Introducing peanuts early can prevent allergies, but parents need clearer guidance

Introducing peanuts early can prevent allergies, but parents need clearer guidance

Feeding babies foods containing peanuts as early as possible can help prevent peanut allergy. But a new study published in JAMA Network Open found that parents need more support to get it right. Interviews with parents revealed widespread confusion about the purpose, risks, and timing of early peanut introduction policies.

"While some parents we spoke with correctly understood that feeding their baby peanut formula trains the immune system to prevent the development of a peanut allergy, other parents mistakenly believed that the purpose was to test whether their baby was allergic - a misconception that fueled fears of severe allergic reactions and led to hesitation and delays in introducing peanuts," said lead author Waheeda Samady, MD, a hospital-based pediatrician at Ann & Robert H. Lurie Children's Hospital in Chicago and associate professor of pediatrics at Northwestern University Feinberg School of Medicine.

“To prevent a peanut allergy, timing and consistency are critical,” she said. "We recommend introducing peanuts as soon as baby begins eating solid foods, before or around 6 months of age. It is also important to continue exposure to peanuts twice a week throughout the first year of life and into the toddler years. It is not enough to feed babies peanut food just once or twice."

In 2017, initial guidelines for introducing peanuts were issued after groundbreaking research showed that the development of peanut allergy was reduced by over 80%. Peanut allergy affects approximately 2% of children in the United States and is the food allergy least likely to be overcome. Therefore, prevention through early adoption is an important public health strategy.

Dr. Samady and colleagues analyzed 49 interviews with Chicago parents of infants ages 8 to 13 months from diverse backgrounds. Participants were recruited from academic primary care hospitals, federally qualified health centers, and private clinics.

The researchers also found that parents mostly didn't understand that eczema puts their baby at high risk of developing a food allergy, making early introduction of peanuts even more important.

If a baby has eczema, introducing peanuts should be started as early as possible, around 4 months of age, to maximize prevention of peanut allergies in conjunction with good skin care. Pediatricians need to reinforce this message because most parents we surveyed did not know that eczema increases the baby's risk of developing food allergies."

Waheeda Samady, MD, lead author

In the study, parents reported that pediatricians were their primary source of information about early peanut introduction.

“Pediatricians are key to successful implementation of the guidelines, but they need better resources for families to provide comprehensive information during busy visits with healthy children,” noted Dr. Samady. “Overall, we found that parents accept the early introduction of peanuts but need clearer guidance and more support.”

Dr. Samady emphasized that improved information and resources for families should make it clear that early introduction of peanuts prevents peanut allergies through regular diet, address the connection between eczema and the risk of food allergy, provide specific guidance on timing and frequency, and inform parents of the low risk of severe allergic reactions in infants.

"Parents need to be reassured that if their baby has a peanut allergy, they may experience hives, swelling or vomiting, but allergic reactions in infancy are usually mild," she explained. “We should equip parents with information and action plans so that this does not deter them from engaging in early peanut introduction.”

This research was funded by the National Institute of Allergy and Infectious Diseases (NIAID K23AI159517).

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