Babies with a high risk of developing peanut allergy should be introduced to the food as early as 4 months according to an expert panel from the National Institute of Allergy and Infectious Disease (NIAID) consisting of representatives from 25 professional organizations, federal agencies, and patient advocacy groups. The recommendations were published in a number of medical journals today including the Annals of Allergy, Asthma and Immunology.
The panel’s recommendations come as no surprise after the findings of the LEAP study were published last year, in which the incidence of peanut allergy in high-risk children was reduced by 80% after the early introduction of the food.
Infants with severe eczema and/or egg allergy are considered at high risk for developing peanut allergy. The panel recommends introducing foods containing peanuts to high-risk infants who have already started solid foods at 4-6 months, after consultation with the child’s healthcare provider or an allergist.
The recommendations state that for such infants, evaluation with peanut-specific IgE test, skin prick test, or both should be “strongly considered before the introduction of peanut to determine if peanut should be introduced and, if so, the preferred method of introduction.”
“To minimize a delay in peanut introduction for children who may test negative, testing for peanut-specific IgE may be the preferred initial approach in certain healthcare settings, such as family medicine, pediatrics, or dermatology practices, in which skin prick testing is not routine. Alternatively, referral for assessment by a specialist may be an option if desired by the heathcare provider and when available in a timely manner,” the guidelines state.
The panel identified three categories of infants based on their response to skin prick testing:
- A wheal diameter of 2 mm or less is indicative of low risk: peanut introduction is recommended soon after testing;
- Wheal diameter of 3 to 7 mm reflects medium likelihood of peanut allergy; supervised peanut feeding or an oral food challenge at a specialist’s office or specialized facility can be employed;
- A wheal diameter of 8 mm or more is indicative of a high likelihood of allergy, and children in this category should be evaluated and managed by a specialist.
Pediatric allergist and panel member Hugh Sampson, MD of the Jaffe Food Allergy Institute at Mount Sinai, said parents and caregivers who introduce peanuts at home should initially give two teaspoons of peanut butter diluted in warm water or a warm puree that the baby enjoys, followed by two more such feedings over the course of a week for a total of roughly six grams of peanut protein. The schedule should be repeated weekly.
“This needs to be done pretty consistently to establish tolerance, at least based on what we know from the LEAP trial,” he told MedPage Today.
The guidelines for low-risk infants recommend that peanut-containing foods be introduced around 6 months of age.