Parents should feed babies creamy peanut butter (mixed with water) or puréed food with nut powder when infants are 4 to 6 months old to help reduce the risk of developing life-threatening peanut allergies, new guidelines from the U.S. National Institute of Allergy and Infectious Diseases urge.
For most babies – those without severe eczema or egg allergies that make peanut allergies more likely – the new guidelines recommend introducing foods containing peanuts as soon as babies are able to tolerate other solid foods.
Whole peanuts, though, should never be given to any child under the age of 4, as it they are a choking hazard.
The new guidelines are a radical reversal of recommendations in 2000 that advised against giving babies peanuts before age 3. Despite this advice, peanut allergies continued to rise.
Revised recommendations in 2008 had suggested no food be delayed past 4 to 6 months but failed offer specific guidance on when to feed babies peanuts.
"Window of time" when body more likely to tolerate peanuts
The new guidelines aim to significantly reduce the number of cases of peanut allergy by helping babies get an early taste that will make severe allergic reactions less likely.
Experts believe there is a window of time when the immune system is less likely to react to peanuts. Waiting until children are older to offer peanuts may miss this opportunity to train the body.
Some allergic reactions can be mild with symptoms like hives or nausea, but more serious reactions can lead to anaphylaxis, when the airways tighten to the point where it's impossible to breathe. People with anaphylaxis can die if they don’t get immediate medical help.
Advice for low-risk, high-risk infants
Under the new guidelines, most babies can have peanuts introduced at home by parents or caregivers, but high-risk infants, those with severe eczema or egg allergies, should see an allergist first. A specialist can test for peanut allergies and if necessary, give babies their first taste of peanuts during a doctor visit.
These precautions are for infants with severe eczema that doesn't respond to treatment with moisturizer or corticosteroid creams or ointments, not babies with temporary rashes.
Infants without severe eczema or egg allergy are unlikely to have peanut allergy by 4-6 months, although they still have a risk for developing peanut allergy later, especially if they are not fed peanut in early infancy, experts say.
For infants without eczema or any food allergies, parents should feel comfortable giving babies a taste of peanuts after they are accustomed to eating other solid foods.
It’s also important for parents to continue feeding peanut-containing foods regularly, about three times a week, through childhood.
New guidelines based on randomized controlled trial
Landmark trials have shown that prevention or food allergies can occur with early introduction of peanut and egg into the diet
The new guidelines follow trial results reported in The New England Journal of Medicine (February 2015) that found regular peanut consumption begun in infancy and continued until 5 years of age led to an 81 percent reduction in development of peanut allergy in infants deemed at high risk because they already had severe eczema, egg allergy or both.
Source: Annals of Allergy, Asthma and Immunology, online January 5, 2017.
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