Infants at high risk for peanut allergies should be given foods containing peanuts before they reach the age of 1 year, a new consensus statement from 10 medical groups states.
The interim guidance, which runs counter to conventional thought, was issued by the American Academy of Pediatrics and other expert groups in response to a study published in February that found early exposure to peanut products reduced the risk of a peanut allergy developing by 80 percent. The statement will be published in the September issue of the journal Pediatrics.
When the study was published in the New England Journal of Medicine, lead researcher Dr. Gideon Lack, from the department of pediatric allergy at King's College London in England, noted that introducing peanut products early was safe and well tolerated. Infants were not given whole peanuts because of the risk of choking.
"Eating peanut [products] in the first year of life protects against the development of peanut allergy in a high-risk group of children," Lack said at the time. "This is the exact opposite of what was recommended."
Peanut products used in the study included smooth peanut butter, peanut soup and ground peanuts added to other foods.
Dr. Rebecca Gruchalla, co-author of an editorial that accompanied the New England Journal of Medicine study, said, "This study clearly shows that early introduction of peanut [products] leads to a decrease in peanut allergy."
Gruchalla, who's with the departments of internal medicine and pediatrics at the University of Texas Southwestern Medical Center at Dallas, cautioned, however, that giving peanut products to high-risk infants needs to be done in consultation with a pediatrician and an allergy specialist.
Peanut allergy and other allergies have been increasing around the world, she said. Why this is so isn't clear. "That's the million dollar question. Is it lifestyle changes? Is it food changes? Is it genetic? We don't know," she added.
In the study, Lack's team selected 640 infants, aged 4 months to 11 months, who were at high risk of developing peanut allergy.
The babies were randomly selected either to eat at least 6 grams of peanuts in food served three or more times a week, or to avoid peanut products until they were 5.
Lack said that even some children who could not tolerate peanuts developed some immunity. Overall, at age 5, the prevalence of peanut allergy in all children who ate peanut products was just over 3 percent, compared with slightly more than 17 percent among those who avoided foods or snacks with peanuts in them, the researchers found.
"This is a greater than 80 percent reduction in the prevalence of peanut allergy," Lack said.
Lack recommended that infants at risk for peanut allergy have a skin test at 4 months of age. If the test is clear, they should be given peanut products regularly until 5 years of age.
If the skin test shows a reaction to peanut, then they should have a challenge to peanut under a doctor's supervision. If they tolerate it, then they should continue eating peanut products. If they cannot tolerate the challenge, then they will need treatment to manage the allergy, Lack said.