Tuesday, Jan. 10, 2017

On Jan. 5, an expert panel sponsored by the National Institutes of Health published new clinical guidelines for pediatric peanut allergy prevention. Santhosh Kumar, M.D., assistant professor of pediatrics, Division of Allergy and Immunology at Children’s Hospital of Richmond at Virginia Commonwealth University, answered questions about the new guidelines and what they mean for children and their parents.

What are the new peanut allergy prevention guidelines?

The guidelines are new in that they address evidence that has been accumulating over the last couple years into formal guidelines for general practitioners and other specialists.

The new guidelines recommend an early introduction of peanuts to infants as young as four months of age as long as they are able to tolerate other solid foods. This early introduction is not without risk. Infants with no history of allergies, eczema or family history of allergies are at the lowest risk of developing a peanut allergy. Infants with a history of eczema or other food allergies are at the highest risk of developing a peanut allergy. It is recommended for every infant to be assessed on an individual basis for early peanut introduction. Based on evidence, however, there is a substantial reduction in peanut allergy in infants who consume peanuts early in life.

How can this change help prevent peanut allergies in children?

Early peanut introduction has been shown to significantly reduce the incidence of peanut allergy.

Do these guidelines also include tree nuts, such as almonds, cashews, pistachios and macadamia nuts?

The new guidelines do not address early tree nut introduction. Although it makes sense to apply the same principles for tree nuts, waiting for additional well-conducted studies might be reasonable before applying the same principles to tree nut introduction. On the other hand, patients with no risk for allergies, meaning no eczema, food allergies or a family history of food allergies, should continue to introduce allergenic foods without restrictions.

Should parents give infants food containing peanuts if there is a family history of peanut allergies?

For infants at high risk (with an egg allergy, eczema or family history of peanut allergy), an evaluation by an allergist might be the first step before an introduction of peanuts.

What are the best ways to introduce your infant to peanuts?

There are a number of options:

• smooth peanut butter mixed with milk or pureed food
• Bamba snack or peanut puff — this can be mixed with milk or mashed with pureed fruits or vegetables
• peanut soup
• finely ground peanuts mixed with other foods, such as yogurt
   

What should parents do if a child has an allergic reaction after introducing peanuts?

If a child has an allergic reaction after peanut introduction, the first step is to remove the child from the source of peanuts — change clothing and wipe away any traces of peanuts. If the reaction is limited to the skin, an antihistamine like Benadryl can be administered with an age-appropriate dose. If the symptoms are much more serious, including trouble breathing, swelling or wheezing, then 911 should be called so that the child can be taken to the nearest emergency room. If parents have already been prescribed an EpiPen for other reasons, this should be used for severe allergic reactions prior to calling 911.