American pediatricians have gone a step further than their initial endorsement of new interim guidelines for infant consumption of peanuts, which had followed on the heels of the landmark LEAP study that was released in February. Those interim guidelines were the result of a consensus endorsement of LEAP’s results in June by more than a dozen medical organizations across U.S., Europe, Japan, Australia, Israel and Canada.
The American Academy of Pediatrics (AAP), which represents 64,000 primary care pediatricians and specialists in the U.S., published its own “consensus communication” in September that cements the AAP’s original endorsement of the interim guidelines, calling for “infants to be introduced to peanuts or peanut-containing products between ages 4 and 11 months of age,” among other directives. The AAP’s statement of endorsement, which summarizes key findings of the LEAP study, also noted: “The purpose of this brief communication is to highlight emerging evidence for existing allergy prevention guidelines regarding potential benefits of supporting early rather than delayed peanut introduction during the period of complementary food introduction in infants.”
However, there are key details to remember, especially as pertains to children at-risk for, or showing signs of allergy:
- Infants who show signs of eczema or egg allergy within the first 4 to 6 months of life should be tested for peanut allergy with a skin prick test and possibly also a medically supervised peanut challenge. Families with such a child should work with a physician to facilitate safe, early introduction of peanut if possible.
- Though LEAP details many aspects of how peanut can be introduced, physicians should note that it does not discuss alternative doses of peanut, the minimal length of treatment necessary to induce tolerance, the potential risks if peanut consumption is stopped early, or what happens if the infant does not consume peanut on a regular basis.
The LEAP study, published earlier this year in The New England Journal of Medicine, showed that feeding infants at heightened risk of allergy — that is, infants with egg allergy or eczema or both already presenting — can reduce the risk of developing a peanut allergy by 70 to 80 percent. At risk children between 4 and 6 months of age are considered to be in the optimal window for inducing tolerance to peanuts according to the findings of the LEAP study.
The AAP’s new position on peanut introduction to infants at risk of allergies is a complete reversal from its 2000 guidelines that advised complete peanut avoidance for such children. In 2008, the AAP had abandoned those guidelines when it realized the recommendation had done nothing to stop the rise in food allergy rates among children.
As reported earlier this year, more extensive formal guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) are expected to follow within the next 9-12 months.