peanut allergy guidelines for infants

Featuring Kathleen Zimmerman, MD

Your baby may not be showing signs of teeth yet, but it’s not too early to discuss the new peanut allergy guidelines with your pediatrician. New studies are finding that introducing peanuts to infants earlier actually helps prevent allergies.

Previously, the American Academy of Pediatrics (AAP) recommended that children younger than 3 with risks such as eczema and/or food allergies (with or without a family history of food allergy) should avoid peanut products.

That’s now changed. The AAP is now recommending that infants between the ages of 4-6 months should be introduced to peanut-containing foods in age-appropriate snacks. (See the guidelines below.) In fact, a clinical trial out of UK(1) tested this recommendation on high-risk infants ages 4-11 months who were followed until age 5.

The trial demonstrated that consumption of a peanut-containing snack by those at risk for developing the allergy prevents the development of the allergy itself. And there’s more od news. Infants who are fed peanut products to prevent nut allergies do not experience shortened breastfeeding or harm to their growth.

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Understanding a Peanut Allergy

So, what happens if a peanut allergy is present? Basically the body falsely identifies peanuts as harmful ingredients, leading the immune system to overreact. An allergic, even life-threatening reaction, can follow.

An allergic reaction releases chemicals, including histamine, into your blood. These chemicals can affect different tissues in the body, such as the skin, eyes, nose, airways, intestinal tract, lungs and blood vessels.

For a mild reaction, an antihistamine will do the trick. For a severe reaction or known allergy, the doctor may prescribe medicine known as epinephrine.

New Guidelines for Peanut Allergies

The new AAP recommendations are as follows:

  1. If an infant has severe eczema or an egg allergy, they should have a blood test to determine a peanut allergy. If positive, they should have a peanut-containing snack at 4-6 months, only while observed in a doctor’s office. If the blood test is negative, they should follow the same directions, but the child does not have to do so under a doctor’s supervision.
    • Severe eczema is defined as persistent or frequently recurring eczema, assessed as severe by a health care provider and requiring frequent need for prescription-strength topical corticosteroids, calcineurin inhibitors or other anti-inflammatory agents despite appropriate use of emollients.
    • Egg allergy is defined as a history of an allergic reaction to egg and a skin prick test.
  2. If an infant has mild to moderate eczema then no test is needed and they should start peanut-containing products at 4-6 months.
  3. If there is no eczema or other food allergy present, then the recommendation is to start peanut-containing products at 6 months or later as a toddler.

You may ask yourself how it makes sense to introduce a product that your child tests positive for developing a potential allergy or already is at risk. The best way to describe the thought process is by comparing it to a vaccine. Immunizations protect us from disease and illness because we are exposing our systems to the “dead” or inactive virus in the form of a vaccination. The immune system kicks into high gear and produces antibodies that fight the germ. This exposure builds an immunity or shield should it encounter the live version.

Recognizing Allergy Symptoms

If your child is past the infant stage and you’re still not sure if he or she has a peanut allergy, speak with your pediatrician. Common peanut allergy signs and symptoms can include(2):

  • Runny nose
  • Skin reactions (hives, redness or swelling)
  • Itching or tingling in or around mouth/throat
  • Digestive problems like diarrhea, stomach cramps, nausea or vomiting
  • Tightening of the throat
  • Shortness of breath or wheezing

Symptoms can start minutes from exposure either by ingesting the food or from cross-contamination and skin contact. If someone used a utensil that touched peanut products and didn’t wash it for use in another food item, there can be trace amounts of peanut products in the non-peanut item causing an allergic reaction.

A life-threatening allergic reaction known as anaphylaxis can occur and peanuts are one of the most common causes. This is an emergency situation and 911 should be called immediately. During an anaphylactic attack, the following can happen:

  • Swelling of the throat that makes it hard to breathe
  • Dizziness or fainting
  • A big drop in blood pressure
  • A rapid pulse
  • Blocked airways

Living with a Peanut Allergy

If your child has a known peanut allergy, there are ways to protect them from becoming sick or having a reaction. Whether at school, a birthday party or grandma’s house, children eventually come into contact with a peanut butter, nut powder or other product containing peanuts. You should always inform all caregivers from relatives and the school, to those parents with whom your child may keep company. Pack alternate snacks and ask ahead of time if peanut products will be accessible.

Keep in mind, nearly 20 percent of peanut allergies can be outgrown and only 4 percent of children have a food allergy. We can’t put our children in a bubble, but we can remain informed and seek the necessary information from medical professionals to protect them. Preparation is better than paranoia.

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About UPMC Harrisburg

UPMC Harrisburg is a nationally recognized leader in providing high-quality, patient-centered health care services in south central PA. and surrounding rural communities. UPMC Harrisburg includes seven acute care hospitals and over 160 outpatient clinics and ancillary facilities serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams, and parts of Snyder counties. These locations care for more than 1.2 million area residents yearly, providing life-saving emergency care, essential primary care, and leading-edge diagnostic services. Its cardiovascular program is nationally recognized for its innovation and quality. It also leads the region with its cancer, neurology, transplant, obstetrics-gynecology, maternity care, and orthopaedic programs.

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