New guidelines: Introduce peanuts to babies by 6 months

Peanuts have been in the news a lot these days. The incidence of peanut allergies has doubled in the last 10 years; they are now considered to affect about 1 to 2 percent of young children. Although peanuts are not the most common food allergy, they can trigger the most deadly of reactions – anaphylaxis, a severe allergic response that can cause swelling, itching, difficulty breathing, wheezing, vomiting, loss of consciousness and possibly even death. The reaction happens within minutes to an hour after the ingestion and requires immediate emergency treatment.

For years, pediatricians (including myself) followed the common-sense guideline, recommending parents not introduce peanuts until their child is 3 years old, to help protect them from developing a peanut allergy. However, it turned out this was not an effective strategy, and actually may have had the opposite effect. In 2008, the American Academy of Pediatrics dropped this recommendation, but it was not until now that there were clear guidelines on when and how to introduce peanuts.

The guidelines are based on a landmark article published in New England Journal of Medicine in February 2015 that showed exposure to peanuts before the age of 1 can significantly reduce the risk of developing a peanut allergy. In this study, called the LEAP study, or Learning Early about Peanut Allergy, infants who were at high risk for developing peanut allergy (who had severe eczema, egg allergy or both) were studied. The study looked at 628 infants aged 4 months to 11 months old. The infants were randomized to either avoidance or consumption of a peanut-containing puffed snack called Bamba (made by Osem). Impressively, exposure reduced the risk of a reaction by 70-86 percent. The study was well done and results were clear, so the conclusion was that early introduction of peanuts did in fact significantly decrease the risk of developing a peanut allergy.

Based on these results, the National Institute of Allergy and Infectious Diseases developed an addendum regarding peanut introduction to the 2010 food allergy guidelines, which have now been released and endorsed by the American Academy of Pediatrics and other healthcare groups. The guidelines assign babies into three groups: high-risk, medium-risk and low-risk.

High-risk infants are those that have severe eczema, egg allergy or both. These babies should be exposed to peanuts between 4 and 6 months old to help prevent a life-threatening allergy. Prior to any exposure to peanuts, these high-risk infants should have testing done, such as a blood test or possibly a referral to an allergist for a skin-prick test or oral food challenge. Depending on the results of these tests, your doctor will guide you whether it is safe to introduce peanuts at home or if it should be done while being monitored at the doctor's office.

Medium-risk infants are those that have mild-to-moderate eczema (check with your doctor if you are unsure). In these infants, it is recommended to introduce peanut-containing foods around 6 months, with some precautions taken by the parents. These include starting with a small amount and monitoring for two hours by an adult afterward to make sure they do not have a reaction.

Low-risk infants are those that do not have eczema or any known food allergies. They can be introduced to peanut-containing foods between 4 and 6 months, but do not have to be. No testing beforehand or special precautions are needed.

So, if you have a child that is 4 months and up (6 months if you are exclusively breastfeeding) who is not at high risk for peanut allergy and who has already tolerated some baby foods, and you would like to give them a taste of nutty heaven, fear not! It may be common sense, but I'll reiterate it just the same: do not give your baby a big spoonful of peanut butter or a handful of crushed or whole peanuts, as these are most definitely a choking hazard!

Instead, mix peanut butter with some warm water to make it into a smooth puree-like consistency that can be fed with a spoon, mix peanut butter powder or flour with a previously tolerated fruit or vegetable puree, or even spread a thin layer on a cracker or teething cookie.

Then let them have at it and sit back and enjoy that adorable gummy smile!

For more information, check out the parent addendum to the guidelines found here: www.niaid.nih.gov/sites/default/files/peanut-allergy-prevention-guidelin.... To ask any questions or for further guidance, contact your doctor.

Stacey G. Fox, MD, FAAP, is a board-certified pediatrician with Beacon Pediatrics, which is affiliated with Beebe Healthcare. Beacon Pediatrics is now accepting new patients and is also available for scheduled urgent appointments for children who are visiting the area. The office is at 18427 John J. Williams Highway, Suite 212, Rehoboth Beach. For more information, call 302-645-8212 or go to www.beaconpediatrics.net.