Early Peanut Introduction

By Payel Gupta, MD-Allergy  

@nycdoctor

The ITCH Podcast

Co-Hosted by Payel Gupta MD & Kortney Kwong Hing

https://www.itchpodcast.com/

This podcast is for the anyone who has questions about allergies, asthma, eczema, and immunologic conditions. Whether you have been living with an allergic or immunologic condition, are newly diagnosed, a family member or a friend, Dr Gupta and Kortney want to help you navigate through the confusion that comes with this diagnosis.

Early Peanut Introduction

What is early peanut introduction?  Why are we recommending early introduction of a food that my child might be allergic to?  How can I make sure that my child is safe? These are some of the questions that likely come into your mind as you decide to give your child peanuts or any other highly allergenic food.

What is early peanut introduction?

Prevention is key when it comes to peanut allergy; with nearly 2% of children being diagnosed with peanut allergy, finding a way to reduce this number is important.

Early introduction is defined as starting a peanut product as early as 4-6 months of age.

Why are we recommending early introduction of a food that my child might be allergic to?

The Learning Early About Peanut Allergy (LEAP) study, which was published in early 2015 looked at different groups of infants and tried to determine if early introduction of peanut product would reduce the risk of peanut allergy.What they found was remarkable.The study showed that early introduction of peanut foods to infants at high risk (those with severe eczema or egg allergy, or both) reduced peanut allergy by 86% in this group!

How can I make sure that my child is safe?

Follow the guidelines.

After these results were published, new guidelines were released to help the medical community put these results into action.

These guidelines divide infants into 3 groups:high risk, some risk and no risk groups.

Group 1

The first group, which I briefly mentioned above is the “high risk” group.These are infants who have severe eczema, egg allergy or have both of these conditions are considered to be at high risk for developing peanut allergy based on the study.

What we need to know:

1. These infants need to be evaluated early by a doctor to determine whether they can be introduced to peanut early.
2. There is a strong recommendation that these infants be sent for either serum testing or skin prick testing to see if they are allergic to peanuts.
3. Depending on the results, oral introduction may be done at home, in the doctor’s office, or not at all.
4. If it is determined that peanut is safe for the infant, then it should be introduced into the diet at 4-6 months of age.
5. The infant should receive age-appropriate peanut foods, in the amount of 2g peanut protein three times per week (see discussion below on how to get this amount of peanut in your infants diet).

Group 2

These infants are at some risk, they have a history of mild to moderate eczema.These infants have mild to moderate eczema only and do not have a known history of other food allergens at baseline.

1. If infants are at moderate risk, the guidelines recommend introducing peanut at home, but caregivers or health professionals may choose to introduce peanut foods in the office.
2. The recommendation is to introduce peanut containing foods around 6 months of age.
3. The infant should receive age-appropriate peanut foods, in the amount of 2 g peanut protein three times per week.

Group 3

These infants do not have any eczema or any food allergy by history and are not considered at risk.According to the guidelines, these infants can be fed peanut foods in whatever way is preferred by the family (according to cultural and family preferences) at the age of 6 months old.

How should I feed my child peanut product?

Parents should feed infants other solid foods before peanut-containing foods in all cases, according to the guidelines.The introduction should generally be with dilute peanut butter. Peanuts can be dangerous, as they can be aspirated and peanut butter can be dangerous because of how sticky it is.The study was done with a product called Bamba, a snack made in Israel.There are many other products available on the market for infant feeding and this link (https://www.niaid.nih.gov/sites/default/files/addendum_guidelines_peanut_appx_d.pdf) provides several other recipes that can be made at home with peanut butter, peanut flour or peanut powder.

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