New Medical Guidelines: “Peanut and Egg Should Be Introduced Around 4-6 Months”

New guidance from leading medical organizations, the American Academy of Allergy, Asthma, and Immunology (AAAAI); the American College of Allergy, Asthma, and Immunology (ACAAI); and the CSACI (Canadian Society of Allergy and Clinical Immunology), recommends that in order “to prevent peanut and/or egg allergy, peanut and egg should be introduced around 6 months of life, but not before 4 months.”

“To prevent peanut and/or egg allergy, peanut and egg should be introduced around [4-]6 months of life.” - AAAAI, ACAAI, and CSACI


These three top allergy organizations (AAAAI, ACAAI, CSACI) worked together to form a consensus report with recommendations for the medical community and parents to address the rise in food allergies that now “affect as many as 8% of children in the United States and 7% in Canada.” In addition, food allergy is “a disease that has no known cure” and can “be quite severe, even potentially life-threatening.” 

Here are some important takeaways from this new guidance:

  • Preventing food allergies in babies: “To prevent peanut and/or egg allergy, peanut and egg should be introduced around 6 months of life, but not before 4 months.”
  • Pre-screening babies for food allergies:  “Screening before introduction is not required, but may be preferred by some families.”
  • Effect of maternal diet on food allergies:  “Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended.” 
  • Effect of breastfeeding on food allergies:  “Although exclusive breast-feeding is universally recommended for all mothers, there is no specific association between exclusive breastfeeding and the primary prevention of any specific food allergy.”
  • Using Bamba to introduce peanut:  “Although Bamba was specifically used as a peanut snack in the LEAP trial and provides a dissolving textured food, it [Bamba] is not necessarily a long-term, healthy weaning food option.”

These national allergy groups explored 5 key questions related to preventing food allergies. Below is an overview of the questions and their recommendations.


5 Key Questions & Recommendations

 

Question 1:

What criteria define an infant at high risk for the development of food allergy?

Recommendations - consider 3 different risk groups for food allergies:

  • High Risk - Infants with severe eczema are at the highest risk of developing food allergy
  • Medium Risk - Infants with mild to moderate eczema, a family history of atopy (or the genetic tendency to develop allergic diseases such as eczema) in either or both parents, or infants with one known food allergy are potentially at some increased risk of developing a food allergy (or an additional food allergy)
  • Low Risk - For infants with no eczema or other risk factors, be aware that food allergy often develops in infants who have no identifiable risk factors

 

Question 2:

What is the evidence supporting the timing of introduction of potentially allergenic foods (like peanut and egg) and the development of IgE mediated food allergy?

Recommendations:

  • Start feeding highly allergenic foods, like peanut and egg, at 4-6 months of age 
  • Do not deliberately delay the introduction of other potentially allergenic complementary foods, like cow’s milk, soy, and wheat
  • Once allergenic foods are introduced, regular ingestion/feeding should be maintained

Question 3:

Is there an association between early infant diet diversity and the development of food allergy?

Recommendations:

  • Upon introducing complementary foods, infants should be fed a diverse diet, as this may help foster prevention of food allergy. 
  • In accordance with a recommendation from question 2, do not deliberately delay the introduction of other potentially allergenic complementary foods (cow’s milk, soy, wheat, tree nuts, sesame, fish, shellfish) once introduction of complementary foods has commenced at around 4-6 months of age

Question 4:

What is the role for the use of hydrolyzed formula for the prevention of food allergy?


Recommendations:

  • Do not routinely prescribe or recommend the use of any hydrolyzed formulas for the specific prevention of food allergy or development of food sensitization

Question 5

What are the roles of prenatal food exposures, postnatal food exposures while breast-feeding an infant, and breast-feeding in general on the development of food allergy?

Recommendations:

  • Maternal exclusion of common allergens during pregnancy and lactation as a means to prevent food allergy is not recommended
  • There are no recommendations to support any particular food or supplement in the maternal diet for the prevention of food allergy in the infant during either the prenatal period or while breast-feeding
  • While exclusive breast-feeding is universally recommended for all mothers, there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy

To read more about all of the other international guidelines, visit our blog here.

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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

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About the author: Our Chief Allergist, Katie Marks-Cogan, M.D., is board certified in Allergy/Immunology and Internal Medicine, and treats both pediatric and adult patients. Originally from Cleveland, Ohio, she received her M.D. with honors from the University of Maryland School of Medicine. She then completed her residency in Internal Medicine at Northwestern and fellowship in Allergy/Immunology at the prestigious University of Pennsylvania and CHOP. After finishing training, she moved to Southern California and currently works in private practice. She is a  member of the scientific advisory board for Ready, Set, Food! She currently resides in Los Angeles with her husband, 4-year-old son, and 1-year-old daughter where she enjoys hiking, building LEGO castles with her kids, and cooking with her family.