What is a food allergy?
A food allergy is a reaction that takes place when the body's immune system reacts to the ingestion of a particular allergenic protein found in food. The immune system acts as though the protein is harmful to the body and triggers various symptoms, ranging from mild to severe. It is important to note that a food allergy is different than food intolerance and should betreated appropriately, a common confusion for many, especially when it comes to dairy foods. Lactose intolerance does not have to mean dairy avoidance; whereas, for those with a milk allergy, dairy should be avoided due to the potential for an allergic reaction.
Just like a milk allergy, a peanut allergy is identified as a priority allergen by Health Canada. Peanut allergy is a significant health issue with no known treatment or cure. Individuals and caregivers who live with peanut allergy have to be cautious about the foods they consume and the environments they enter in order to evade allergic reactions. Peanut allergy usually develops in infancy and persists throughout the duration of life. However, new evidenced-based guidelines have been released which suggest that introducing peanut into the diet during infancy can reduce the risk of developing peanut allergy.
New Guidelines for the Prevention of Peanut Allergy
The U.S. National Institute of Allergy and Infectious Diseases (NIAID) recently published Addendum Guidelines for the Prevention of Peanut Allergy, which provides recommendations regarding the introduction of peanut to babies. The 2017 clinical guidelines are grouped by an infant’s risk of peanut allergy and are intended to aid health care providers when offering care to patients and families. The addendum guidelines are based on the landmark 2015 Learning Early about Peanut Allergy (LEAP) study, which discovered that infants aged 4–11 months who were at high risk for peanut allergy decreased their risk of developing peanut allergy when exposed to peanut during these early months of life.
The Three Guidelines for Peanut Allergy Prevention
If the infant has severe eczema and/or egg allergy, introduce age-appropriate, peanut-based food as early as 4–6 months. Parents and caregivers are strongly advised to consult with the infant’s health care provider prior to feeding the baby peanut. Allergy testing, consisting of a peanut-specific IgE blood test and/or skin prick test, should be considered to determine whether or not peanut-containing food should be introduced to the infant. If the decision is made to introduce peanut, the total amount of peanut protein to be regularly consumed per week should be approximately 6–7 g over 3 or more feedings.
Guideline # 2
If the infant has mild to moderate eczema, introduce age-appropriate, peanut-containing food around 6 months of age. It is recommended that the introduction of peanut take place at home; however, an in-office supervised feeding can be done with a physician if preferred.
If no eczema or egg allergy exists, introduce peanut-containing food without reservation at an age-appropriate time with other solid foods. Family diet preferences and cultural customs should be considered.
For all of the above guidelines, other solid foods should be introduced prior to the introduction of peanut-based food to ensure the infant is developmentally ready.
Home Introduction of Peanut-Containing Food
- Ensure child is healthy
- Introduce peanut in home setting when caregiver can be with infant for 2 hours post-exposure
- Stop feeding if signs and symptoms of allergic reaction present and call 9-1-1
Recommended Peanut Preparation
Parents and caregivers are not advised to introduce peanut protein to infants via whole peanuts or peanut butter due to the risk of choking. Therefore, the recommended preparation method for peanut introduction is:
- Combine 2 tsp of peanut butter with 2–3 tsp of hot water. Stir until blended.
- Once mixture has cooled, place a small amount on the tip of a spoon and feed to infant.
- Wait 10 minutes.
- If no symptoms of allergic reaction are observed, continue to feed infant at their regular feeding rate.
For additional introductory peanut recipes, read Instructions for Parents and Caregivers on Feeding Peanut Protein to Infants from NIAID.
Professional Organization Endorsement
Be advised that the recommendations for the timing of food introduction is not harmonized between all professional organizations. Allergy prevention guidelines typically recommend that the introduction of food to infants take place between 4-6 months. In contrast, world feeding guidelines and BC guidelines currently recommend exclusive breastfeeding until 6 months of age and advise that complementary foods only begin to be introduced following this period of time.
