Yesterday the National Institutes of Health (NIH) released new peanut guidelines for infants as an addendum to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States (1). Previously, the recommendation was to withhold peanut introduction until 3 years of age (per the American Academy of Pediatrics 2000 guidelines) for high-risk infants, including those with parents or siblings with a food allergy (2). Now the NIH, by an expert working group sponsored by the National Institute of Allergy and Infectious Disease (NIAID), is recommending early introduction of peanut-containing foods to infants to reduce the risk of developing peanut allergy. The change comes in response to the Learning Early About Peanut Allergy (LEAP) study, which found only 3% of high-risk infants developed peanut allergy by age 5 when assigned to eat peanut-containing foods three times weekly, compared to 17% of children randomized to avoid peanuts until age 5 (3).
What’s being recommended:
High risk infants (infants with severe eczema and/or an egg allergy) – Introduction of peanut-containing foods between 4 and 6 months for infants who have already started solid foods, after approval from their healthcare provider. The first introduction may potentially take place in the healthcare provider’s office (4).
Medium risk infants (infants with mild to moderate eczema – Introduction of peanut-containing foods around 6 months of age for infants who have already started solid foods, not requiring in-office evaluation (4).
Low risk infants (no eczema or egg allergy) – Freely introduce peanut-containing foods to infants who have already started solid foods (4).
Note: Whole nuts should not be given until age 5, and peanut butter in lumps or directly from a spoon should not be given until age 4, due to choking risks. The recommendation is for peanut-containing foods (4).
5 Easy Ways to Introduce Peanuts Safely
The National Peanut Board released an infographic displaying 5 easy ways to safely introduce peanut-containing foods to infants. With their permission, I’ve shared it here so you have tangible tips for your tots to taste!
More About Peanuts & Food Allergies
Peanut allergy can be costly, in terms of money and mortality. Peanut allergy has tripled in the United States over the past decade, affecting ~2% of children (1,4). Peanut allergies cost an annual $24.8 billion nationwide.1 Allergic reactions to food allergens range in severity, with little predictability, from tingling around the mouth or lips to anaphylaxis or death (1,5). Kids with peanut allergy are more likely to have asthma, eczema or a skin allergy, eosinophilic esophagitis, or a respiratory allergy (5,6).
The “big eight” food allergens accounting for over 90% of food allergies, and include: peanuts, tree nuts (includes almonds, cashews, walnuts, pine nuts, and more), milk, eggs, fish, shellfish, soy, or wheat (5). Peanut allergy is less prevalent than milk or egg allergy (2). Interestingly, peanuts are technically legumes, (like soy, peas, and lentils), not tree nuts (7).
Often, kids “grow out” of food allergies, particularly milk, eggs, soy, and wheat (6). Peanut allergy is less likely to be “grown out of” but still has a ~20% likelihood (7). There is currently no treatment for food allergies. Food allergens must be avoided, and when not avoided, only the symptoms may be treated not the actual allergy.
- NIH-sponsored expert panel issues clinical guidelines to prevent peanut allergy. National Institutes of Health. https://www.nih.gov/news-events/news-releases/nih-sponsored-expert-panel-issues-clinical-guidelines-prevent-peanut-allergy. Published January 5, 2017. Accessed January 5, 2017.
- Greenhawt M. The learning early about peanut allergy study. Pediatr Clin North Am. 2015; 62(6): 1509-1521.
- LEAP study results. Leap. http://www.leapstudy.com/leap-study-results#.WHATrbYrJsM. Accessed January 5, 2017.
- Togias A, Cooper SF, Acetal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases – Sponsored expert panel. Ann Allergy Asthma Immunol. 2016; 1-8. Link here.
- Food allergy among U.S. children: Trends in prevalence and hospitalizations. Centers for Disease Control & Prevention. https://www.cdc.gov/nchs/products/databriefs/db10.htm. Last reviewed November 6, 2015. Accessed January 5, 2017.
- Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010; 126(6): S1-S58).
- Peanut allergy. American College of Allergy, Asthma & Immunology. http://acaai.org/allergies/types/food-allergies/types-food-allergy/peanut-allergy. Accessed January 5, 2017.
Updated April 27, 2017.