Peanut Allergy: Early Exposure Is Key to Prevention
Posted on by Dr. Francis Collins
With peanut allergy on the rise in the United States, you’ve probably heard parents strategizing about ways to keep their kids from developing this potentially dangerous condition. But is it actually possible to prevent peanut allergy, and, if so, how do you go about doing it?
There’s an entirely new strategy emerging now! A group representing 26 professional organizations, advocacy groups, and federal agencies, including the National Institutes of Health (NIH), has just issued new clinical guidelines aimed at preventing peanut allergy . The guidelines suggest that parents should introduce most babies to peanut-containing foods around the time they begin eating other solid foods, typically 4 to 6 months of age. While early introduction is especially important for kids at particular risk for developing allergies, it is also recommended that high-risk infants—those with a history of severe eczema and/or egg allergy—undergo a blood or skin-prick test before being given foods containing peanuts. The test results can help to determine how, or even if, peanuts should be introduced in the youngsters’ diets.
This recommendation is turning older guidelines on their head. In the past, pediatricians often advised parents to delay introducing peanuts and other common causes of food allergies into their kids’ diets. But in 2010, the thinking began shifting when a panel of food allergy experts concluded insufficient evidence existed to show that delaying the introduction of potentially problematic foods actually protected kids . Still, there wasn’t a strategy waiting to help prevent peanut or other food allergies.
As highlighted in a previous blog entry, the breakthrough came in 2015 with evidence from the NIH-funded Learning Early about Peanut Allergy (LEAP) trial . That trial, involving hundreds of babies under a year old at high risk for developing peanut allergy, established that kids could be protected by regularly eating a popular peanut butter-flavored Israeli snack called Bamba. A follow-up study later showed those kids remained allergy-free even after avoiding peanuts for a year .
Under the new recommendations, published simultaneously in six journals including the Journal of Allergy and Clinical Immunology, all infants who don’t already test positive for a peanut allergy are encouraged to eat peanut-enriched foods soon after they’ve tried a few other solid foods. The guidelines are the first to offer specific recommendations for allergy prevention based on a child’s risk for peanut allergy:
- Infants at high risk for peanut allergy—based on severe eczema and/or egg allergy—are suggested to begin consuming peanut-enriched foods between 4 to 6 months of age, but only after parents check with their health care providers. Infants already showing signs of peanut sensitivity in blood and/or skin-prick tests should try peanuts for the first time under the supervision of their doctor or allergist. In some cases, test results indicating a strong reaction to peanut protein might lead a specialist to recommend that a particular child avoid peanuts.
- Infants with mild to moderate eczema should incorporate peanut-containing foods into their diets by about 6 months of age. It’s generally OK for them to have those first bites of peanut at home and without prior testing.
- Infants without eczema or any other food allergy aren’t likely to develop an allergy to peanuts. To be on the safe side, it’s still a good idea for them to start eating peanuts from an early age.
Once peanut-containing foods have been consumed safely, regular exposure is key to allergy prevention. The guidelines recommend that infants—and particularly those at the greatest risk of allergies—eat about 2 grams of peanut protein (the amount in 2 teaspoons of peanut butter) 3 times a week.
Of course, it’s never a good idea to give infants whole peanuts, which are a choking hazard. Infants should instead get their peanuts in prepared peanut-containing foods or by stirring peanut powder into other familiar foods. They might also try peanut butter spread on bread or crackers.
In recent years, peanut allergy in the U.S. has nearly quadrupled, making it the leading cause of death due to severe, food-related allergic reactions. The hope is that, with widespread implementation of these new guidelines, many new cases of peanut allergy can now be prevented.
 Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Togias A, Cooper SF, Acebal ML, et al. Pediatr Dermatol. 2017 Jan;34(1):e1-e21.
 Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. NIAID-Sponsored Expert Panel., Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA Jr, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM. J Allergy Clin Immunol. 2010 Dec;126(6 Suppl):S1-58.
 Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; the LEAP Study Team. N Engl J Med. 2015 Feb 23.
 Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. Du Toit G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, Brough HA, Santos AF, Harris KM, Radulovic S, Basting M, Turcanu V, Plaut M, Lack G; Immune Tolerance Network LEAP-On Study Team..N Engl J Med. 2016 Apr 14;374(15):1435-43.
Guidelines for Clinicians and Patients for Diagnosis and Management of Food Allergy in the United States (National Institute of Allergy and Infectious Diseases/NIH)
Food Allergy (National Institute of Allergy and Infectious Diseases/NIH)
Learning Early about Peanut Allergy (LEAP) Study
NIH Support: National Institute of Allergy and Infectious Diseases