Infants should regularly be fed peanut products starting at six months old to reduce the risk of developing life-altering and potentially dangerous peanut allergies, according to new recommendations.
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The guidelines suggest introducing peanuts gradually using foods suitable for infants, such as peanut butter or peanut flour mixed with pureed baby food.
The recommendations, created by a panel of doctors organized by the U.S. government, build upon evidence that consuming peanuts from an early age can prevent the development of peanut allergies, which affect about 1 in 50 Canadian children.
“These new guidelines contradict what many parents have been hearing – that they should be cautious about feeding peanut foods to infants,” said Dr. Edmond Chan, the only Canadian member of the panel. “But that has probably led to more peanut allergies. Feeding peanut to children around six months is the best way to prevent an allergy to peanut.”
The guidelines were published Thursday in several medical journals, including Canada’s Allergy, Asthma and Clinical Immunology.
The panel of recommends that “high risk” infants with severe eczema or egg allergies be tested before they are fed peanut products – such as peanut butter or peanut flour – between four and six months of age. All other children should consume peanut products around six months.
Once introduced, peanut products should continually be given to children a few times each week, the doctors suggest.
The recommendations from the panel, commissioned by the U.S. National Institute of Allergy and Infectious Diseases, seemingly contradict some Canadian doctors’ standards. A 2013 study found that more than 80 per cent of doctors in Atlantic Canada recommended holding off on giving a child peanut products until they turn one year old.
“I can understand parents’ fears – they hear about children having severe reactions, or about parents having to carry EpiPens, and figure that it’s better to be safe than sorry,” Chan said. “But the safer thing to do, for almost all infants, is to feed them peanut by the sixth month and then give it regularly thereafter.”
The panel was organized in response to an in-depth 2015 study that suggested introducing peanuts to high-risk infants could significantly slash their chances of developing an allergy by the age of five.
'180-degree turn'
Since the 2015 study was released, the panel has tried to “implement those findings into the real world, which is quite different from conducting a research study,” Chan said in an interview with CTV News Channel Thursday.
“The guidelines give advice based on risk category,” Chan explained.
“So that highest risk category is an infant who has severe eczema or egg allergy. So if either of those criteria are true for your infant, then yes, see your physician first to discuss the approach.”
Parents of infants with mild to moderate eczema or infants without any eczema “should have reassurance that they don’t need any testing prior, and it’s very safe to introduce at home,” Chan said, adding the “likelihood” of a reaction is very low.
He noted that countries such as Israel have done that for “decades, and it’s a normal part” of the early food introduction process.
“They haven’t experienced any safety problems,” he said.
Previous advice that suggested parents wait until their children are toddlers to introduce peanut products was based on theories, “animal-type” models and expert opinion, Chan said in an earlier interview with CTV’s Your Morning on Thursday.
“It wasn’t based on the type of rigorous, reliable research that we have for these guidelines,” Chan said. “And so while it does feel like a complete 180-degree turn -- and it is -- at least now this recommendation is based on the (2015) study.”
There can be consequences to holding off on introducing peanut-based foods until toddlerhood, said Chan, including an increased risk of developing a peanut allergy.
“You’re really, in that scenario, delaying what needs to be found out at some point and in those intervening years, there could be less safety,” he said.
“Let’s say a child has a peanut allergy, and they’re not practising the management that is necessary for peanut allergy, that child could have more of a risk of having a reaction that is not adequately addressed at the time of the ingestion.”
Chan said these guidelines could potentially work for other allergens. He said data points to a “reduction in egg allergy” with early introduction, but that it appears the egg must be thoroughly cooked for it to work.
“For other allergens, it just hasn’t been studied in the same fashion as peanut and egg, but we feel that the other allergens shouldn’t work any differently.”
