05 Jan When Should Babies Eat Peanut-Containing Foods?
MedicalResearch.com Interview with:
Dr. Anna Nowak-Wegrzyn
Anna Nowak-Wegrzyn, MD
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
Jaffe Food Allergy Institute
New York, NY 10029
MedicalResearch.com: What is the background for this study?
Response: Peanut allergy can be fatal, is usually life-long and has no cure. Considering a dramatic increase in prevalence of peanut allergy over the past decades, affecting estimated 2-3% of infants and young children in the US, there is a dire need for prevention. Prior studies determined that risk of peanut allergy is highest in the infants with severe eczema, those with mutations in filaggrin gene resulting in an impaired skin barrier function and those not eating peanut but exposed to peanut in the household dust. In addition, the prevalence of peanut allergy was 10-fold higher among Jewish children in the United Kingdom compared with Israeli children of similar ancestry. In Israel, peanut-containing foods are usually introduced in the diet when infants are approximately 7 months of age and consumed in substantial amounts, whereas in the United Kingdom children do not typically consume any peanut-containing foods during their first year of life.
Based on these observations, a landmark clinical trial (Learning Early about Peanut Allergy, LEAP) has been designed to evaluate whether early introduction of peanut into the diet of infant considered at high risk for peanut allergy can reduce the risk of peanut allergy compared to avoidance of peanut. LEAP and other studies suggested that peanut allergy can be prevented by introduction of peanut-containing foods in infancy. The overall reduction in peanut allergy among the infants in the LEAP trial randomized to an early introduction group compared to those who avoided peanut until age 5 years was 81%.
MedicalResearch.com: How are infants defined as high, low or intermediate risk of peanut allergy?
Response: Many studies reported that infants with severe eczema, egg allergy or both, are at the highest risk to become allergic to peanut. Infants with mild to moderate eczema might be considered at an intermediate risk, whereas infants without eczema and any food allergy are considered at low risk for peanut allergy.
MedicalResearch.com: What are the main guideline recommendations?
Response: The guidelines recommend introducing peanut-containing foods in an age-appropriate forms to infants at risk (with severe eczema, egg allergy or both), preferably during breast feeding, starting at the age 4-6 months. The document provides practical recommendations on safe introduction of peanut to such infants. In addition, the guidelines recommend introducing peanut to infants with mild-moderate eczema around 6 months of age. For infants without eczema or any food allergy, free introduction of peanut in the diet, together with other solid foods that are age-appropriate, as per family preferences is recommended.
MedicalResearch.com: What should readers take away from your report?
Response: It is critically important to implement the early peanut introduction guidelines for the infants with severe eczema or egg allergy. Primary care providers and parents should be made aware of the preventative potential of this early intervention, even if initiated at an age older than 4-6 months.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: It is important to educate the caregivers that following initial introduction, peanut should be continued in the diet at least 3 times per week. In the LEAP study, regular peanut intake was continued until the age 5 years. No doubt, this may prove challenging to many families but the effort is well worth making! We don’t have a cure for peanut allergy so the strategy proven to prevent peanut allergy is priceless!
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
NIAID guidelines regarding the introduction of peanut-containing foods to infants at risk of peanut allergy:
https://www.niaid.nih.gov/diseases-conditions/food-allergy
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on January 5, 2017 by Marie Benz MD FAAD