Does early introduction of peanuts to an infant’s diet reduce the risk for peanut allergy?
EVIDENCE-BASED ANSWER:
Probably not, unless the child has severe eczema or egg allergy. In a general pediatric population, introducing peanuts early (at age 3 to 6 months) doesn’t appear to alter rates of subsequent peanut allergy compared with introduction after age 6 months (strength of recommendation [SOR]: B, randomized clinical trial [RCT] using multiple potential food allergens).
In children with severe eczema, egg allergy, or both, however, the risk for a peanut allergy is 12% to 24% lower when peanut-containing foods are introduced at age 4 to 11 months than after age 1 year. Early introduction of peanuts is associated with about 1 additional mild virus-associated syndrome (upper respiratory infection [URI], exanthem, conjunctivitis, or gastroenteritis) per patient (SOR: B, RCT).
Introducing peanuts before age 1 year is recommended for atopic children without evidence of pre-existing peanut allergy; an earlier start, at age 4 to 6 months, is advised for infants with severe eczema or egg allergy (SOR: C, expert opinion).
RECOMMENDATIONS
A 2017 National Institute of Allergy and Infectious Diseases guideline recommends a 3-tiered approach to peanut introduction: 4
- For children with severe eczema or egg allergy who aren’t currently allergic to peanuts (per SPT or immunoglobulin E [IgE] test), the guideline advises adding peanuts to the diet between ages 4 and 6 months. (Patients with positive SPT or IgE should be referred to an allergy specialist.)
- Children with mild or moderate eczema can be introduced to peanuts around age 6 months “in accordance with family preferences and cultural practices.”
- Children with no evidence of allergy or eczema can be “freely introduced” to peanut-containing foods with no specific guidance on age.
Editor’s takeaway
Good-quality evidence supports family physicians encouraging introduction of foods containing peanuts at age 4 to 6 months for children at increased risk because of atopy, allergies, or eczema.
