New advice: Peanuts in baby's diet can prevent scary allergy
WASHINGTON (AP) — New parents, get ready to feed your babies peanut-containing foods; starting young lowers their chances of becoming allergic.
The National Institutes of Health issued new guidelines Thursday, saying most babies should regularly eat those foods starting around six months of age, some as early as four months. It's a major shift in dietary advice for a country fearful of one of the most dangerous food allergies.
"We're on the cusp of hopefully being able to prevent a large number of cases of peanut allergy," said Dr. Matthew Greenhawt of the American College of Allergy, Asthma and Immunology, a member of the NIH-appointed panel that wrote the guidelines.
Two percent of all children in the US now have peanut allergies - four times as many as 10 years ago. Former guidelines that suggest no peanuts before age 3 for babies at high risk may be partly to blame.
"When you're delaying exposure to by not eating the food, you are limiting your chances of building tolerance to peanuts," said Dr. Kirsi Jarvinen-Seppo, a pediatric allergy researcher at URMC in Rochester.
The new recommendations are based on landmark research that found early exposure is far more likely to protect babies from developing peanut allergies than to harm them. The guidelines spell out exactly how to introduce infants to age-appropriate peanut products depending on whether they're at high, moderate or low risk of becoming allergic as they grow.
Babies at high risk — because they have a severe form of the skin rash eczema or egg allergies — need a check-up before any peanut exposure, and might get their first taste in the doctor's office. "This introduction should not be done at home, cold turkey," said Dr. Jarvinen-Seppo. "There has to be some evaluation done in a doctor's office."
For other tots, most parents can start adding peanut-containing foods to the diet much like they already introduced oatmeal or mushed peas.
No, babies don't get whole peanuts or a big glob of peanut butter — those are choking hazards. Instead, the guidelines include options like watered-down peanut butter or easy-to-gum peanut-flavored "puff" snacks.
"It's an important step forward," said Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, which appointed experts to turn the research findings into user-friendly guidelines. "When you do desensitize them from an early age, you have a very positive effect."
The guidelines, published Thursday in several medical journals, make that clear, urging parents and doctors to proactively introduce peanut-based foods early.
"Just because your uncle, aunt and sibling have an allergy, that's even more reason to give your baby the food now," even if they're already older than 6 months, added Sicherer, a pediatric allergist at Mount Sinai Hospital in New York.
In Columbus, Ohio, one doctor told Carrie Stevenson to avoid peanuts after her daughter was diagnosed with egg allergy. Then Stevenson found an allergy specialist who insisted that was the wrong advice — and offered baby Estelle a taste test of peanut butter in his office when she was 7 months old.
"I was really nervous," Stevenson recalled, unsure which doctor to believe. But, "we didn't want her to have any more allergies."
Now 18 months old, Estelle has eaten peanut butter or peanut-flavored puffs at least three times a week since then and so far seems healthy. Stevenson, pregnant again, plans early exposure for her next child, too.
The guidelines recommend:
—All babies should try other solid foods before peanut-containing ones, to be sure they're developmentally ready.
—High-risk babies should have peanut-containing foods introduced at age 4 to 6 months after a check-up to tell if they should have the first taste in the doctor's office, or if it's OK to try at home with a parent watching for any reactions.
—Moderate-risk babies have milder eczema, typically treated with over-the-counter creams. They should start peanut-based foods around 6 months, at home.
—Most babies are low-risk, and parents can introduce peanut-based foods along with other solids, usually around 6 months.
—Building tolerance requires making peanut-based foods part of the regular diet, about three times a week.
What's the evidence? First, researchers noticed a tenfold higher rate of peanut allergy among Jewish children in Britain, who aren't fed peanut products during infancy, compared to those in Israel where peanut-based foods are common starting around age 7 months.
Then in 2015, an NIH-funded study of 600 babies put that theory to the test, assigning them either to avoid or regularly eat age-appropriate peanut products. By age 5, only 2 percent of peanut eaters — and 11 percent of those at highest risk — had become allergic. Among peanut avoiders, 14 percent had become allergic, and 35 percent of those at highest risk.
What if an older sibling or someone else in the home already is allergic to peanuts? The new baby needs a chance at prevention so talk to your doctor about how to do so while keeping the allergic family member safe, with extra care in washing hands and keeping food separate, said Greenhawt, an allergy specialist at Children's Hospital Colorado.
Whether the dietary change really will cut U.S. peanut allergies depends on how many parents heed the new advice, and the guidelines urge doctors to follow up, even offer lower-risk tots an in-office taste, to reassure them.
"We would encourage everybody to get on board with this," Greenhawt said.
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