Atlanta Allergy & Asthma News

Guidelines for When and How to Introduce Peanut-Containing Foods to Infants

Updated on Tuesday, January 5, 2021

Physicians/nurse practitioners mentioned in this post: Lily G. Hwang, MD Stanley M. Fineman, MD

If you asked parents when and how they should introduce peanut-containing foods to their babies, you would most certainly get a number of different answers. And determining if an infant might be at high-risk for developing a peanut allergy is also a point of confusion for many caregivers.

To clarify and simplify the recommendations, here is a summary of the current guidelines:

Guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) define high-, moderate-, and low-risk infants for developing peanut allergy, and how to proceed with the introduction of peanut-containing foods based on risk.

According to the guidelines, an infant at high-risk of developing peanut allergy is one with severe eczema and/or egg allergy. In this case, the guidelines recommend the introduction of peanuts as early as 4 to 6 months for infants who have already started eating solid foods. The guidelines also recommend that parents take their child who is in the high-risk category for an evaluation by an allergy specialist. That evaluation might involve peanut allergy testing, followed by trying a peanut-containing food for the first time while the parent and child are in the safety of the doctor’s office.

One of the studies NIAID used to establish the guidelines is the 2015 landmark Learning Early About Peanut Allergy (LEAP) study. The LEAP study’s authors found that the early introduction of peanut to the diet of children in infancy (until they were five years old) led to an 81 percent reduction in peanut allergy for children considered to be at high risk.

“The LEAP study concluded that early introduction of potentially allergenic foods such as egg and peanut can be beneficial in preventing food allergy,” says Atlanta Allergy & Asthma’s Dr. Stanley Fineman. “However, infants deemed high risk for food allergy should consult with an allergist before introducing these foods.”

Parents/Guardians/Caregivers should follow these guidelines when introducing peanut-containing foods:

  • A recommendation that infants with severe eczema, egg allergy, or both, have introduction of age-appropriate peanut-containing food as early as 4 to 6 months of age to reduce the risk of peanut allergy. Check with the infant’s healthcare provider before feeding the infant peanut-containing foods. A blood test or skin prick test by a board-certified allergist may be recommended to determine whether peanut should be introduced to the infant, and if so, the safest way to introduce it.
  • The suggestion that infants with mild-to-moderate eczema should have introduction of age-appropriate peanut-containing food around 6 months of age to reduce the risk of peanut allergy.
  • The suggestion that foods with peanuts can be freely introduced to infants who do not have eczema or any food allergy.

Atlanta Allergy physician, Dr. Lily Hwang, guides parents with at-risk children in safe ways to introduce peanut into their infant’s diet. Some suggestions include peanut teething biscuits, mixing peanut butter into water or breast milk, or into a purée of previously tolerated fruit or vegetable. Your allergist can guide you in amounts and frequency for at-risk infants. Babies not at risk can be offered peanut products without restrictions.

“Patients with food allergy should be reassured that there is ongoing high-quality, evidence-based research helping us understand the mechanism and potential therapies for our patients,” Dr. Hwang adds. “Atlanta Allergy & Asthma’s Research Department continues to conduct clinical trials on food allergy. As these studies progress, our knowledge and available treatments will advance.”

Atlanta Allergy & Asthma’s board-certified allergists can help you determine if your infant is at high risk for food allergy and the proper time and technique for introduction of allergenic foods. Schedule an appointment.