The earlier the better is the short answer, but it can be more complicated depending on individual risk factors. There was a time when delayed introduction of allergenic foods was recommended. In 2017, findings from the Learning Early About Peanut Allergy (LEAP) study prompted the release of new guidelines for introduction of peanut. Researchers from the LEAP study had noticed that peanut allergy was less common in countries where peanut was introduced earlier and were able to show that early introduction of peanut reduces the risk of developing peanut allergy.
About 20% of children will outgrow their peanut allergy, but, for most, peanut allergy is lifelong. One in 13 children has food allergy and doctors are counseling about early introduction of peanut in and effort to reduce the rate of peanut allergy. Peanut allergy affects 1.2% of the population overall and 2.5% of the pediatric population. Siblings of children with peanut allergy have a 5-7% risk of also having peanut allergy. There is no distinct recommendation regarding siblings of children with peanut allergy, but consulting with your board certified allergist to discuss risk factors is reasonable.
In children with severe eczema, egg allergy, or both, testing may be indicated to determine the best way to introduce peanut. If testing allows, the goal in children with severe eczema and/or egg allergy is to introduce peanut around 4-6 months of age. The testing referenced in the LEAP guidelines includes skin testing with an allergist, blood testing, or both. Children with mild to moderate eczema should start peanut around 6 months of age. The American Academy of Pediatrics’ (AAP) general recommendations are to introduce solids around 6 months, but this recommendation should be tailored based on individual risk factors according to the LEAP guidelines. If your child has severe eczema or egg allergy, or you aren’t sure where he or she falls in the risk stratification, your allergist can help formulate a plan for peanut introduction.
Introduction of peanut can be done with a small amount of peanut butter inside the mouth. Peanut butter can also be mixed with other solids, depending on how the infant is doing with various textures. Commercially available powdered peanut products that dissolve well in fluid. Bamba is a peanut based snack produced in Israel. The rate of peanut allergy in Israel is much lower compared to the US. The reduced rate of peanut allergy in Israel is thought to be related to their early introduction of peanut in the form of Bamba, among others. Bamba can be softened with water, breast milk, or formula and fed with a spoon if needed.
Pediatricians and family physicians have done a wonderful job helping their patients navigate the newer guidelines regarding early introduction of peanut. For the subset of patients with risk factors for peanut allergy, a thorough allergy evaluation around the age of 4-6 months is recommended. We look forward to caring for you and your baby.
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