Where and how should you do your first exposure

After all the news stories about food allergies and the seemingly endless “poor [child] found out he has a peanut allergy…” from friends, the advice to start with peanuts right-away can be scary. We’ve heard stories of people giving their baby a first taste of peanut in the doctor’s office waiting room, or ER parking lot as a result of our sensitivity and fear. But the truth is that for the majority of parents, that probably isn’t necessary.

The pediatric guidelines purposely divide patients into three groups based on their risk of a peanut allergy.

Low risk children: children with no family history of food allergy, no known food allergies, and no eczema

For these babies, there is no reason to wait, worry, or do anything out of the ordinary. Doctors suggest low risk children be given peanuts whenever the family feels appropriate, in line with their customs and preferences. You can follow the instructions for first feeding below, and after that, continue to make peanuts a regular part of the diet.

Medium risk children: children with mild-to-moderate eczema

For medium risk children, the risk of a peanut allergy is still really low. Despite an increased awareness of allergens, and even a growing population of children likely to develop allergies, the overall chance of a peanut allergy is only 2%. The majority of those that will develop the allergy are in the high risk group. If your child is medium risk, doctors suggest starting peanuts around 5-6 months old at home. For the first feeding, follow the instructions below, and maintain regular exposure to peanuts in baby’s diet 3-4 times per week for the first year.

High risk children: children with severe eczema, egg allergy, or both

Doctors still recommend starting solid foods beginning at 4 to 6 months of age. First, start with solid food other than peanut, so that you can establish that the baby is ready for solids. Again, follow the instructions below.

Almost all infants have a 4 month and 6 month well visit, which is a great time to discuss solids and allergen introduction with your pediatrician, and get assessed for signs of eczema. If you miss the 4- to 6-month time window, still start. Older babies who have not had peanut do have a higher likelihood of a peanut allergy, but the LEAP study showed that starting anytime between 4 and 11 months is better than not.

General Instructions for Allergen Introduction from the Guideline Authors

  1. Feed your infant only when he or she is healthy; do not do the feeding if he or she has a cold, vomiting, diarrhea, or other illness.

  2. Give the first peanut feeding at home and not at a day-care facility or restaurant.

  3. Make sure at least 1 adult will be able to focus all of his or her attention on the infant, without distractions from other children or household activities.

  4. Make sure that you will be able to spend at least 2 h with your infant after the feeding to watch for any signs of an allergic reaction.

 Feeding your infant

  1. Prepare a full portion of one of the peanut-containing foods

  2. Offer your infant a small part of the peanut serving on the tip of a spoon.

  3. Wait 10 min.

  4. If there is no allergic reaction after this small taste, then slowly give the remainder of the peanut-containing food at the infant’s usual eating speed.

 What are symptoms of an allergic reaction? What should I look for?

  • Mild symptoms can include:
    • a new rash
    • a few hives around the mouth or  face
  • More severe symptoms can include any of the following alone or in combination:
  • lip swelling
  • vomiting
  • widespread hives (welts) over the body
  • face or tongue swelling
  • any difficulty breathing
  • wheeze
  • repetitive coughing
  • change in skin color (pale, blue)
  • sudden tiredness/lethargy/seeming limp

If you have any concerns about your infant’s response to peanut, seek immediate medical attention/call 911.


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