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The number of children with peanut allergy has increased dramatically over the past 20 years. Parents may be particularly concerned about peanut allergy because most food-related serious allergic reactions, such as anaphylaxis, a severe allergic reaction that includes breathing difficulties as well as fatal allergic reactions, are associated with peanuts.
Because peanut allergy is common and can be quite serious, many parents want guidelines for how to best prevent allergies to peanuts. Many research studies over the past 20 years have focused on peanut allergy and how best to prevent it. This research has been translated into guidelines for families that are mostly focused on what time in a child’s life is safest to introduce peanuts into the diet. With new research emerging, these guidelines have been updated to represent the best available evidence from research. An article in this month’s JAMA Pediatrics reviews these guidelines and the research studies that informed the guidelines.
Initial guidelines about peanut allergies emerged approximately 16 years ago and focused on children who were considered at risk for food allergies. This included children who had close family members with a strong history of allergic disease. At that time, the guidelines suggested avoiding eating peanuts during pregnancy and avoiding any exposure to peanuts for children until age 3 years.
Why These Guidelines Changed
Research conducted after these guidelines were released found that eating peanuts during pregnancy was associated with lower risk of peanut allergy in the child. Furthermore, research did not find a relationship between avoiding peanuts early in life and prevention of peanut allergies.
At this time, guidelines on food allergy prevention do not support avoiding peanuts during pregnancy or breastfeeding, so mothers should feel at ease with eating their preferred amounts of peanuts in their everyday diet. Furthermore, while guidelines still support avoiding introduction of solid foods for babies until age 6 months, parents can introduce food with peanuts at any time after age 6 months. There is no current evidence supporting that delaying introduction of peanuts into the diet will prevent peanut allergies. However, high-risk infants, including infants who have severe atopic eczema and/or egg allergy, should undergo food allergy testing to understand whether introduction of peanuts is beneficial for that infant.
What Parents Can Do
If your child has had a rash or reaction to peanuts in the past, see your pediatrician before giving him/her peanuts again. The guidelines described in the previous section are about preventing peanut allergies and should not be applied to treating children who may be experiencing allergic symptoms.
If your child is in an at-risk category, including children who have people in the family with strong food allergies or severe eczema, ask your pediatrician if your child may need allergy testing before introducing peanuts into his/her diet.
If your child does not have any food allergies or additional risk factors, consider introducing peanuts into his/her diet after age 6 months. Please remember that giving whole peanuts or peanut pieces is dangerous for children aged younger than 4 years, who can choke on those small pieces. Consider peanut butter or other foods that have peanuts in them.
Anvari S, Chokshi N, Kamili QA, Davis CM. Evolution of guidelines on peanut allergy and peanut introduction in infants [published online November 7, 2016]. JAMA Pediatr. doi:10.1001/jamapediatrics.2016.2552.
Corresponding Author: Megan A. Moreno, MD, MSEd, MPH, Seattle Children's Hospital, 6200 NE 74th St, M/S CW 8-6 PO Box 5371 Seattle, WA 98145 (firstname.lastname@example.org).
Correction: The title of this article has been changed from “Guidelines for Children With Peanut Allergy” to “Guidelines to Help Prevent Peanut Allergy.” This article was corrected on February 6, 2016.
Conflict of Interest Disclosures: None reported.
Moreno MA. Guidelines to Help Prevent Peanut Allergy. JAMA Pediatr. 2017;171(1):100. doi:10.1001/jamapediatrics.2016.3085
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