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 In a practice guide for health care providers published in CMAJ, a
team of pediatricians and allergy specialists encourage introducing
peanuts in pureed or powdered form as early as age 4 months for most
babies, and making sure the babies continue to get exposure to
"substantial" amounts of peanut products in their first years of
life.
However, the allergy status of the baby should be checked with a
doctor in advance, said one of the guide's authors, Dr. George du
Toit of King's College London in the UK.
He added that at-home introduction of peanut products is best suited
for infants who do not have eczema, or have only a mild form of the
skin disorder.
The hardest part of implementing the current guidelines regarding
peanut exposure for babies is that they "are a complete reversal
from the prior practice of delaying peanut exposure," said Dr. Ruchi
Gupta of the Northwestern University Feinberg School of Medicine in
Chicago, a pediatrician and food allergy researcher who wasn't
involved in the practice guide.
"There's also resistance from parents because they're fearful about
doing this at home with their infants and what may happen," she told
Reuters Health in a phone interview.
Peanut allergies typically develop before age 2. These allergies are
a constant worry for parents, who need to closely monitor everything
their kids eat inside and outside the home.
Allergic reactions to peanuts can include skin rashes and blisters,
difficulty breathing, low blood pressure, nausea and vomiting, and
swelling of the tongue, eyes or face. In severe cases, a peanut
reaction can be fatal unless halted with an injection of
epinephrine.
As a result, doctors previously advised parents to avoid giving
peanut products to babies. But a 2015 study prompted a rethink of
the guidelines.
The trial included 640 babies younger than 11 months with either egg
allergy or eczema - both risk factors for developing peanut allergy.
But researchers found that when these high-risk infants were fed a
small amount of peanut butter 3 times a week, only 3% went on to
develop peanut allergy after 5 years, while 17% of children who
avoided peanuts during infancy became allergic.
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In the practice guide, a team of pediatricians and allergy
specialists recommends introducing peanut protein to babies aged
between 4 and 6 months in the form of paste, butter or powdered puff
as one of the first foods during the process of weaning off breast
milk.
"A lot of people assume that this just means feed it to (babies)
once but it is really important that you feed repeatedly and over a
longer period of time so that the immune system actually learns to
tolerate it," said Gupta's colleague Christopher Warren, also of the
Feinberg School of Medicine, who joined her on the phone interview.
Guidelines from the U.S. National Institute of Allergy and
Infectious Diseases recommend checking the allergy status of
high-risk infants through the skin-prick method or specific
immunoglobulin E (IgE) testing before introducing peanuts. The
allergy societies of Canada, Australia and the UK don't mandate this
test, the authors write.
The method of early introduction has also been tested with other
major allergenic foods such as milk, egg, sesame, fish and wheat,
but the protective effect of early introduction of these foods in a
child's diet was most pronounced in the case of peanuts and eggs,
experts noted.
Parents should look out for signs of vomiting, choking, rashes,
swelling of the lips or an extreme dislike for the food, which could
signal the onset of an allergic reaction. But very few infants
develop the more severe symptoms such as breathing difficulty or low
blood pressure, Gupta said, and doctors are likely to recommend
consulting with an allergy specialist to see if the baby could try
peanuts again under medical supervision.
SOURCE: https://bit.ly/2Zezafe CMAJ, online July 22, 2019.
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