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New peanut allergy guidelines: Start infants early to prevent allergies, says US panel

Parents may be able to reduce the chance that their children will develop peanut allergies by introducing the food early on, as young as four to six months of age, experts now say.

Parents may be able to reduce the chance that their children will develop peanut allergies by introducing the food early on, as young as four to six months of age. 

An expert panel in the United States on Thursday (Jan 5) published guidelines on when to introduce foods containing peanut to an infant's diet - a way of avoiding allergies that was validated by a study on it.

The Learning Early About Peanut (LEAP) allergy study found that infants at high risk of 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.

"We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States," said Dr Anthony Fauci, director of the National Institute of Allergy and Infections Diseases, which sponsored the expert panel.

Doctors who helped draft the guidelines said the timing and method should depend on the infant’s risk of a peanut allergy.

"Guidance regarding when to introduce peanut into the diet of an infant is changing, based on new research that shows that early introduction around four to six 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 guidelines offers three approaches to peanut introduction depending on the infants’ risk of allergy: 

1. Infants with severe eczema, egg allergy or both are deemed to be at high risk of developing peanut allergy. They should be exposed to peanuts as early as four to six months to reduce the risk of allergy. Parents can also get a reference to an allergist, who will give the child a skin prick test or a blood test to see if they are allergic to peanuts. 

2. Infants with mild to moderate eczema should be exposed to peanuts at six months of age to reduce the risk of allergy.

3. Infants without eczema or any food allergy are at low risk, and food containing peanuts can be introduced freely into their diets. 

In all cases, infants should start other solid foods before they are introduced to food containing peanuts, the guidelines added.

And 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 left to cool, or serving corn puffs containing peanut. For older infants, peanut butter can be added to apple sauce or other fruit purees.”

“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,” Fineman said, adding that these new guidelines will be of help.