Review the NIAID’s New Peanut Introduction Guidelines

The National Institute of Allergy and Infectious Diseases (NIAID), with the help of the AAAAI and 24 other organizations, has added an addendum to its clinical guidelines on when to introduce children to peanut-containing foods. The guidelines now recommend that children should be introduced to peanuts early in life, instead of avoiding all peanut-containing foods.

The change in recommendations was prompted by the results of the Learning Early About Peanut allergy (LEAP) trial. Researchers found children at high risk of developing peanut allergy were far less likely to develop an allergy when introduced to peanuts before they turned 12 months-old. This led NIAID to convene a panel of experts to review 64 publications, including the LEAP study, to create an update to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States. The result is the Addendum Guidelines for the Prevention of Peanut Allergy in the United States, published in the January issue of The Journal of Allergy and Clinical Immunology and several other journals.

The addendum gives detailed instructions for peanut introduction to infants at three risk levels. The first set of guidelines applies to infants who are most at risk for a peanut allergy and are most likely to avoid allergy with early introduction compared to other risk groups. In the LEAP study, only 1.9% of infants at high risk of peanut allergy who were introduced to peanuts early in life developed a peanut allergy by age 5. In the group that avoided peanuts, 13.7% of the children had developed an allergy.

The addendum recommends parents of children in the high risk group should introduce their child to peanuts as early as 4 to 6 months. For children in the second highest risk group, with mild to moderate eczema, it is recommended to introduce to peanuts around 6 months to reduce the risk of peanut allergy. Children in the lowest risk group, with no signs of eczema or food allergy, can be introduced to peanuts when age-appropriate and according to family and cultural preferences.

The addendum includes specific instructions for both allergist/immunologists and parents as well as four age-appropriate recipes containing peanuts for infants. It is now available at jacionline.org. You can also find a summary for clinicians and a summary for parents and caregivers at the NIAID website.