Introducing Your Infant to Allergens: Understanding the Latest Recommendations

Food Allergy Center

The Food Allergy Center at Mass General for Children specializes in transitional care through adolescence into adulthood.
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The National Institute of Allergy and Infectious Disease (NIAID) recently published new guidelines aimed at preventing the development of peanut allergy, in response to a recent clinical trial called Learning Early About Peanut Allergy, or LEAP, conducted by the Immune Tolerance Network.

The randomized study divided 600 infants, at high risk for developing peanut allergy in to two controlled groups. The consumption group regularly consumed peanut-containing food and the other; the avoidance group was asked to refrain from any peanuts or their products. The researchers found that those children who were regularly exposed to peanut-containing foods at an early age were 81% less likely to develop an allergy.

Wayne Shreffler, MD, PhD, the chief of Pediatric Allergy and Immunology and director of the Food Allergy Center at Massachusetts General Hospital, provides insight into the updated recommendations and their potential implications for patient care.

Q: The clinical trial began with infants who were then monitored until age five. How early do peanut allergy symptoms arise and what signs should parents look for?
A:  I would advise parents to introduce peanut products into a child’s diet as early as 4 months, but no later than 11 months. Food allergy in children is a serious and growing health concern affecting one in 20 children; however peanut and other common allergen avoidance can actually lead to its development. Symptoms of a peanut allergy frequently include hives, skin rashes, trouble breathing, tongue or lip swelling or sneezing, appearing quickly after exposure.

Q: What are the new NIADI guidelines?
A: Babies included in the LEAP trial were at a higher risk of developing an allergy because they already exhibited eczema, egg allergy, or both. Based on the severity of a child’s skin condition and sensitivities, the NIADI outlined the below preventive measures:

High severity: Introduce peanut-containing foods as early as 4 to 6 months, reducing changes of developing the allergy. However, first check with your pediatrician as he or she may recommend blood tests or specialist evaluation. These results can better inform both parent and clinician on the safest way to introduce foods. 

Mild to moderate sensitivity: Add peanut products to your child’s diet at around 6 months old. Young children should never be given whole peanuts as for risk of choking. Ideally, if a family does not regularly consume peanuts or their products, parents can insert them into a child’s diet at an older age.

No sensitivity: Parents can begin peanut-containing foods when solids are introduced. Like those children with mild to moderate eczema or egg allergies, family routines should be taken into consideration.   

Q: How likely is it that the new guidelines will decrease the number of children with peanut allergies?
A: For every four to five high-risk children who we introduce peanuts to as an infant, we expect to prevent one case of peanut allergy. We hope to see the impact of these new guidelines over time by observing lower prevalence of peanut allergy in young children.