New peanut allergy guidelines: Most children should be fed peanut products

by: Debbie Lord, Cox Media Group National Content Desk Updated:

In this photo provided by Carrie Stevenson, her daughter Estelle holds a bag of peanut snacks in her pediatrician’s office at age nine-months. Most babies should start eating peanut-containing foods well before their first birthday, say guidelines.
(Carrie Stevenson via AP)

For children who are allergic to peanuts, consuming the nut, even in small amounts, can have life-threatening consequences.

That’s why new guidelines for parents of children with those allergies released Thursday may be a bit surprising for some.

The National Institute of Allergy and Infectious Diseases (NIAID), along with other groups, are encouraging parents to feed peanut products to children early in life in order to train their immune systems not to cause a dangerous allergic reaction known as anaphylaxis.

The guidelines suggests that even children who have the highest risk of an allergic reaction to peanuts should be given small doses to keep the body form developing an allergy to the nut.

Around 5 percent of Americans have some sort of food allergy, and 1 to 2 percent have peanut allergies. According to one study, the prevalence of peanut allergy has doubled over the past 10 years in the United States and other countries that advocate avoidance of peanuts during pregnancy, lactation, and infancy. Children allergic to peanuts can have a life-threatening anaphylactic reaction to even a tiny bit of peanut dust or food containing peanuts. 

The guidelines announced Thursday are addendum to guidelines issued in the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States.

Here’s what NIAID and others suggest: 

1. Infants deemed at high risk of developing peanut allergy because they already have severe eczema, egg allergy or both should have peanut-containing foods introduced into their diets as early as 4 to 6 months of age to reduce the risk of developing peanut allergy. Parents and caregivers should check with their infant’s health care provider before feeding the infant peanut-containing foods. The health care provider may choose to perform an allergy blood test or send the infant to a specialist for other tests, such as a skin prick test or an oral food challenge. The results of these tests will help decide if and how peanut should be safely introduced into the infant’s diet.

2. Infants with mild or moderate eczema should have peanut-containing foods introduced into their diets around 6 months of age to reduce the risk of peanut allergy.

3. Infants without eczema or any food allergy have peanut-containing foods freely introduced into their diets.

Whole peanuts can choke small children and no child under the age of 4 should be given whole peanuts, the groups warned.

The technique suggested in the study has been validated by a Learning Early About Peanut allergy, or LEAP, study.

The LEAP study included more than 600 children between 4 and 11 months of age at high risk for peanut allergy. One group was fed peanuts, while the other was not.

According to the study, “Of the children who avoided peanut, 17 percent developed peanut allergy by the age of 5 years. Remarkably, only 3 percent of the children who were randomized to eating the peanut snack developed allergy by age 5. Therefore, in high-risk infants, sustained consumption of peanut beginning in the first 11 months of life was highly effective in preventing the development of peanut allergy.”

“Living with peanut allergy requires constant vigilance. Preventing the development of peanut allergy will improve and save lives and lower health care costs,” said NIAID Director Anthony S. Fauci, M.D. “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”