New peanut allergy prevention guidelines released

January 05, 2017

The National Institute of Allergy and Infectious Diseases have released new, formal guidelines for pediatricians, allergists and parents in an effort to decrease the prevalence of children with peanut allergies.

While it was once thought that infants and children should avoid peanuts altogether until the age of three, more recent studies have suggested the exact opposite: Giving your baby peanuts earlier rather than later might actually prevent them from developing an allergy.

It is this stance in which the new guidelines are based and aim to eliminate the confusion about which kids could benefit from early exposure, the optimal timing of the exposure, and how exactly one should feed peanuts (which, after all, are a choking hazard in their raw form) to babies. The recommendations are "really simple and straightforward," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said in a recent article.

Now published in six medical journals, the guidelines include three separate sets of recommendations based on the level of risk an infant has for developing a peanut allergy. Those at highest risk are defined as babies with severe eczema — a skin condition where patches of skin become inflamed, itchy, red and cracked, have an egg allergy, or have both an egg allergy and severe eczema. Those in the middle group have mild-to-moderate eczema, and those in the lowest-risk group have no eczema or food allergies.

For those that fall into the high risk category, the guidelines explain they should be exposed to peanuts earliest — at four to six months — and be referred to a specialist who might perform a blood or skin test before deciding how to handle their first exposure to peanuts. Some may decide that with low readings, the child could be given peanuts at home, while others may suggest giving a child peanuts for the first time in a doctor's office.

Those precautionary measures reflect the tricky nature of diagnosing a peanut allergy, the article explains. Many people can test positive for allergies through a skin test or a blood test but may tolerate the food just fine. The opposite, while less common — that you can have a low reaction to a blood or skin test but still have a severe allergic reaction — also can be true.

Those in the middle group should be fed peanuts when they are about six months old, and can be done at home. Those at lowest risk can have them at any time, also at home, but can typically start when they are about six months old. “For these kids, we are not considering peanut as different than any other type of food,” said Matthew Greenhawt, a physician at Children's Hospital Colorado.

Dr. Fauci goes on to explained in the article that the new thinking on peanut exposure grew out of observations of Israeli children in Israel versus Israeli children in Britain. In the former, parents as part of their culture often give various types of peanut preparations such as paste or nuggets in the very earliest days of a child's life. Scientists noted that the incidence of peanut allergies in Israeli children in Israel is lower than in Israeli children in Britain and wondered whether the two things could be related.

That theory was put to a test with a randomized trial involving 640 infants considered at high risk of developing peanut allergies. The results, published in 2015, showed that children at high risk who regularly consumed peanuts as infants had an 81% lower chance of developing a peanut allergy by age five. Fauci called the results “very striking” and estimated that the new guidelines could prevent thousands of children from developing peanut allergies.

The guidelines also contain other advice as well and remind parents that all infants should first progress to solid foods — such as pureed vegetables and cracker puffs — on their regular schedule, before being exposed to peanuts. The guidelines also provide step-by-step instructions along with “recipes” for home exposure to peanuts.

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Category: Food Safety