The NIAID guidelines are officially supported by the Canadian Society of Allergy and Clinical Immunology (CSACI) and the Academy of Nutrition and Dietetics, as well as multiple other international organizations. Furthermore, Dr. Edmond Chan, the only Canadian member on the NIAID expert panel, who is the Head of the Division of Allergy and Immunology in the UBC Department of Pediatrics, and the Director of the Allergy Clinic at BC Children’s Hospital, recently stated, “Feeding peanut to children around six months is the best way to prevent an allergy to peanut.”
Currently, Health Canada, Dietitians of Canada and the Canadian Pediatric Society have not formally endorsed the NIAID Addendum Guidelines.
The complete addendum guidelines and summaries for parents/caregivers and physicians can be found on the NIAID website. Additionally, you can read FAQs from parents regarding the addendum guidelines, compiled by CSACI and Food Allergy Canada.
- A Togias et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. (2017) Journal of Allergy and Clinical ImmunologyDOI: 10.1016/j.jaci.2016.10.010
- National Institute of Allergy and Infectious Disease. (2017) NIH-Sponsored Expert Panel Issues Clinical Guidelines to Prevent Peanut Allergy. Retrieved from https://www.niaid.nih.gov/news-events/nih-sponsored-expert-panel-issues-clinical-guidelines-prevent-peanut-allergy
- Dietitians of Canada. (2018) Facts on Peanut Allergies. Retrieved from http://www.unlockfood.ca/en/Articles/Food-allergies-intolerances/Peanut-Allergies-FAQs.aspx
- Food Allergy Canada. (2017). Important Changes with the Introduction of Peanuts to Babies. Retrieved from http://foodallergycanada.ca/2017/01/important-changes-introduction-peanuts-babies/
- Dietitians of Canada. (2017) Introduction of Allergenic Foods to Infants, especially Peanuts: Interim Guidance for Canadian Dietitians. Retrieved from https://www.dietitians.ca/Downloads/Members-Only/DC-Infant-Allergy-interim-January-2017.aspx
- Feeney M, Toit GD, Roberts G, et al. Impact of peanut consumption in The LEAP Study: feasibility, growth and nutrition. (2016). The Journal of allergy and clinical immunology, 138(4):1108-1118. doi:10.1016/j.jaci.2016.04.016.
- National Institute of Allergy and Infectious Disease. (2017). Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary for Parents and Caregivers. Retrieved from https://www.niaid.nih.gov/sites/default/files/peanut-allergy-prevention-guidelines-parent-summary.pdf
- National Institute of Allergy and Infectious Disease. (2107). Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary for Clinicians. Retrieved from https://www.niaid.nih.gov/sites/default/files/peanut-allergy-prevention-guidelines-clinician-summary.pdf
- Health Canada (2017). Peanuts- A priority food allergen. Retrieved from https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/peanuts-priority-food-allergen.html
- National Institute of Allergy and Infectious Disease. (2017). Appendix D. Instructions for Home Feeding of Peanut protein for Infants at Low Risk of an Allergic Reaction to Peanut. Retrieved from https://www.niaid.nih.gov/sites/default/files/addendum_guidelines_peanut_appx_d.pdf
- Food Allergy Canada. (2017). New Guidelines for Introducing Peanut to Babies: What do they Mean? Retrieved from http://foodallergycanada.ca/resources/videos-presentations/#healthcare
- Canadian Society of Allergy and Clinical Immunology (CSACI) & Food Allergy Canada.(2017)Early Infant Feeding Guidelines FAQs. Retrieved from http://csaci.ca/wp-content/uploads/2017/10/FAQs-for-early-infant-feeding-guidelines.pdf
- HealthLinkBC(2017). Introducing Solid Foods to your Baby. Retrieved from https://www.healthlinkbc.ca/health-topics/te4473
- The University of British Columbia: Faculty of Medicine. (2017). The best way to prevent peanut allergies? Feeding your infant peanut-based foods early. Retrieved from http://www.med.ubc.ca/the-best-way-to-prevent-peanut-allergies-feeding-your-infant-peanut-early/