Peanut allergies are a significant concern for parents, causing anxiety when introducing new foods to infants. For decades, standard advice recommended avoiding highly allergenic foods. Medical guidance has undergone a dramatic reversal, shifting toward early, controlled exposure. This article details the current, evidence-based recommendations for safely introducing peanut-containing foods to infants.
The Shift in Medical Advice on Peanut Introduction
The medical community’s shift from avoidance to early introduction was driven by scientific evidence demonstrating that delayed introduction was not preventing allergies and may have been contributing to their rise. This change was prompted by the Learning Early About Peanut Allergy (LEAP) study, published in 2015. The LEAP trial focused on high-risk infants with severe eczema, an egg allergy, or both.
Researchers found that infants who regularly consumed peanut-containing food, starting as early as four months, had a significantly lower rate of peanut allergy later in childhood. By age five, children who consumed peanuts regularly experienced an 86% reduction in allergy compared to the avoidance group. This established that sustained, early introduction promotes immune tolerance, forming the basis for current global guidelines.
Current Guidelines: Timing and Risk Assessment
The timing for introducing peanuts is determined by assessing an infant’s individual risk level for developing a food allergy. Health organizations divide infants into three categories based on the presence of eczema and existing food allergies. This risk stratification dictates the optimal timing and whether prior testing is recommended.
High-Risk Infants
Infants considered high-risk have severe eczema, an existing egg allergy, or both. Introduction of age-appropriate peanut foods is recommended as early as four to six months, provided they are developmentally ready for solids. A blood test (peanut-specific IgE) or a skin prick test is strongly considered before introduction. This testing helps determine the safest method, which may include a supervised feeding with an allergist.
Moderate-Risk Infants
Moderate-risk infants have mild to moderate eczema but no known food allergies. Peanut introduction is suggested around six months of age. Introduction can be performed safely at home without a prior allergy evaluation.
Low-Risk Infants
Low-risk infants have no history of eczema or any other food allergy. These babies can have peanut-containing foods introduced freely into their diet, along with other solid foods, around six months of age. No pre-testing is necessary for this population.
For all groups, first introduce other solid foods to ensure the baby is developmentally ready. This ensures the infant can eat from a spoon and swallow purees without difficulty.
Step-by-Step Guide for Safe Introduction
The successful introduction of peanuts relies heavily on safe preparation and careful observation to mitigate both allergic and physical risks. Whole peanuts and chunky peanut butter pose a significant choking hazard and must never be given to children under four years of age. The goal is to provide the peanut protein in a smooth, easily swallowed form.
To prepare a safe mixture, smooth peanut butter should be thinned considerably with liquid. Mix two teaspoons of peanut butter with two to three teaspoons of warm water, breast milk, or formula. The resulting texture must be runny, similar to a puree, not sticky or thick. Alternatively, peanut flour or peanut puff snacks, like Bamba, can be mixed with a small amount of liquid until they form a soft paste or porridge.
The first introduction should occur at home when the infant is healthy, allowing a caregiver to observe them closely for at least two hours. Start by offering a very small amount, such as the size of a grain of rice. If no immediate signs of a reaction appear after 10 minutes, the rest of the planned serving can be given.
After successful initial exposure, continue feeding the infant peanut-containing foods two to three times per week. This sustained exposure, often aiming for about two teaspoons per serving, maintains the protective effect of tolerance. If introduction is interrupted for a week or more, especially in high-risk infants, parents should consult their doctor about the safest way to reintroduce the food.
Recognizing and Responding to Allergic Symptoms
Parents must be prepared to recognize and respond to potential allergic reactions, which occur within minutes to two hours of ingestion. Mild to moderate reactions include hives around the mouth, a new skin rash, or mild vomiting and stomach discomfort. In these cases, a non-sedating antihistamine may be administered if previously discussed and prescribed by a physician.
A severe reaction, known as anaphylaxis, requires immediate emergency intervention. Signs of anaphylaxis include difficulty or noisy breathing, a sudden hoarse cry or voice, or swelling of the tongue or throat. Other severe signs are the baby becoming pale, floppy, or suddenly sleepy. If any of these severe symptoms appear, call emergency services immediately.
If an epinephrine auto-injector has been prescribed, use it at the first sign of a severe reaction, even before calling for emergency medical help. It is important to note that reactions can vary in severity, and a child’s reaction to a food is unpredictable, so all reactions should be taken seriously and discussed with a healthcare provider.