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New guidelines encourage more early exposure to peanuts


An expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, recently issued new guidelines to help healthcare providers advocate for the early introduction of peanut-containing foods to infants in order to prevent the development of peanut allergy.

Internationally, many people introduce peanuts into a child’s diet early on. In the United States, there has been fear about introducing peanuts to young children because of concerns that feeding peanuts would raise the risk of getting peanut allergy. In the general population, only 6 percent of patients (adults and children) have true food allergy. Of that, peanut allergies make up 2 percent.

Peanut allergies are among the most complex food allergies to manage. People don’t necessarily have to eat a peanut to have a reaction. Many foods contain peanuts as ingredients of which people aren’t always aware. A particularly risky time of the year for those with peanut and other food allergies is between Halloween and New Year’s. This is because people consume food prepared by others. Entrees, snacks and desserts shared at parties and gatherings might contain peanuts not readily apparent to those with peanut allergy.

The traditional wisdom was that if there was a family history of peanut or tree nut allergies, the pediatrician or family doctor would recommend not giving children peanuts at an early age. A study published in the New England Journal of Medicine in 2005 (the Learning Early about Peanut Allergy or LEAP trial) found that withholding peanuts from very young children at risk for peanut allergy actually resulted in more peanut allergy than those who did allow the child to consume them.

The new guidelines seek to extend the results of this study to the public in a safe and efficient way, bringing focus on preventing development of peanut allergy in children at risk.

Three-tiered approach

The Guidelines review recommendations for three levels or categories of risk for developing peanut allergy.

Guideline 1 focuses on infants at highest risk for developing peanut allergy. These infants typically also have severe eczema, allergies to eggs, or both. Parents should seek evaluation prior to making a decision to introduce peanuts into the infant’s diet (between 4 and 6 months of age) to help reduce the risk of developing peanut allergy. This will entail testing for evidence of allergy to food (peanut, egg) and possibly, an oral food challenge if necessary to establish the presence or absence of a food allergy diagnosis.

Twenty percent of the US population is atopic. Atopy refers to the innate (genetic) tendency to become an allergic person. Atopic persons become allergic after exposure to foreign proteins cause their immune response to make IgE antibodies (the ‘allergic antibody’) rather than other types of antibodies. IgE primes histamine-bearing cells to react when binding allergen, starting an allergic reaction. Eczema is an early marker for allergy in infants, and often presages the development of other allergic conditions (hay fever, asthma) later in life. Allergy specialists call this the “the atopic march.”

Guideline 2 recommends infants with mild or moderate eczema should be introduced to peanuts at 6 months of age.

Guideline 3 recommends all other healthy infants be freely exposed to peanuts.

Hearing these new guidelines can be concerning to some parents who worry about peanut allergies in their children. While this is understandable, it is important to remember that these guidelines were developed as a result of the findings in the LEAP trial and other studies, which show that children at risk for peanut allergy are more likely to become allergic to peanut if it is withheld from the diet. These recommendations do not pertain to those with established peanut allergy.

Sometimes having fear and worry about a condition may be worse than having the condition itself. Needless avoidance of foods only suspected of causing allergy can result in illness (weight loss, poor nutrition, etc). The best way to alleviate concerns and fears about food allergy is to understand them and have a viable plan on how to best manage them.

If you’re concerned about peanut allergies, talk to your family physician.

About Thomas Scott MD

I am a Fellow of the American Academy of Allergy, Asthma and Immunology and a Fellow of the American College of Allergy, Asthma and Immunology. I practice at Ascension Medical Group on Murdock in Wichita, Kan.