Summary of Guidelines
The guidelines for introducing peanut products to infants depends on their risk of peanut allergy. Infants are divided into three groups based on their risk of peanut allergy. Infants in the LEAP study ate two grams of peanut protein, three times per week. It is not known whether the same reduction in peanut allergy will occur with a lower quantity or frequency of consumption of peanut products.
Infants at high risk of peanut allergy
Infants with a history of severe eczema and/or an egg allergy are considered at high risk for the development of peanut allergy. The guidelines recommend that these infants are introduced to age-appropriate peanut products at six months of age, but no earlier than four, to reduce the risk of peanut allergy. The infant should first be introduced to other solid foods to determine developmental readiness. Healthcare providers should strongly consider that these infants are first tested with peanut specific immunoglobin E (peanut sIgE), skin prick testing (SPT) or both to determine if peanut products should be introduced and, if so, the method of introduction (i.e. in office oral challenge or introduction at home). A referral to a pediatric allergy specialist should be considered if available in a timely manner. Testing of other potential food allergies is not recommended due to the risk of false positives.
Infants at moderate risk of peanut allergy
Infants with mild to moderate eczema are considered at moderate risk of peanut allergy. These infants should be introduced to age-appropriate peanut products at about six months of age at home. Other solid foods should be introduced first to determine developmental readiness. Once introduced, peanut products should be offered regularly to help reduce risk of peanut allergy.
Infants at low risk of peanut allergy
Infants with no eczema and no history of food allergy are considered at low risk of peanut allergy. These infants may have age-appropriate peanut products introduced freely in the diet with other solid foods from about six months.
Introduction of peanut products to infants with no eczema or food allergies, but with a positive family history of peanut allergy was not addressed by the LEAP study. These infants should be introduced to age-appropriate peanut products in accordance with Canadian recommendations at approximately six months of age. Once introduced, peanut products should be offered regularly to reduce the risk of peanut allergy. Care should be taken to avoid cross-contamination and risk of reaction for the family member with a peanut allergy.
How can families safely introduce peanut products
Generally, it is safe for most infants to be introduced to peanut products by about six months of age when they are showing signs of readiness.
- Healthcare providers should counsel parents/caregivers to monitor infants for allergic reactions. The signs and symptoms of allergic reactions, including rash, vomiting, diarrhea, or breathing problems, should be reviewed. Parents/caregivers should be encouraged to seek medical attention with concerns about a possible food allergy.
Healthcare Provider Tools
- Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary for Parents and Caregivers
- Early Infant Feeding Guidelines - FAQs
- Feeding your Baby – A guide to help you introduce solid foods (PDF)
- Food Allergies and Babies
- Instructions for Home Feeding of Peanut Protein for Infants at Low Risk of An Allergic Reaction to Peanut
- Peanuts – A priority food allergen
- Video: New guidelines for introducing peanuts to babies – What do they mean?
Key Documents/Best Practice Guidelines
- Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the NIAID-sponsored Expert Panel (PDF)
- Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-sponsored Expert Panel
- Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months
- Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months
- Timing of introduction of allergenic solids for infants at high risk