Nutrition: New guidelines issued for food allergy prevention

These new guidelines are based on more recent evidence, including a leading randomized trial that showed an 80 percent decreased risk of developing a peanut allergy in children at age 5 when given peanut-containing foods as infants. The new National Institute of Allergy and Infectious Diseases guidelines, which were published this month in the Journal of Allergy and Clinical Immunology and endorsed by the American Academy of Pediatrics, lay out steps parents can take to introduce peanuts to their children.

Consulting with a physician beforehand is not suggested unless parents have questions or concerns. Guideline three pertains to infants who are at low risk for developing a peanut allergy and don’t have eczema or an egg allergy. These infants may have peanut-containing foods introduced to them at any time similarly to other age-appropriate foods. Guideline two suggests that parents of children with mild to moderate eczema should introduce peanut-containing foods to their infants at about 6 months of age.
In addition, peanuts and other nuts pose a serious choking hazard to infants and toddlers. Parents of high-risk children should discuss the feeding of peanuts with their physician before giving them to their infant. Guideline one recommends that infants at the highest risk who have severe eczema and/or an egg allergy be given peanut-containing foods at 4 to 6 months, following the successful introduction of other solid foods. As this method is for the prevention of an allergy, not the treatment, the study excluded children who had tested positive for a peanut allergy. Therefore, peanut butter or a peanut powder should be used in the introduction of peanuts instead of whole nuts or pieces of nuts.

Not only is peanut allergy among the most common food allergies, it can cause a severe allergic reaction that can be fatal, called anaphylaxis. In the past, pediatricians recommended that children, especially those at high risk for food allergies, wait until 2 to 3 years old to consume potentially risky foods such as peanuts. Food allergies among children have increased 50 percent since the late 1990s, and peanut allergies have tripled during the same time. During the past couple of years, experts have changed their thoughts on food allergy prevention, and recent science has led to a new and likely more successful approach.