Pureed peanuts advised for infants to stave off allergy

Feeding pureed peanut products regularly to babies before their first birthday could reduce their risk of developing peanut allergies later on, doctors advise.

In a practice guide for health care providers published in CMAJ, a team of pediatricians and allergy specialists encourage introducing peanuts in pureed or powdered form as early as age 4 months for most babies, and making sure the babies continue to get exposure to “substantial” amounts of peanut products in their first years of life.

However, the allergy status of the baby should be checked with a doctor in advance, said one of the guide’s authors, Dr. George du Toit of King’s College London in the UK.

He added that at-home introduction of peanut products is best suited for infants who do not have eczema, or have only a mild form of the skin disorder.

The hardest part of implementing the current guidelines regarding peanut exposure for babies is that they “are a complete reversal from the prior practice of delaying peanut exposure,” said Dr. Ruchi Gupta of the Northwestern University Feinberg School of Medicine in Chicago, a pediatrician and food allergy researcher who wasn’t involved in the practice guide.

“There’s also resistance from parents because they’re fearful about doing this at home with their infants and what may happen,” she told Reuters Health in a phone interview.

Peanut allergies typically develop before age 2. These allergies are a constant worry for parents, who need to closely monitor everything their kids eat inside and outside the home.

Allergic reactions to peanuts can include skin rashes and blisters, difficulty breathing, low blood pressure, nausea and vomiting, and swelling of the tongue, eyes or face. In severe cases, a peanut reaction can be fatal unless halted with an injection of epinephrine.

As a result, doctors previously advised parents to avoid giving peanut products to babies. But a 2015 study prompted a rethink of the guidelines.

The trial included 640 babies younger than 11 months with either egg allergy or eczema - both risk factors for developing peanut allergy. But researchers found that when these high-risk infants were fed a small amount of peanut butter 3 times a week, only 3% went on to develop peanut allergy after 5 years, while 17% of children who avoided peanuts during infancy became allergic.

In the practice guide, a team of pediatricians and allergy specialists recommends introducing peanut protein to babies aged between 4 and 6 months in the form of paste, butter or powdered puff as one of the first foods during the process of weaning off breast milk.

“A lot of people assume that this just means feed it to (babies) once but it is really important that you feed repeatedly and over a longer period of time so that the immune system actually learns to tolerate it,” said Gupta’s colleague Christopher Warren, also of the Feinberg School of Medicine, who joined her on the phone interview.

Guidelines from the U.S. National Institute of Allergy and Infectious Diseases recommend checking the allergy status of high-risk infants through the skin-prick method or specific immunoglobulin E (IgE) testing before introducing peanuts. The allergy societies of Canada, Australia and the UK don’t mandate this test, the authors write.

The method of early introduction has also been tested with other major allergenic foods such as milk, egg, sesame, fish and wheat, but the protective effect of early introduction of these foods in a child’s diet was most pronounced in the case of peanuts and eggs, experts noted.

Parents should look out for signs of vomiting, choking, rashes, swelling of the lips or an extreme dislike for the food, which could signal the onset of an allergic reaction. But very few infants develop the more severe symptoms such as breathing difficulty or low blood pressure, Gupta said, and doctors are likely to recommend consulting with an allergy specialist to see if the baby could try peanuts again under medical supervision.