By Christine Palumbo
It’s not often that a health organization makes a complete 180-degree turn with a long-standing recommendation. But the National Institute of Allergy and Infectious Diseases did just that earlier this year with their advice about preventing peanut allergies.
Rather than avoiding peanuts, the new guidelines recommend exposing infants to peanuts early — as young as four to six months of age — to prevent or reduce the chance of developing a peanut allergy later.
“This is a significant change in practice, as parents were previously told to avoid peanuts until age 3,” says Rachael Costello at Rachael Costello Nutrition.
The landmark study that influenced the reversal, “Learning Early About Peanut Allergy” clinical trial, showed that introduction of peanut products into the diets of infants at high risk of developing peanut allergy is safe. Not only that, but the study showed that early peanut introduction reduced later development of peanuts allergy by a whopping 81 percent.
The trial was the first and only large, randomized prevention trial for peanut allergies. Its findings are considered definitive.
Peanut allergies affect fewer children than most people suspect: only two percent of kids in the U.S. Peanut-allergic children, their parents, and caregivers must be constantly vigilant against even a trace of peanut exposure. It is thought as many as 20 percent of children will outgrow their peanut allergy.
Three risk categories
In order to reduce the risk of peanut allergy in high risk infants, introduce peanuts as early as 4 months of age. But don’t wait too long. Your baby could develop peanut allergies at 6 months. Sure, it can be scary for a mom to introduce these foods when peanut allergies run in the family.
The specific timing depends upon which of the three risk categories your infant falls under.
Group 1: This group is the smallest percentage but has the greatest potential for peanut allergy. The infant suffers from severe eczema, egg allergy, or both. Start introducing peanut at four to six months of age. Parents should discuss how to introduce peanut with their pediatrician; the infant may need to have a supervised feeding in the medical office.
Group 2: This group has mild to moderate eczema but no egg allergy. Introduce peanut-containing foods around the age 6 months.
Group 3: Everybody else; no eczema or any known food allergy. Introduce peanut-containing foods any time after 6 months.
The panel’s recommendation is to introduce peanuts by mixing 2 teaspoons peanut butter or powdered peanut butter into a food the child is already eating. You can add it to applesauce or infant cereal or even thin it out with formula or breast milk. In all cases, infants should start other solid foods before they are introduced to peanut-containing foods.
When introducing peanuts, always keep safety top of mind. Whole peanuts are a choking hazard even if the child has teeth.
In order to prevent peanut allergies, are there guidelines for peanut consumption for an expectant mother? Costello says there are no recommendations to restrict peanut intake while pregnant as there is no strong evidence to support avoiding peanuts will prevent an allergy. Ditto for breastfeeding.
“Waiting to start solids until 4 to 6 months and exclusive breastfeeding up until that time have shown to reduce food allergy development in children,” adds Costello.
With early introduction there are no guarantees we can prevent peanut allergies in every child. But we will see a lot of reduction in the next five to 10 years. Be sure to always discuss your child’s diet with your health provider.
Christine Palumbo is a Naperville, Ill.-registered dietitian nutritionist who is a new Fellow of the American Academy of Nutrition and Dietetics. Follow her on Twitter @PalumboRD, Facebook at Christine Palumbo Nutrition, or Chris@ChristinePalumbo.com.