New research shows that less than half of parents are following current NIAID guidelines for introducing peanut. Learn other important findings from this new study and what they mean for families and doctors.
In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) released groundbreaking guidelines covering the introduction of peanut-containing foods.
These guidelines, inspired by results of the landmark Learning Early About Peanut Allergy (LEAP) trial, recommend introducing peanut to babies early and often, in order to reduce babies' risk of developing a peanut allergy.
But recent research indicates that, four years after the guidelines were released, less than half of parents are following these important early peanut introduction guidelines.
Today, we'll break down this and other important findings from this survey, and what they indicate.
But first, let's review the peanut introduction guidelines from the NIAID, which the survey checked parents' use of.
NIAID Guidelines: Introduce Peanut Early
According to the NIAID's 2017 guidelines, "A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy."
The recent trial that the guidelines reference, and are based on, is known as the LEAP trial, or Learning Early About Peanut Allergy trial.
- In the LEAP trial, babies ages 4-11 months and at high risk for peanut allergy were randomly assigned to either consume peanut regularly or avoid peanut until they reached 5 years of age.
- The results of this trial found that consuming peanut early and often, starting between 4 and 11 months of age, reduced the babies' risk of developing a peanut allergy by over 85%.
Based on the results of the LEAP trial, the NIAID guidelines recommend that:
- Babies at high risk for peanut allergy (due to an egg allergy or severe eczema) should be introduced to baby-safe forms of peanut between 4 and 6 months of age.
- Babies at moderate risk for peanut allergy (due to mild or moderate eczema) should be introduced to baby-safe forms of peanut around 6 months of age.
- Babies at low risk for peanut allergy should be introduced to baby-safe forms of peanut along with other solid foods, within the first year of life.
Less Than Half Of Parents Are Following NIAID Guidelines
Surprisingly, though, a new study presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting reveals that many parents aren't following these important guidelines from the NIAID.
This study found that, out of 3062 U.S. households with children age 7 months to 3 ½ years:
- Only 44% of parents/caregivers reported that they introduced peanut to their baby by 11 months of age.
- Only 13% of parents/caregivers knew about the NIAID guidelines recommending early peanut introduction.
- 58% were able to recall a discussion with their pediatrician about when to feed their baby peanut-containing foods.
- But only 40% received a recommendation from their pediatrician to introduce peanut within the first year of life, in line with NIAID guidelines.
Among parents and caregivers of children with allergic conditions (including eczema, asthma, environmental allergies, or other food allergies), awareness of the guidelines was greater, but only slightly.
- 70% of these parents/caregivers had some sort of discussion with a pediatrician about when to introduce peanut.
- But only 46% --- still less than half --- received a recommendation from their pediatrician to introduce peanut in a way that's consistent with NIAID guidelines.
- And only 18% of these parents/caregivers knew about the NIAID guidelines recommending early peanut introduction.
What do these findings indicate?
The new study's findings show that more parents need to hear about the evidence-based NIAID guidelines, so they can make an informed decision about when to introduce their baby to peanut.
More importantly, the findings illustrate how crucial it is for pediatricians to make parents aware of the NIAID guidelines, and make recommendations about peanut introduction that are in line with these guidelines.
As the 2021 study's lead author, Dr. Christopher Warren, PhD. (Northwestern University Feinberg School of Medicine), shared: "Our survey showed that while [pediatricians] are discussing the idea of early peanut introduction with parents of infants, they aren’t recommending that most parents begin peanut by 11 months of age," as the NIAID guidelines recommend.
Dr. Warren continues, "We now know that the earlier peanut is introduced, as early as when a child begins solid foods, the better the chance that peanut allergy can be prevented.”
And Dr. Ruchi Gupta, MD (Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children’s Hospital of Chicago), co-author of the study, echoes Dr. Warren's thoughts: "Early peanut introduction should be discussed with parents/caregivers of all infants, including those at higher risk of developing peanut allergy.”
The authors report that it's difficult to pinpoint the exact barriers keeping parents from hearing about the NIAID guidelines and putting them into practice --- and keeping pediatricians from giving recommendations in line with these current guidelines.
But the authors believe that pediatricians need more education and training on these important guidelines, so they can best equip parents to follow the guidelines and introduce peanut early.
The 2017 NIAID Guidelines: A Shift In Peanut Introduction Approaches
It's also important to keep in mind that the 2017 NIAID guidelines on peanut introduction represent a direct reversal of the previously-held approach to introducing peanut.
Before 2017, the common approach was to completely avoid giving young children peanut.
The previous (now outdated) medical guidelines even recommended peanut avoidance.
But now, evidence from the LEAP clinical trial shows that the opposite approach --- introducing peanut to babies in their first year of life --- is best.
As the 2021 survey shows, though, many parents and caregivers are still using the outdated approach, rather than introducing peanut early.
They haven't heard about the new NIAID guidelines, and haven't received an evidence-based recommendation from their pediatrician to introduce peanut early.
That's why it's so vital for both pediatricians and parents to be informed about the new NIAID guidelines.
Particularly, pediatricians need to advise parents to introduce peanut based on NIAID guidelines, and present the guidelines in a way that's easy for parents to understand and implement.
And parents should become familiar with the NIAID guidelines and bring any questions to their pediatrician.
For more information on the NIAID guidelines, please read this summary for parents and caregivers written by the NIAID.
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Jessica Huhn is a Content Writer for Ready, Set, Food!