is to decrease peanut allergy in children
Given the increasing incidence of food (especially peanut) allergies over the past 20 years, it is hoped that these guidelines with help to decrease the frequency of peanut allergy in children and adults.
Worried that your child might have peanut allergy and whether you should give him/her peanuts? Come in and see me.
If you think your child might be allergic to peanuts and want guidance as to how to proceed, please come in and see me. An allergy, asthma and immunology specialist with Westchester Health Pediatrics, I have been in practice for over 30 years. The sooner I can examine and diagnose your child, the sooner we can start to manage or even prevent a peanut allergy.