New peanut guidelines have been officially introduced by the National Institute of Allergy and Infectious Diseases in response to the earlier studies we have discussed from the LEAP trials.
Peanut allergy is a growing public health problem. In the United States, peanut allergy prevalence is approximately 2% among children. Peanut allergy is the leading cause of death related to food induced anaphylaxis in the United States. In 2015, the New England Journal of Medicine published results from the Learning Early about Peanut Allergy (LEAP) trial. The study concluded that early introduction of peanut into a babies diet significantly reduced the onset of peanut allergy (13.7% to 1.9%).
Since this landmark study, peanut guidelines have been introduced to recommend how and when to introduce peanuts to babies.
Children with no eczema or food allergy
These children do not need any evaluation and peanut can be introduced in accordance with family preferences and cultural practices.
Mild to moderate eczema
Introduce peanut containing foods around 6 months of age. Bamba, a popular Israeli peanut snack is commonly used when introducing peanut products at that age.
Severe eczema or Egg Allergy
The peanut guidelines are not so simple for children who fall into this category. For children who fall into this category, they will need to be referred to an allergy specialist or a pediatric allergy doctor to better evaluate these children. A peanut skin test or a peanut IgE blood test should be done. If either testing is negative, at approximately 4-6 months of age, peanut products can either be introduced at home or as a supervised feeding in the office.
If the IgE allergy blood test is positive, depending on how positive, an allergist may or may not do a skin test. If the skin test is negative, they should be observed ingesting the peanut in the office. If the skin test is between 3-7 millimeters, an oral graded challenge should be performed in a specialized facility. If the skin test is greater than 8 millimeters, the infant is probably allergic to peanut and he/she should continue evaluation and management by an allergy specialist.
These peanut guidelines helps providers with early introduction of peanut-containing foods in infants at various risk levels for peanut allergy. Early introduction of peanut will results in the prevention of peanut allergy in a large number of infants.
Always speak to your pediatrician or pediatric allergist before giving any peanut products the first time at home.
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