The common belief that children at risk of developing a peanut allergy shouldn’t be exposed to the nut until at least their 3rd birthday has been overruled.
New guidelines released on Thursday from the National Institutes of Health say that children could actually benefit from being given peanuts earlier on, well before their first birthday.
The recommendations are based on new research which has shown that early exposure lowers a baby’s chances of developing the dangerous nut allergy. A 2015 study on 600 babies who were assigned either to avoid or regularly eat peanut products found that by age 5, only 2% of the peanut eaters — 11% of those at highest risk — had become allergic. Among the peanut avoiders in the study, 14% had become allergic overall — 35% in the highest risk category.
You can skip to the bottom of this post for the new guidelines.
Although many doctors have been giving out this advice for a while, there has been a great deal of confusion over the potential benefits of exposing young babies, with some experts claiming it was best for parents to wait it out until children were older.
The NIH document, which has been published in six medical journals so far, aims to clear up any doubts.
The release includes three separate sets of recommendations which are dependent on the level of risk an infant has for developing a peanut allergy.
Those at highest risk are babies who have severe eczema — a condition characterised by flaky, red, inflamed skin — or an egg allergy. Those in the middle group have mild-to-moderate eczema, which would be patches that don’t cover the majority of the body. Babies who are in the low-risk group have no eczema or food allergies at all.
“We’re on the cusp of hopefully being able to prevent a large number of cases of peanut allergy,” said Dr. Matthew Greenhawt of the American College of Allergy, Asthma and Immunology, a member of the NIH-appointed panel that wrote the guidelines.
Babies at high risk need a check-up before any peanut exposure, and might get their first taste in the doctor’s office. For other children, most parents can start adding peanut-containing foods to the diet much like they already introduced oatmeal or mushed peas.
Of course, peanuts are choking hazards, so instead of feeding young children whole nuts the guidelines include options like watered-down peanut butter or easy-to-gum peanut-flavored “puff” snacks.
“It’s an important step forward,” said Dr. Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, which appointed experts to turn the research findings into user-friendly guidelines. “When you do desensitize them from an early age, you have a very positive effect.”
Peanut allergies are a growing problem around the world. The rate of peanut allergies has doubled over the last five years in both Europe and the US, and is now estimated to affect 1 in 50 young infants. The reasons for this increase are still poorly understood, but it is in line with the general increase in all forms of allergy, including eczema, asthma, and hayfever, according to Allergy UK.
These are the new guidelines:
- All babies should try other solid foods before peanut-containing ones, to be sure they’re developmentally ready.
- High-risk babies should have peanut-containing foods introduced as early as 4 to 6 months after a check-up to tell if they should have the first taste in the doctor’s office, or if it’s OK to try at home with a parent watching for any reactions.
- Moderate risk babies have milder eczema, typically treated with over-the-counter creams. They should start peanut-based foods around 6 months, at home.
- Most babies are low risk, and parents can introduce peanut-based foods along with other solids, usually around 6 months.
- Building tolerance requires making peanut-based foods part of the regular diet, about three times a week.
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