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 “If your infant has a history of an allergic disorder (i.e. eczema,
food allergy), we would recommend that he/she be evaluated for a
peanut allergy by an allergist, before introducing a peanut
containing product at home,” said lead study author Dr. Sara Anvari
of Texas Children’s Hospital and Baylor College of Medicine in
Houston.
“Also, when introducing peanuts at home, do not introduce whole
peanuts as they can be a choking hazard,” Anvari added by email.
Reports of peanut allergies have increased more than three-fold
among U.S. children in the last 20 years, Anvari and colleagues note
in JAMA Pediatrics.
During this time, feeding guidelines have moved away from telling
parents to avoid introducing some foods that can cause allergies
until kids are 2 or 3 years old, and stopped telling women to avoid
peanuts when they’re pregnant or nursing. But many recommendations
still stop short of urging parents to give babies eggs and peanuts
early in life.
For the current analysis, researchers summarized research published
since 2008, when the American Academy of Pediatrics (AAP) revised
its guidelines for peanut introduction to note there’s no evidence
to suggest waiting longer than six months could reduce the risk for
allergies to this food.
After these guidelines and other similar recommendations came out, a
shift in thinking about peanuts came courtesy of a study of 640
babies in the U.K. who were already at high risk for nut allergies
because they had eczema or an egg allergy already, researchers note.
This U.K. experiment compared the effects of giving some babies a
6-gram dose of peanut each week to strict peanut avoidance in
children over a five-year period. All of the kids in the study got
skin tests to determine if they developed a peanut allergy.
At age 5, about 14 percent of the kids who avoided nuts had a peanut
allergy compared with roughly 2 percent of the children who got an
early taste of this food.
Based on these results, some proposed guidelines may be shifting
toward early introduction of peanuts even in babies with a history
of other allergies, the authors note.
But when these high risk babies get that first taste of peanuts,
they should have it in a clinical setting with lab tests to check
for allergic reactions before parents offer peanuts to children at
home, the researchers point out.
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This study had some limitations, including a lack of data on how
much peanuts babies could have at one time or how long they might
need to continue eating nuts on a regular basis to protect against
allergies. It’s also unclear what risks babies might face if they
got a taste of peanuts then stopped eating them.
Still, guidelines in development from the National Institute of
Allergy and Infectious Diseases are expected to come out soon and
recommend that all kids get their first taste of peanuts around 4 to
6 months of age as long as they have tried some other foods first,
said Dr. Matthew Greenhawt, a food researcher at the University of
Colorado School of Medicine who wasn’t involved in the current
analysis.
“Guidance regarding when to introduce peanut into the diet of an
infant is changing, based on new research that shows that early
introduction around 4 to 6 months of life, after a few other foods
have been introduced into the infant’s diet, is associated with a
significantly reduced risk of such infants developing peanut
allergy,” Greenhawt added by email. “This is an amazing opportunity
to help potentially reduce the number of cases of peanut allergy.”
Babies, however, should stick to nut butters and pastes, said Dr.
Robert Boyle, a pediatric allergy researcher at Imperial College
London who wasn’t involved in the current analysis.
“Whole nuts are not advised for babies or children up to the age of
3, due to the risk of choking,” Boyle added by email.
SOURCE: http://bit.ly/2ePiiQW JAMA Pediatrics, online November 7,
2016.
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