January 6, 2017

NIH just drastically changed its peanut recommendations for infants

Daily Briefing

    Babies should be exposed to peanut-containing foods before age 1 to help build a tolerance to peanuts, according to recommendations released Thursday by an expert panel sponsored by NIH's National Institute of Allergy and Infectious Diseases (NIAID).

    Background on peanut allergies

    Public health officials say peanut allergies are a growing concern. Research shows peanut allergy prevalence in children grew from 0.4 percent in 1999 to about 2 percent in 2010. Further, the new recommendations note that "peanut allergy is the leading cause of death related to food-induced anaphylaxis in the United States."

    Previously, pediatricians advised against introducing high-risk infants, such as those with egg allergies or a severe form of the skin rash eczema, to peanuts until age 3. However, according to the Associated Press, no benefit was shown from delaying exposure. By 2008, that recommendation was dropped, but wariness among parents has persisted.

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    Recommendation details

    The recommendations provide guidance about how to safely introduce young children to peanuts. They are based on a research review NIAID conducted between January 2010 and June 2016 that found evidence to support early introduction of peanuts. For instance, the 2015 Learning Early About Peanut (LEAP) study found that early introduction to peanut protein was linked to an 81 percent reduction in the allergy among high-risk kids.

    NIAID then tasked a panel of 26 experts—including representatives from professional organizations, federal agencies, and patient advocacy groups—to use the research review "to develop evidence-based recommendations for the early introduction of dietary peanut to prevent peanut allergy."

    Recommendations

    The panel broke the recommendations down into three categories:

    • Infants who are at high-risk of developing a peanut allergy, such as those who have severe eczema, egg allergy, or both;
    • Infants who are considered moderate risk to develop a peanut allergy, such as those who have mild to moderate eczema; and
    • Infants who are unlikely to develop a peanut allergy, such as those with no eczema or food allergies and no family history of food allergies.

    Matthew Greenhawt—a physician at Children's Hospital Colorado who chairs the food allergy committee of the American College of Allergy, Asthma, and Immunology—explained that the new guidelines are closely tied to eczema because it is an obvious external measure that has been linked to food allergies going back to the 1900s. While no one has been able to definitively explain why these conditions appear together so often, children with eczema produce a lot of immunoglobulin E antibodies, which play a role in food allergies, hay fever, and asthma.

    According to the new guidelines, infants who are deemed high-risk should visit a pediatrician or allergist as early as age 4 to 6 months to determine if they should be introduced to peanut-containing foods at a physician's office or at home under the supervision of a parent. The recommendations state that infants who are low- to moderate-risk should be exposed to peanut-based foods at home at around 6 months of age.

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    The recommendations say the initial exposure should take place when infants are healthy and parents should monitor children for signs of reaction. Afterward, peanut-based foods should be eaten about three times a week to build a tolerance, the recommendations state.

    In addition, the panel recommended that all infants be introduced to other solid foods, such as pureed vegetables and cracker puffs, before being exposed to foods that contain peanuts.

    The panel said there is a lack of evidence to determine if early exposure could help prevent other food allergies. 

    Comments

    NIAID Director Anthony Fauci called the recommendations "an important step forward." He added, "When you do desensitize [children] from an early age, you have a very positive effect."

    Panel member Matthew Greenhawt of the American College of Allergy, Asthma and Immunology said, "We're on the cusp of hopefully being able to prevent a large number of cases of peanut allergy."

    With the new guidelines introduced, John Andrew Bird, director of the Food Allergy Clinic at UT Southwestern's Children's Medical Center in Dallas, said "the hope is that pediatricians and family practitioners will come on board" (Boyles, MedPage Today, 1/5; Neergard, AP/Washington Times, 1/5; Scutti, CNN, 1/5; Cha, "To Your Health," Washington Post, 1/5).

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