Q: The National Institute of Allergy and Infectious Diseases (NIAID) revised peanut allergy guidelines earlier this year. What do parents need to know before introducing peanut to infants?
Matthew Greenhawt, MD: If you look at the history of peanut allergy, for a period of time the guidelines said infants and young children should avoid peanut early in life. Now, we have research – specifically the LEAP and LEAP-On studies – that shows giving it early in a specific time frame is associated with a much better outcome in terms of reducing risk of peanut allergy.
The take-home message is this: Allergists now encourage you to include peanut in your infant’s diet. It shouldn’t be the first solid food given – try it in a cereal or something similar so the child can get used to the taste, texture and skill of eating it.
I was part of the NIAID expert panel charged with developing and translating the revised guidelines into practice. The best part about the revised guidelines is, if they are right, we could prevent tens of thousands of peanut allergy cases each year, which would be fantastic.
Q: How do you determine when to introduce peanut?
Dr. Greenhawt: The guidelines recommend the following:
- Infants with severe eczema, egg allergy or both are at high risk for peanut allergy and should be given peanut-containing foods – such as peanut butter – between 4-6 months of age to reduce the risk of developing peanut allergy. The infants should first see a board-certified allergist for peanut allergy testing to determine if peanut can be safely introduced; this needs to be done in an allergist’s office.
- Infants with mild or moderate eczema should have peanut-containing foods introduced into their diets at 6 months of age to reduce the risk of developing peanut allergy. These children do not need to first see a specialist and can have peanut-containing foods introduced at home.
- Infants without any eczema symptoms or egg allergy can have peanut-containing foods freely introduced into their diets together with other solid foods, in accordance with family preferences and cultural practice. These children also do not need to first see a specialist and can have peanut-containing foods introduced at home.
Q: What types of peanut-containing foods should be given to infants?
Dr. Greenhawt: Certainly not whole peanuts – these are choking hazards until about age 4. You can use spooned-out peanut butter that’s thinned with breast milk or formula or water. You can use bamba, a commercial product similar to a cheese puff, but it’s covered in peanut instead of cheese. There’s even a peanut soup using ground peanut.
Introducing peanut is not something you should do on a day where your child has a little cold, or a cough – you really want the child in good health, so that any allergy symptoms are not affected by the ingestion of peanut. And you should do this early in the day – not right before bed.
The guidelines recommend 2 grams of peanut given three times per week, but if you don’t give exactly that amount, or if it’s not three times per week, or if the child doesn’t like it one day, don’t worry. The timing and quantity of how often you give peanut is not critical. You just have to be patient and persistent.
Matthew Greenhawt, MD, FACAAI, is a board-certified allergist and immunologist and assistant professor of pediatric allergy at Children’s Hospital Colorado. He is chair of the Food Allergy Committee for the American College of Allergy, Asthma & Immunology (ACAAI).
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