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New allergy guidelines for introducing peanuts
May 22, 2020
New allergy guidelines for introducing peanuts

    New allergy guidelines: Evidence is now available that shows a reduction in peanut allergy in children who eat peanuts early in life

    Whether it’s school, camp or another setting where lots of kids are, we’re all familiar with being asked not to send in peanut products. For important health reasons, it’s too risky not to have these restrictions in place: Peanut allergy is the leading cause of life-threatening allergic reactions and related complications in children – and in the last two decades the number of children allergic to peanuts has risen significantly.

    New allergy guidelines will hopefully help reduce these numbers. Previous guidelines that recommended avoiding highly allergenic foods in infancy did not result in reducing food allergies as hoped. But there’s promising news: Evidence is now available that shows a reduction in peanut allergy in children who eat peanuts early in life.

    New peanut allergy guidelinesNew evidence, new guidelines

    This new evidence led to new peanut allergy-prevention guidelines which were published in 2017 by an expert panel from the National Institutes of Health. These guidelines are based on studies supporting early introduction of peanuts to prevent peanut allergy.

    Here’s what’s important to know about these new recommendations and about safely introducing peanuts into a child’s diet:

    • The new guidelines recommend early introduction of peanuts in infants who are at high risk of developing a peanut allergy and that it’s OK to start this as young as four months, as long as the child is able to eat and tolerate at least one solid food.
    • Infants with a history of eczema or food allergies are considered high risk.
    • High-risk infants should be assessed individually by an allergist or pediatrician BEFORE being given any peanut product. We also recommend that parents are familiar with allergic reaction symptoms.

    It’s also important to note that there is no urgency in introducing peanuts to children who have no risk factors for allergies. Having “no risk factors” means the child does not have eczema, other food allergies or a family history of food allergies.

    Also, the new guidelines only relate to peanuts. They do not address early introduction of tree nuts (almonds, cashews, pistachios, macadamia nuts, etc.). Although it makes sense to apply the same principles for tree nuts, waiting for additional well-conducted studies is recommended before doing so.

    How to introduce peanuts safely

    An infant, high risk or not, should never be given a whole peanut. There are a number of alternative options for introducing peanuts to infants and toddlers, including powder, flour and snack form. There are also several products now commercially available for easy measurement and introduction of peanuts.

    Aim for 2 grams of peanut protein, two to three times per week. Two grams of peanut protein is equal to 2 teaspoons of peanut butter, flour or powder or 21 Bamba peanut butter snacks. (Again, be sure to check with your child’s doctor first if your child is high risk.) For toddlers and older children, once they tolerate peanuts (eat without showing signs of allergic reaction), they don’t have to restrict to 2 grams, but can consume as much as desired for a healthy diet appropriate for their age.

    The following can be especially helpful for adding peanut products to meals or snacks for those who are learning to eat or have feeding difficulties:

    • Mixing smooth peanut butter (not chunky) with milk or pureed food
    • Mixing peanut puffs or Bamba peanut butter or peanut snacks with milk or mashing with pureed fruits or veggies
    • Mixing peanut flour or powder with pureed fruit or vegetables

    What to do if child has an allergic reaction

    If a child has an allergic reaction after peanut introduction, the first step is to remove the child from the source of peanuts. It’s also important to change their clothing and wipe away any traces of peanuts from both their mouth and hands.

    If the reaction is limited to the skin (like hives), an age-appropriate dose of an antihistamine like cetirizine can be administered. If the symptoms are more serious – including trouble breathing, swelling or wheezing – call 911 so the child can be taken to the nearest emergency room. If the child has been prescribed an EpiPen for severe allergic reactions, use it BEFORE calling 911. 

    - Dr. Santhosh Kumar, allergy specialist

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