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Health & Safety

New Guidelines Aim to Prevent Peanut Allergy

Surprising new allergy-prevention recommendations suggest introducing foods with peanuts at an early age

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In a surprising recommendation, the National Institute of Allergy and Infections Diseases issued new guidelines about babies and foods with peanuts. The guidelines, published in the Annals of Allergy, Asthma & Immunology and endorsed by the American Academy of Pediatrics (AAP), are a major switch from past recommendations that kids at high-risk for allergies avoid peanuts until age 3.

But recent studies have supported a change-one study found that kids who avoided peanuts until age 3 had ten times the rate of peanut allergies as kids who ate peanut foods during the first year of life. Another study had some children start eating peanut-containing food on a regular basis between 4 and 11 months of age, while others avoided peanuts until age 5. The group that ate peanut-containing products early had an 80 percent reduction in the risk of developing a peanut allergy.

"That was the major push behind the change in the guidelines," explains Dr. Matthew Greenhawt, co-author of the new guidelines and chairman of the American College of Allergy, Asthma, and Immunology's food allergy committee. "It seems there is a critical window in which the body can be exposed to a potential high-risk food and learn to tolerate it. For peanuts, that time appears to be between 4 and 6 months, and such an early introduction offers the best chance to reduce the risk your child will develop a peanut allergy."

Here's what to know about the new guidelines (though keep in mind you should always consult your child's doctor to decide what's right for your baby.)

Know your child's risk.The new recommendations are divided into three categories based on a baby's risk for developing a peanut allergy. For babies who are high-risk (they have severe asthma and/or an egg allergy), parents should ask their pediatrician for a referral to an allergist for peanut allergy testing when their child is between 4 and 6 months.

If there's no sign of allergy, parents should talk to their doctor about introducing foods with peanuts before 6 months. If the testing is positive, they should discuss with their doctor whether to expose their child to peanuts under medical supervision or avoid them. For children with moderate risk (those with mild to moderate eczema) or low allergy risk, you can feed your baby peanut-based foods before 6 months once she's started solids.

Avoid choking hazards. "By 'peanut' we mean age-appropriate peanut-containing products," says Dr. Greenhawt. "Whole peanuts should never be given to a child under the age of 4 as these are a choking hazard." Instead, offer a peanut-containing puff or add peanut butter powder or thinned peanut butter (mix it with warm water to create a soupy consistency) to baby food or cereal. (Chunks of peanut butter are also a choking hazard.)

Don't put peanuts first. When you start your baby on solids-which you should do under the guidance of your pediatrician-don't make peanuts your kid's first food. However, once you do offer age-appropriate peanut-containing foods, feed them to your child regularly-ideally three times a week throughout the first few years of life.

Keep calm during pregnancy. There are no current recommendations that pregnant or nursing women should avoid eating peanut-containing products to help prevent peanut allergies in their baby.

Take it slow. When you expose your infant to food with peanuts, do so a bit at a time and watch for reactions such as the development of hives, coughing, wheezing, vomiting, or the baby becoming lethargic within a few minutes to a few hours. Seek immediate medical care if this occurs.

Be cautiously optimistic. "If there is a high-level of buy-in from parents and providers, and the recommendations are followed, potentially tens of thousands of cases of peanut allergy each year could be prevented," says Dr. Greenhawt. "However, parents should be aware that while these guidelines will help decrease the risk of developing a peanut allergy, it unfortunately won't prevent all possible cases."