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 The timing and method should depend on the infant’s risk of a peanut
allergy, according to doctors who presented a preview of updated
guidelines today in San Francisco at the annual meeting of the
American College of Allergy, Asthma and Immunology.
“Guidance regarding when to introduce peanut into the diet of an
infant is changing, based on new research that shows that early
introduction around 4-6 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,” said Dr. Matthew Greenhawt, a pediatrician and co-director
of the Food Challenge and Research Unit at Children’s Hospital
Colorado in Aurora, Colorado, who coauthored the update.
“This is an amazing opportunity to help potentially reduce the
number of cases of peanut allergy, but this can only be done with
the cooperation of parents and healthcare providers,” Greenhawt told
Reuters Health.
The basis for recommendations is the Learning Early about Peanut
Allergy (LEAP) study. In that trial, infants at high risk for peanut
allergies who were exposed to peanuts early were less likely to
develop an allergy by the time they reached five years of age. The
findings were published last year in The New England Journal of
Medicine and reported by Reuters (http://reut.rs/2fqGZ6V).
The updated guidelines offer three approaches to peanut introduction
depending on the infants’ risk of allergy, according to Greenhawt.
1. Infants with severe eczema, egg allergy or both are at high risk
for peanut allergy. They should be exposed to peanuts as early as
four to six months to reduce the risk of allergy. Beforehand,
however, these infants should undergo a skin prick test. If the test
yields no welt or a small welt of up to 2mm, parents can introduce
peanuts at home. But if the test yields a welt of 3mm or larger,
peanuts should be introduced in the doctor’s office - or not at all
if the welt is large and an allergist recommends avoidance.
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2. Infants with mild to moderate eczema who have already started
solid foods should be exposed to peanuts at six months of age.
3. Infants without eczema or any food allergy are at low risk, and
parents can introduce peanuts in an age-appropriate form at any time
starting at age six months.
Of course, infants might choke on whole peanuts. So what are
age-appropriate forms of peanut? Another coauthor of the new
guidelines, Dr. Amal Assa’ad, a pediatrician and director of the
FARE Food Allergy Center of Excellence at the Cincinnati Children’s
Hospital Medical Center in Ohio, told Reuters Health, “Several
appropriate forms of peanut-containing foods are creamy peanut
butter that can be made softer or more liquefied by adding warm
water and let it cool, or serving corn puffs containing peanut. For
older infants, peanut butter can be added to apple sauce or other
fruit purees.”
The updated guidelines will be published in January on the National
Institute of Allergy and Infectious Diseases website; in the
meantime, the site provides the current 2010 guidelines on peanut
and other food allergies (http://bit.ly/2eKdsUd).
“As allergists, we’re very excited to see research being done to
understand how children develop peanut allergy and how to treat it
and how to prevent it,” said Dr. Stanley Fineman, an allergist at
Atlanta Allergy and Asthma in Marietta, Georgia, who was not
involved in updating the guidelines.
“The problem was that we didn’t have any good guidance about who to
give it to early and who not to give it to early,” but these new
guidelines will be helpful, Fineman said.
SOURCE: http://bit.ly/2ePxVKh American College of Allergy, Asthma
and Immunology, online November 11, 2016.
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