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Early Introduction of Peanuts Reduces Allergy Risk in Babies

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Worried about peanut allergies in children?

A practice article in CMAJ (Canadian Medical Association Journal) outlines five things to know about early introduction of peanuts in infants to reduce the risk of peanut allergy.

  • Infants who are fed peanut protein regularly have a lower risk of peanut allergy.
  • To prevent peanut allergy, peanut protein (such as peanut butter or powdered puff) may be introduced at home for most babies between 4 and 6 months as one of the first foods.
  • Babies with severe eczema are more likely to have peanut allergy, and those with no or only mild eczema are best-suited for peanut introduction in the home.
  • Infants with risk factors for peanut allergy, such as severe eczema, egg allergy or both, should be seen by a specialist before peanut introduction.
  • To reduce the risk of peanut allergy, 8 grams of peanut protein (1 heaped teaspoon of peanut butter) should be eaten at least twice a week.

A randomized controlled trial that included 640 infants younger than 11 months with either egg allergy or moderate–severe atopic dermatitis found that 3.2% of children in the treatment group, who ate 2 g of peanut butter 3 times per week, developed peanut allergy after 5 years compared with 17.2% of children in the avoidance group.

To prevent the development of peanut allergy, it is sensible to introduce infant-safe peanut protein (i.e., paste, butter, powdered puff) as a first food. Information on the introduction of peanut is available in Canadian and American recommendations.

The more severe the atopic dermatitis in infants, the greater the risk of peanut allergy, especially if other household members eat peanut at home. Infants without atopic dermatitis or with mild atopic dermatitis (e.g., requiring only barrier cream) are best suited for peanut introduction in the home.

The US National Institute of Allergy and Infectious Diseases recommends allergy testing (skin-prick or specific immunoglobulin E testing) in infants with severe eczema, egg allergy or both before introducing peanut.

The Allergy Societies of Canada, Australia and the UK do not mandate this. Allergy tests for peanut can provide reassurance at negative or low values; universally agreed upon safe cut-off thresholds have not been established.

Eight grams of peanut butter (1 heaped teaspoon, 1.5 regular teaspoon) or 17 g of peanut puffs should be consumed at least twice weekly to protect against peanut allergy.

This intervention does not treat peanut allergy.

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