Feed peanuts early and often: new recommendations for peanut allergy prevention

Kristin Johnson, RD, CSP, LD, Pediatric Registered Dietitian
CentraCare Health

“When should I introduce peanuts?” Introducing peanuts and other high allergen foods is a frequent question when discussing solid food introduction during infancy. As these recommendations, have dramatically changed over the last two decades, parents may be receiving varying advice.

In 2000, the American Academy of Pediatrics recommended to delay introduction of peanuts in high-risk infants until 3 years of age. In 2008, these recommendations were revised as there was no convincing evidence that delaying the introduction of these foods, such peanuts, beyond 4-6 months of age, provided significant protective effects.

In January 2017, The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, says that babies should be exposed to peanut-containing foods before age 1 to help build a tolerance to peanuts. As highlighted in a previous blog post, the recommendations are based on a research review conducted by NIH’s National Institute of Allergy and Infectious Diseases (NIAID) between January 2010 and June 2016. 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. High-risk kids include infants with severe eczema and/or egg allergy.

Per the new recommendations, infants who are considered high-risk should visit a pediatrician or allergist as early as 4 to 6 months of age 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.

NIH says the initial exposure to peanuts 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. However, it is recommended that all infants be introduced to other foods before being exposed to foods that contain peanuts.

Remember, whole peanuts and peanut butter can be choking hazards for infants. Instead, add water to peanut butter to make a slurry or mix a little peanut butter or fine powdered peanuts into a previously introduced puree, such as infant cereal or fruit. Only a small amount is needed to build tolerance. Please be aware that this will not prevent food allergies in all children.