Some babies should be given peanuts early say new US guidelines

"Babies should be given peanut early – some at four months old – in order to reduce the risk of allergy, according to new US guidance," BBC News reports. The guidelines are based on UK-led research that found early exposure reduced allergy risk.

The new US guidelines, which are informed by expert panel discussions and a new UK study, suggest that if an infant has severe eczema or an egg allergy, peanuts may be introduced at around four to six months. And that waiting later may increase the risk of an allergy developing.

However, they suggest checking with a health professional first if the infant does have these severe allergies.

For babies with no signs of allergies or mild to moderate eczema the new US guidelines recommend that peanuts can be introduced without seeking medical advice.

Current UK guidelines say that if your child already has an allergy (such as eczema or a diagnosed food allergy), or there's a family history of allergy, you should get medical advice before giving them peanuts for the first time. See Food allergies in babies.

If there's no history of food allergies or other allergies in your family, UK guidelines say you can give your baby peanuts from the age of six months, as long as they're crushed or ground into peanut butter. Whole nuts, including peanuts, shouldn't be given to children under five as they can choke on them. See Food to avoid giving your baby.

Who produced the guidelines?

The guidelines were produced by the National Institute of Allergy and Infectious Diseases, part of the Department of Health and Human Services, National Institutes of Health in the US.

What evidence did they look at?

Despite the guidelines being for the US, they are actually based on research from the UK; specifically a clinical trial called the Learning Early About Peanut Allergy (LEAP).

LEAP was a randomised controlled trial (RCT) involving 600 children aged between 4 and 11 months with severe eczema, egg allergy or both. The babies were randomised to eat or avoid peanut-containing foods (but not whole nuts) until 60 months of age.

At the age of five the children were given a "peanut oral food challenge" which involves exposing the mouth to a small amount of peanuts (2 to 3.9g) to see if there was any allergic reaction(s).

The researchers found that regular consumption of peanut-containing foods in early life reduced the risk of developing a peanut allergy by 81%.

We discussed this study in detail in February 2015.

Along with this evidence, the guideline committee also carried out a literature review of recent research and asked an expert panel, consisting of 26 experts from clinical, public health and scientific backgrounds, to contribute to the guidelines.

What are the main recommendations?

Based on the evidence considered by the authors, three guidelines have been produced:

• Guideline one – designed for parents who know their infant has severe eczema, egg allergy or both.
• Guideline two – designed for parents who know their infant has mild to moderate eczema.
• Guideline three – designed for parents who have an infant with no history of eczema or food allergies.

Guideline one

Peanut-containing foods should be introduced as early as 4-6 months for infants with severe eczema, egg allergy or both.

However, parents should check with the doctor in charge of their child's care before feeding them peanut-containing food.

In some cases an allergy test may be needed to determine if peanut should be introduced and the safest way of doing so. The suggested amount to introduce is around 6 to 7 grams per week, divided over three feeds.

Guideline two

For infants with mild to moderate eczema, peanut-containing foods should be introduced around six months to reduce risk of developing a peanut allergy. This should be done in line with the family's dietary preferences – if peanuts are not part of everyday diet, they do not have to be introduced at such an early stage.

Guideline three

For infants with no eczema or food allergy, peanut-containing foods can be introduced freely into their diet. This can be done at home in an age-appropriate manner, along with other solid foods.

How have independent experts received the guidelines?

As these are US guidelines, the current official UK guidelines on peanuts and diet are currently unchanged. UK advice is:

• If your baby already has an allergy (such as eczema or a diagnosed food allergy), or there's a family history of allergy, you should get medical advice before giving them peanuts for the first time. See Food allergies in babies.
• If there's no history of food allergies or other allergies in your family, you can give your baby peanuts from the age of six months, as long as they're crushed or ground into peanut butter. Whole nuts, including peanuts, shouldn't be given to children under five as they can choke on them. See Food to avoid giving your baby.

That said, many UK experts have welcomed the new US guidelines.

Michael Walker, member of the European Academy of Allergy and Clinical Immunology said: "The guidelines are based on sound medical research carried out in the UK. For infants with severe eczema or egg allergy or both, and thus most at risk, the guidelines suggest clinical tests before a decision to introduce peanut-containing foods. Infants at less risk, e.g. mild eczema, or no eczema, can receive peanut-containing food from about 6 months, subject to family preferences and cultural norms. This is sensible advice that I am sure UK authorities will wish to think about."

He recommends parents in the UK should consult their GP, bringing to attention these US guidelines before attempting peanut allergy prevention in their own infant.

Alastair Sutcliffe, a Professor of Paediatrics at UCL also welcomes these new US guidelines. He said "the USA leads as is often the case where others follow and I, as a practicing paediatrician, welcome this new guidance".

However, Prof. Alan Boobis, Professor of Biochemical Pharmacology at Imperial College London, pointed out that: "The implications of these findings, with the possible introduction of solid food prior to 6 months, are complex."

The advice is currently being reviewed by the Department of Health and a related report is expected in the first half of the year.