NIH Guidance: Early Introduction of Peanuts to Prevent Severe Allergy

SUMMARY:

The prevalence of peanut allergy in the US has more than doubled between 1997 to 2008 and is a leading cause of death due to food related allergic reactions. 26 professional organizations, including the NIH, have issued new clinical guidelines to prevent peanut allergy. In 2010, an expert panel determined that there was insufficient evidence to advise the delay of introducing peanuts into children’s diets. Based on strong evidence, to prevent severe peanut allergy the latest guidelines now promote early introduction of peanuts, which for most infants will be between 4 to 6 months of age.

Infants at high risk for peanut allergy—based on severe eczema and/or egg allergy—are suggested to begin consuming peanut-enriched foods between 4 to 6 months of age, but only after parents check with their health care providers.

Infants already showing signs of peanut sensitivity in blood and/or skin-prick tests should try peanuts for the first time under the supervision of their doctor or allergist. In some cases, test results indicating a strong reaction to peanut protein might lead a specialist to recommend that a particular child avoid peanuts.

Infants with mild to moderate eczema should incorporate peanut-containing foods into their diets by about 6 months of age. It’s generally OK for them to have those first bites of peanut at home and without prior testing.

Infants without eczema or any other food allergy aren’t likely to develop an allergy to peanuts. To be on the safe side, it’s still a good idea for them to start eating peanuts from an early age.

• Following the safe introduction of peanuts, continue regular exposure
• Those at greatest risk for allergies are advised to consume 2 grams of peanut protein (2 teaspoons of peanut butter) 3 times per week
• Avoid whole peanuts in infants to prevent choking

FDA Statement (September 7, 2017)

The FDA has released a statement regarding food labeling based on the above NIH recommendations and the Du Toit et al. (NEJM, 2015) study.  Aside from the current messaging on food that provides information on whether food contains peanuts or peanut residue

Recognizing the importance of science-based food decisions, the FDA has responded to a petition for a new qualified health claim that states “for most infants with severe eczema and/or egg allergy who are already eating solid foods, introducing foods containing ground peanuts between 4 and 10 months of age and continuing consumption may reduce the risk of developing peanut allergy by 5 years of age.” This is the first time the FDA has recognized a qualified health claim to prevent a food allergy. Our goal is to make sure parents are abreast of the latest science and can make informed decisions about how they choose to approach these challenging issues. The new claim on food labels will recommend that parents check with their infant’s healthcare provider before introducing foods containing ground peanuts.

Learn More – Primary Sources:

Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases – sponsored expert panel

NIH Director’s Blog: Peanut Allergy: Early Exposure Is Key to Prevention

NEJM: Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy

Statement from FDA Commissioner Scott Gottlieb, M.D., on a new qualified health claim advising that early introduction of peanuts to certain high-risk infants may reduce risk of peanut allergy

AAP: New guidelines detail use of ‘infant-safe’ peanut to prevent allergy

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