Ask a Doc: What should parents make of the latest peanut allergy prevention guidelines?

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The guidelines categorize children into three groups according to their risk for developing peanut allergy..

Question:

I have been reading about reducing risks for developing peanut allergies in the news. What can I do to help prevent them for my child?

Answer: Peanut allergy has become increasingly common and recent efforts have focused on ways to prevent it.  The latest guidelines incorporate new recommendations based on recent findings that early introduction of peanut during infancy may prevent peanut allergy.

The guidelines categorize children into three groups according to their risk for developing peanut allergy.  Group 1 includes children with severe eczema and/or egg allergy who are most likely to develop peanut allergy.  Group 2 is comprised of children with mild to moderate eczema.  Finally, Group 3 includes children without eczema or food allergies.

Between 4-6 months of age, children in group 1 should have a blood or skin test before introducing peanut-containing foods into the diet. If the test is negative, parents should start feeding their child peanut. Those with positive tests should be seen by a specialist who will determine whether they are allergic or should eat peanut once under medical supervision.

Children in group 2 should introduce peanut-containing foods into the diet around six months of age.

Children in group 3 may introduce peanut into their diet according to family preference.

Major shift

The new guidelines represent a major shift in practice as the 2000 guidelines issued by the American Academy of Pediatrics recommended delaying the introduction of commonly allergenic foods until 2 years old. This recommendation was subsequently retracted in 2008 as evidence began to emerge that avoiding these foods early in life might actually lead to food allergies.  The expert panel that developed the new guidelines was cautious to make evidence-based recommendations this time around.

The recommendations do have some shortcomings.  First, they only focus on early introduction of peanuts and not other allergenic foods (i.e. milk or eggs).

Second, not all children who go on to develop food allergy have egg allergy or eczema, therefore, additional children might benefit from early peanut introduction.  Also, some may not have access to an allergist who can perform specialized testing.

Finally, the guidelines contradict the recommendations made by the World Health Organization that infants should be exclusively breastfed until 6 months old.

Prevention

While early peanut introduction may prevent future cases of peanut allergy, there are many individuals with established peanut allergy, which has no cure.

Over the past few decades, researchers have been investigating an emerging treatment called oral immunotherapy. This treatment works by gradually feeding patients increasing amounts of peanut under medical supervision until they are desensitized.

While this treatment is promising there are still questions regarding its safety and effectiveness.  Dr. James Lee and I at Mayo Clinic are investigating the side effects of this treatment and exploring ways to make it safer.

In a nutshell, if your child has severe eczema and/or an egg allergy they should be seen by an allergist.  If they have eczema that doesn’t require prescription creams/ointments they should introduce peanuts by 6 months. If your child doesn’t have food allergies or eczema you can introduce peanut whenever.  Finally, treatments for patients with existing peanut allergies are on the horizon.

Credit:Dr. Benjamin Wright, Special for The Republic | azcentral.com