Sheila is a new mom whom you’ve been counseling for the past few months to help her with postpartum weight loss. Now that her infant daughter is 5 months old, she’s starting to think about introducing solid foods and asks for your recommendations. Her sister says she should wait to introduce peanuts until her daughter is at least age 3, since that’s what her pediatrician told her when her kids were younger. Her neighbor, the nurse, says she can introduce peanuts after one year. She also heard a news report that said early introduction of peanuts could help prevent peanut allergy. She’s interested in knowing more about when and how to introduce peanuts, since she’s received mixed information.
Even if you don’t practice pediatric nutrition, you’ll probably be asked about this important and changing issue, and all RDs need to know what the latest guidelines recommend. Fortunately, the National Institute of Allergy and Infectious Diseases-sponsored expert panel just released new guidelines to help answer these common questions.
With as many as 2% of children diagnosed with peanut allergy, prevention is key. Based on the Learning Early About Peanut Allergy (LEAP) Study published in early 2015, early introduction of peanut foods to infants at high risk (those with severe eczema or egg allergy, or both) of developing peanut allergy reduced peanut allergy by 86%. This remarkable study finding resulted in the rapid adoption of recommendations to introduce peanuts early to slow the increase in the numbers of children with peanut allergy. The new guidelines explain in detail how and when early introduction should be done, and for whom.
Here’s a brief summary of some of the new recommendations:
- Infants are broken down into three risk groups: 1. Those with severe eczema or egg allergy or both are considered highest risk; 2. Infants with mild to moderate eczema are considered to be at some risk; 3. If a child has no allergy or eczema, they aren’t categorized as at risk.
- For those at highest risk, an assessment by a health professional is recommended. Health care providers may recommend a blood serum IgE test or skin prick test to assess potential allergy or refer to a specialist. Depending on the results, oral introduction may be done at home, in the doctor’s office, or not at all. If introduction is recommended, infants should receive age-appropriate peanut foods starting as early as 4 to 6 months, in the amount of 2 g peanut protein three times per week. They should be monitored for two hours after introduction.
- If infants are at moderate risk, the guidelines recommend introducing peanut at home, but caregivers or health professionals may choose to introduce peanut foods in the office. The infant should receive age-appropriate peanut foods starting at 6 months, in the amount of 2 g peanut protein three times per week.
- Those infants considered not at risk can be fed peanut foods in whatever way is preferred by the family starting at 6 months.
RDs should be ready to advise clients and patients on the guidelines and what their next steps should be. For those who fall into the at-risk groups, refer them to their pediatrician or allergist for evaluation. In those not at risk—which will be most children—encourage introduction and help clients overcome fears of a reaction with facts about the importance of this potentially preventative step. Easy ways to introduce peanut protein include mixing 2 tsp peanut butter or powdered peanut butter into 2 to 3 T of infant cereal or puréed fruits or vegetables, or just thinning it with some warm water. Parents also can purchase packaged products such as Bamba brand peanut puffs, but this is unnecessary.
Dietitians should read the details of the guidelines to understand the nuances. For instance, the guidelines provide specific information on how much peanut protein is in common peanut-containing foods, as well as recipes for safe and easy introduction. Early introduction will prevent peanut allergy in many infants and may significantly reduce the burden of peanut allergy for future generations. Let’s spread the word.
— Sherry Coleman Collins, MS, RDN, LD, maintains a private practice in the metro-Atlanta area with a focus on food allergies, whole-health wellness, and nutrition communications. She serves as an expert consultant and spokesperson for the National Peanut Board. Keep up with Sherry at www.southernfriednutrition.com and by following DietitianSherry on Twitter, Facebook, and Instagram.