(Editor's note: Story updated Jan. 5, 2017, to reflect the National Institutes of Health releasing new guidelines.)
Nov. 14, 2016 -- Parents are learning that the old advice to wait to give babies peanuts or peanut-containing foods until they’re at least a year old was wrong.
The National Institutes of Health has officially released new guidelines aimed at preventing children from facing serious and sometimes lifelong struggles with peanut allergies.
The new guidelines reverse years of advice, calling for much earlier introduction of peanut-containing foods. Experts now agree that all infants should start regularly eating foods made with peanuts -- like peanut butter -- much earlier, around 6 months of age.
Infants who have the highest chances of developing a peanut allergy -- because they have severe eczema, an egg allergy, or both -- need the most regular exposure to peanut-containing foods, according to the guidelines, but only after they've been tested and cleared by a doctor to start a regular peanut routine.
“Living with peanut allergy requires constant vigilance. Preventing the development of peanut allergy will improve and save lives and lower health care costs,” says Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”
The guidelines take their cues from a highly regarded study published in 2015 found that early exposure can slash a child’s chances for developing peanut allergies by about 80%.
The study left many parents and doctors with questions about exactly how to work peanuts into a baby’s diet, especially since the whole nuts themselves are a choking hazard: How much and how often do babies need to eat to see a benefit? And what if your baby is considered as having a high chance of getting a peanut allergy?
Experts say the first thing to consider is your child’s chance of having an allergy. Early exposure is particularly beneficial for a group of children who are vulnerable to developing a peanut allergy because they’ve got other things that raise their odds -- like a moderate to severe case of the skin condition eczema, an allergy to eggs, or both.
(Lots of babies get a little eczema from time to time. That doesn’t necessary mean they have a higher chance of having a peanut allergy. Doctors are most worried about kids who need longer or more frequent treatment with steroid creams to clear their skin, or kids that have eczema on a large portion of their bodies.)
If they don’t have either of those risk factors, you should still feed them peanuts, but you can be fairly casual about it. You don’t need to worry so much about how much or how often. Just start offering them some peanut-containing foods sometime before their first birthday -- that’s supposed to be the optimal window for training the immune system.
“There’s a magic window where we can take advantage of the developing immune system where we can promote tolerance by introducing it,” says David Stukus, MD, a pediatric allergist at Nationwide Children’s Hospital in Columbus, OH, and one of the authors of the new guidelines.
Stukus says peanut butter -- especially the powdered kind -- is a good choice for this. It can be thinned with water, milk, or juice or mixed into applesauce or baby cereal. Peanut puffs called Bamba, which are fed to babies in Israel as one of their first foods, can also be ordered online.
If your child is in the at-risk group, it’s important not to feed them anything with peanuts until they can be evaluated by a doctor. At the doctor, they’ll be given a blood test or a skin test to see if they are already having an immune response to the peanut protein.
“If it’s negative, you’re good to go. You can introduce at home,” Stukus says. The goal is to get them to eat about 2 teaspoons of peanut butter about three times a week.
If they are reacting, your next steps will depend on exactly how strong their initial reaction is. Babies who experience a mild to moderate reaction can still benefit from an early peanut introduction, but it needs to start in the doctor’s office so they can be monitored in case they start showing symptoms like hives, trouble breathing, or a drop in blood pressure.
“Those are the kids who really benefit the most because they’re sensitized. We don’t know if they’re allergic yet. They’re at the highest risk of reacting later in life if they don’t eat it early,” Stukus says.
As long as the in-office feeding goes well, families can continue at home and should be a little stricter about the routine -- working to incorporate 2 teaspoons of peanut butter a minimum of three times a week.
“I’m thrilled to finally have these guidelines,” Stukus says. “This is amazing. This is one of the greatest breakthroughs because we’re talking about prevention of allergy in the first place. If we can prevent them from becoming allergic in the first place, this is truly remarkable.”