New Peanut Allergy Guidelines Raise Concerns

LOVELAND, Colo. – With updates to peanut allergy guidelines rolled out earlier this year, a local doctor advises parents to consult their pediatrician or allergist before making introductions to high-risk foods. While the updates suggest parents introduce foods containing peanuts to infants as young as 4 months old, a closer read of the guidelines reveal varying methods of introductions based on family history and food sensitivities.

The new guidelines stem from a 2015 study where researchers found that children who incorporated peanut-containing food into their diet as an infant had significantly lower rates of peanut allergies compared to children who avoided peanuts altogether. 

The guidelines, announced in January by the National Institute of Allergy and Infectious Disease, propose that: 

  • Children with severe eczema, egg allergy or both, be tested for peanut allergies before being introduced to peanut-containing foods. That information will help guide the decision making about if and when to introduce the peanuts and how best to do so. In appropriate cases, peanut-containing food may be introduced as early as 4 to 6 months old.
  • Children with mild to moderate eczema should be introduced to age-appropriate peanut containing food around 6 months of age.
  • Children who have no eczema or any food allergy should have age appropriate peanut containing foods introduced in the diet together with other solid foods.

In all cases, said Banner Health allergist William Culver, MD, the child’s first exposure to peanuts should be to peanut butter in an amount small enough to fit on a child’s pinky fingernail. And parents should always discuss peanut introduction with their pediatrician or allergist first.

“I equate it to driving,” said Dr. Culver. “You don’t just give a child keys and put them behind the wheel. You start slow.”

Peanut allergies among children in Western countries have doubled over the last 10 years and are still the leading cause of anaphylaxis, a life-threatening allergic reaction in which airways can constrict and prevent a person from breathing, according to a 2015 study in The New England Journal of Medicine.

Culver says people with food allergies or parents who suspect their children may have food allergies should be cautious, as predicting allergies can be challenging and false test results are common.

For those who suspect a food allergy in their family, Culver recommends the following:

  1. Cause and effect: If someone has a reaction every time they ingest a particular food, they likely have an allergy or sensitivity. It is best to avoid these foods.
  2. Careful observation:  When introducing high allergy foods, always observe the individual carefully for any signs of reaction.
  3. Know what to do if there is a reaction: People with severe allergies are typically encouraged to have an epinephrine auto-injector such as EpiPen at home and to know how to use it. The auto-injector is a device with a syringe loaded with epinephrine, a medication that reduces the harmful effects of the body’s allergic response and can open airways in individuals having an anaphylactic reaction.  
  4. Re-evaluation: Not everybody that had a reaction as a child will have a reaction later. Individuals who have avoided foods for many years should talk to an allergist about whether they should try the food again.

Headquartered in Arizona, Banner Health is one of the largest nonprofit health care systems in the country. The system owns and operates 28 acute-care hospitals, Banner Health Network, Banner – University Medicine, academic and employed physician groups, long-term care centers, outpatient surgery centers and an array of other services; including Banner Urgent Care, family clinics, home care and hospice services, pharmacies and a nursing registry. Banner Health is in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming.