Babies at high risk for developing peanut allergies should be introduced to peanut-containing foods in a controlled way as early as 4 to 6 months of age, according to new guidelines from an expert panel sponsored by the National Institute of Allergy and Infectious Disease (NIAID).

Early peanut introduction was shown to dramatically reduce the risk for allergic sensitization in high-risk infants in the landmark LEAP trial. The new guidelines are largely based on findings from the 2015 study, which showed early introduction of peanut protein to be associated with an 81% reduction in peanut allergy among high-risk children.

Infants with severe eczema, egg allergy, or both are considered to have a high risk for peanut and other food allergies. The revised guidelines recommend that parents or caregivers introduce peanut-containing foods as early as 4-6 months to high-risk babies who have already started solid foods, after evaluation by the baby's healthcare provider or a specialist.

The expert panel recommended that evaluation with peanut-specific IgE measurement, skin prick testing, or both be "strongly considered before the introduction of peanut to determine if peanut should be introduced and, if so, the preferred method of introduction."

The revised guidelines were published simultaneously Jan. 5 in the Annals of Allergy, Asthma & Immunology and related journals. The NIAID's expert panel, which included representatives from 25 professional organizations, federal agencies, and patient advocacy groups, included separate guidelines for infants with different peanut allergy risks.

The panel defined three categories of sensitivity risk associated with skin prick testing with peanut extract:

• A wheal diameter of 2 mm or less with skin prick testing is indicative of low risk, and the panel recommended peanut introduction soon after testing
• Wheal diameter of 3 to 7 mm reflects medium likelihood of peanut allergy; supervised peanut feeding or an oral food challenge at a specialist's office or specialized facility can be employed
• A wheal diameter of 8 mm or more is indicative of a high likelihood of allergy, and children in this category should be evaluated and managed by a specialist

Parents and caregivers who introduce peanuts at home should initially give two teaspoons of peanut butter diluted in warm water or a warm puree that the baby enjoys, followed by two more such feedings over the course of a week for a total of roughly six grams of peanut protein. The schedule should be repeated weekly. Babies at high risk for peanut allergies often become allergic before the age of 12 months, which is why early peanut introduction is so important.

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