Rochester General Health System : New Peanut Allergy Guidelines

by: Dr. S. Shahzad Mustafa

Peanut allergy affects approximately 1% of the US population. Although there are numerous ongoing studies regarding potential therapies for peanut allergy, current management of established peanut allergy is based on peanut avoidance and treatment of accidental ingestions with epinephrine. Given the limited treatment options, prevention of peanut allergy is of utmost importance.

Previous food allergy guidelines from the late 1990s and early 2000s recommended delaying the introduction of peanut to a child until 3 years of age. Over time, more and more research showed earlier introduction of peanut may actually decrease the risk of allergy. In February 2015, the Learning Early About Peanut Allergy (LEAP) study demonstrated that the introduction of peanut between 4-11 months of age in a high risk population (infants with severe eczema and/or egg allergy) dramatically decreased the risk of developing peanut allergy compared to late introduction at five years of age. This landmark study, along with numerous other similar studies supporting the same concept, has led to a reversal in food allergy guidelines.

Last week, the National Institute of Allergy and Infectious Diseases (NIAID), along with several other groups, published the first guidelines on the prevention of peanut allergy in the Unites States. The most recent guidelines are a significant change from the previous versions, and encourage peanuts to be introduced into an infant's diet as early as 4-6 months of age. Early introduction can 'train' the immune system to become tolerant to the food, rather than allergic.

The new guidelines can be summarized as follows:

Children at low risk for peanut allergy, as defined by no history of eczema or egg allergy, can be given peanuts at home whenever the parents wish, but ideally by 6 months of age. This applies to the majority of children in the US. Remember that children this young should never be given whole peanuts due to the risk of choking, so instead should be given peanut butter, peanut powder, or peanut-based snacks like Bamba.

Children at moderate risk for developing peanut allergy, as defined by those with mild to moderate eczema, can also be given peanuts at home, without the help of their pediatrician or allergist.

Children at high risk for peanut allergy, as defined by those with egg allergy or severe eczema, should be evaluated between 4-6 months of age by an allergist specializing in food allergy. Based on a thorough evaluation, the allergist can decide the best way to introduce peanut into the diet of these high risk infants.

These new guidelines provide tremendous hope that the majority of peanut allergy can be prevented before it develops.