New guidelines for peanut allergies

New guidelines for peanut allergies

Are you concerned about your baby developing a peanut allergy? New guidelines recommend introducing peanuts before age 1 in some children.

A common and severe food allergy

Peanut allergy is one of the most common food allergies in the U.S. Up to 2 percent of children and adolescents are allergic to the legume — and that number has doubled in Western nations over the last 10 years.

Peanut allergy, a severe and potentially fatal immune response to certain peanut proteins, develops early in life and is rarely outgrown. Why some children develop peanut allergies or why the prevalence has grown in recent years is unknown.

Introducing peanuts at a younger age

For many years, national guidelines recommended that women avoid peanut consumption during pregnancy and while breastfeeding. These same guidelines recommended that children under age 1 should not be given peanuts.

However, a 2015 study in The New England Journal of Medicine shows that early introduction of peanuts to babies at high risk for allergy reduces the development of peanut allergy later in life by about 80 percent.

As a result, the National Institute of Allergy and Infectious Diseases released new guidelines in January 2017 for peanut allergy prevention. They provide specific recommendations depending on the child’s risk of developing peanut allergy:

  • Babies at high risk of peanut allergy: Infants with severe eczema and/or egg allergy are at high risk of developing a peanut allergy. Parents should schedule a doctor’s visit for an allergy blood test, a skin prick test or both to determine whether it is safe to give the baby peanuts. If these tests show the baby does not have a peanut allergy and the doctor approves, you can introduce peanut-containing food at home as early as 4 to 6 months of age. Alternately, test results may show that introducing peanuts should be done under supervision in a doctor’s office.
  • Babies less likely to have a peanut allergy: Parents can give infants with mild or moderate eczema foods containing peanuts around 6 months of age, while at home and without prior allergy testing.
  • Babies at low risk of peanut allergy: Infants without eczema or any food allergy are at low risk of developing a peanut allergy.  Parents can freely introduce peanut-containing foods when their baby is ready to eat solid foods.

If your baby meets the criteria for early peanut consumption, waiting offers no benefit, according to Maria Garcia-Lloret, MD, UCLA pediatric immunologist. “Babies are born with an immune system that has an enormous capacity to adapt to the environment and early exposure to certain allergens facilitates tolerance,” she says.

Peanut safety

Talk to your baby’s doctor about safe ways to incorporate peanuts into his or her diet. Because a spoonful of peanut butter or whole peanuts are choking hazards, try small amounts of watered-down peanut butter instead.

Most peanut reactions in infants occur within seconds to minutes of ingestion and many happen on first exposure. Signs and symptoms may include:

  • Severe itching in and around the mouth
  • Lip and eyelid swelling
  • Skin flushing
  • Hives

More severe symptoms that may require immediate medical attention include:

  • Coughing
  • Difficulty breathing
  • Restlessness
  • A pale appearance
  • Vomiting

If you’re concerned about peanut allergy in your child, schedule an appointment with an allergy and immunology physician at UCLA Mattel Children's Hospital.

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