How to introduce peanuts is a common question asked from parents ever since the LEAP study was published. Peanut Allergy Prevention The first step is to identify high risk infants for peanut allergy. Before introducing peanut to high risk infants, the infant should be seen by their pediatrician if an allergist referral is required. The allergist will determine if in-office testing or in-office introduction is needed.
A high risk infant is one who has severe eczema or egg allergy. The guidelines recommend peanut protein introduction (not whole peanut) is early as 4-6 months for high risk infants after determining it is safe to do so. If a child is determined to be at risk and to have sensitization, we don’t know if they are truly allergic yet. Just because a child is peanut sensitized, that does not mean they can’t tolerate peanut. The peanut sensitized infant is the one who benefitted most from the early introduction. Unless the infants skin test is very large (greater than 8 mm), in office introduction could be offered. If the child has greater than 8mm on the skin test or in office introduction shows peanut allergy, then they’ll need to avoid peanuts all together and have annual re-assessments.
Children who have mild to moderate eczema, do not need to have an evaluation and can have peanut containing foods as early as 6 months of age. Children with no eczema or no egg allergy can have peanut containing foods introduced at their parents preference.
It is extremely important that parents understand the choking hazard of giving whole peanuts to infants and not to give peanut butter to infants. An Israeli snack, Bamba is a popular peanut product to try. Peanut containing foods should not be the first solid food introduced and it should not be attempted when a child is sick.
The early introduction seems to depart from the recommendations of exclusive breast feeding for six months, but research shows that it did not affect the length or frequency of breast feeding and it didn’t negatively influence growth or nutrition.
So if you would like to introduce peanuts to your child, speak to your pediatrician or pediatric allergist how to go about it.