WHEN it comes to introducing the potentially allergenic peanut to a baby, there has been a revolution in thinking. In early 2017, an expert panel convened by the National Institute of Allergy and Infectious Diseases (NIAID) issued new clinical guidelines on the early introduction of foods containing peanut.
The goal? To prevent peanut allergies and stop the steady rise of this condition.
On the strength of the groundbreaking LEAP (Learning Early About Peanut Allergy) study, the recommendation to start infants – from four to six months old – on peanut was born.
This new prevention strategy has great potential to change the future, but it won’t be for all babies. The guidelines recommend that if an infant is at high risk for food allergy due to an egg allergy or severe eczema, you should speak to your physician about allergy testing before trying peanut.
Dr. David Erstein, a New York City allergist, reminds: “It is imperative that a high-risk infant be evaluated by their pediatrician or allergist prior to any form of peanut introduction.” The concern is that you not introduce peanut if a baby might already have a peanut allergy.
These recommendations are contrary to the old strategies of early-life allergen avoidance, which pediatricians taught parents for years. Remarkably, the LEAP study discovered up to 80 percent of children at high risk for food allergy did not develop a peanut allergy with early introduction.
“I know this is a complete reversal of prior information, but as we learn more about the gut microbiome, we realize that there are a multitude of changes occurring during infancy,” says Dr. Priya Bansal, a Chicago-area allergist.
If you get the green light from your doctor, the question is, how to begin? Feeding the notorious legume to your young baby can be a nerve-racking and confusing proposition. The NIAID panel’s guidelines suggest recipes to thin peanut butter (so a baby can swallow it) and how peanut flour can be added to an infant’s food.
But emerging as well is a whole new category of baby food add-ins plus pre-measured foods, designed for convenience for busy young parents. The new products are not your mother’s baby food – they aim directly at early introduction needs. The new brands offer smartly packaged products, which are to be mixed into baby’s solid food or directly consumed.
Each product has strong wording and disclaimers, confirming these products are not cures or treatments. “This is not to be used in kids with diagnosed food allergy, this is not oral immunotherapy, this is not for kids with a sensitivity,” stresses pediatrician Dr. Wendy Sue Swanson, who’s the chief medical officer for the new SpoonfulOne product launched in October by Before Brands, a California-based company.
Allergist Erstein founded Hello, Peanut! – a product that in September, 2017 got the approval of the U.S. Food and Drug Administration (FDA) to make a qualified health claim that links early peanut introduction and peanut allergy prevention. Hello, Peanut! offers parents packets that are a pre-measured mix of organic ground peanut powder and sprouted oat flakes, which are fed to baby on a schedule of increasing amounts.
“There have been great strides over the last few years and validated medical research performed that indicates early introduction of peanuts can help prevent a peanut allergy from developing,” says Erstein. He sees Hello, Peanut! as helping “provide parents with the tools to be proactive and allay their anxiety with a guided and gradual introduction to peanut.”
While LEAP made the scientific case for the protective values of early peanut introduction, some allergists are also getting behind products designed to introduce several potential allergens. Dr. Kari Nadeau, director of Stanford University’s Sean N. Parker Center for Allergy and Asthma Research, is the co-founder of SpoonfulOne, a multi-allergen supplement for baby.
“Science has shown us that delaying introduction of potentially allergenic foods may actually increase the risk of food allergies,” says Nadeau. “But introduction is only part of the story. Independent data show that consistent inclusion of potential food allergens, not only peanuts, in the diet of infants and toddlers is key to educating the immune system.” In keeping with this thinking, each SpoonfulOne packet contains a powdered blend of the top eight allergenic foods, plus sesame.
Convenience and consistency of giving baby a steady diet of often-allergenic food is a central focus of the new products. Boston’s Dr. Lynda Schneider is the medical director of the Inspired Start brand. “Families often struggle with how to introduce the potential allergens,” she says, and suggests that Inspired Start offers a solution with handy pouches that contain a choice of pureed fruits with a top allergen (except for dairy, but including sesame).
While many food allergy parents are starting to embrace the early introduction products for babies and lauding the convenience, there are also skeptical parents on social media. “I’m shocked, actually,” said one allergy mom on Facebook, while another remarked: “I hope it comes with epinephrine.”
Other parents have questioned the costs – in the range of $20 to $90 a month, depending on the product – to purchase pre-measured products, rather than simply buying peanut flour, or other allergens, to mix into baby food. Bansal notes that the NIAID guidelines and allergy advocacy organizations are offering information to institute the revised peanut advice “easily at home, in a cost-effective way.”
With the new products launching, pediatricians and family practitioners may find themselves playing catch up. Boston allergist Dr. Michael Pistiner says the new claim the FDA has approved for peanut on baby food products “adds urgency to the work that organizations like the American Academy of Pediatrics are doing to increase awareness and offer support to clinicians and families to implement these guidelines.”
In fact, a recent survey of 188 U.S. pediatricians found that many were not yet discussing early peanut introduction, and most were not referring high-risk babies (with severe eczema or egg allergy) for allergy testing prior to peanut introduction. Pistiner, who is the director of food allergy advocacy, education and prevention at MassGeneral Hospital for Children’s allergy center, says parents may want to bring along articles or guideline links to discuss with their doctor.
For high-risk babies who are four to six months old and not suspected of being allergic, the new guidelines recommend they be fed six to seven grams of peanut protein per week over at least three meals.
If a family decides to tackle multiple allergenic foods, Pistiner notes that, beyond peanut, there isn’t yet “a best-practice approach” for introducing foods known to be top allergens as a means of disease prevention. He looks forward to having more studies “to be able to give additional solid recommendations.”
But in the meantime, informed health-care providers can offer guidance specific to the families they care for. Speak to your physician about the best advice for your baby and your family.
New Baby Products at a Glance
Hello, Peanut! – Organic peanut-only introduction and maintenance mixes to add to baby food. Introduction packets contain gradually increasing amounts of peanut powder, plus organic sprouted oat flakes.
Inspired Start – Three-phase, multiple allergen introduction kit. Comes in pouches of eight fruit purees, plus one added allergen category: peanut, tree nut mix, fish, shellfish, wheat, soy, egg and sesame. Does not include dairy.
Simply Peanut – Organic peanut only introduction supplement. Each packet contains peanut and a proprietary blend of vitamins to add to baby’s liquid or solid food.
SpoonfulOne – A multiple allergen, daily add-in powder. Each packet contains peanut, tree nut, milk, soy, wheat, fish, egg, shellfish, sesame and vitamin D to be mixed into food.