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The AAP’s New Recommendations for Childhood Food Allergies: What Families Need to Know

Learn more about the new recommendations from the American Academy of Pediatrics on early allergen introduction.

In 2019, the American Academy of Pediatrics (AAP) released new recommendations for childhood food allergies and other allergic conditions, such as eczema. This report is based on a review of all current evidence from clinical studies, including the recent landmark LEAP (Learning Early About Peanut Allergy) on early allergen introduction. Most notably, the new AAP report recommends introducing your baby to peanut as early as 4 to 6 months of age.


“After a thorough review of the latest research on early allergen introduction, the AAP issued updated guidance that reinforces that there is no reason for parents to delay allergen introduction, explains Dr. Jonathan Spergel, Head of Allergy at Children’s Hospital of Philadelphia. “In fact, parents should introduce peanut as early as 4-6 months according to the AAP and recent landmark studies. In addition, the AAP simplifies the advice by recommending early allergen introduction, even for breastfed or hydrolyzed formula-fed infants.”  


Here are the key points that your family should take away from the report, to help you introduce allergens for your baby:

  • Introduce allergenic foods such as peanut starting as early as 4-6 months of age
  • Babies at high risk for peanut allergy should be introduced to peanut starting between 4-6 months of age
  • All babies should be introduced to peanut starting in their first year of life, regardless of food allergy risk
  • There is no conclusive evidence that breastfeeding alone can prevent food allergies, but breastfeeding may help prevent eczema

What Families Need To Know

    1. Early Allergen Introduction Starting At 4-6 Months

    According to the AAP report, "there is now evidence that the early introduction of infant-safe forms of peanuts reduces the risk for peanut allergies." The AAP report mainly focuses on findings from the LEAP study:


      • In the LEAP study, over 600 infants at high risk for peanut allergy were randomly assigned to either consume peanut protein regularly as early as 4 months of age, or avoid peanut protein until 5 years of age.
      • The study showed early and sustained peanut introduction reduced peanut allergy risk by over 81%
      1. Babies At High Risk For Food Allergies


      The AAP defined the following groups as high risk for developing peanut allergies (in accordance with the guidelines developed by the National Institute of Allergy and Infectious Diseases (NIAID)), specifically infants with:

        • Severe eczema
        • Egg allergy

      "An expert panel has advised peanut introduction as early as 4 to 6 months of age for infants at high risk for peanut allergy (presence of severe eczema and/or egg allergy). The recommendations contain details of implementation for high-risk infants, including appropriate use of testing (specific IgE measurement, skin-prick test, and oral food challenges) and introduction of peanut-containing foods in the health care provider’s office versus the home setting, as well as amount and frequency. For infants with mild to moderate eczema, the panel recommended introduction of peanut-containing foods at around 6 months of age, and for infants at low risk for peanut allergy (no eczema or any food allergy), the panel recommended introduction of peanut-containing food when age appropriate and depending on family preferences and cultural practices (ie, after 6 months of age if exclusively breastfeeding)."

      1. Breastfeeding

      The latest guidance from the AAP reinforces that "no conclusions can be made about the role of any duration of breastfeeding in either preventing or delaying the onset of specific food allergies." 

      1. Breastfeeding and Eczema

      The AAP reinforces: "there is evidence that exclusive breastfeeding for the first 3 to 4 months decreases the cumulative incidence of eczema in the first 2 years of life."

      1. Hydrolyzed Infant Formula

      "There is lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease in infants and children, even in those at high risk for allergic disease."

      What is hydrolyzed formula? Extensively hydrolyzed formula is designed for babies with a milk allergy or intolerance. The milk protein is broken down into small enough pieces that baby’s immune system will not recognize and react to it.



      Key Takeaways From The Report

      1. The AAP report recommends early, “purposeful” introduction of peanut.
      2. Families with babies at high risk for peanut allergies (due to family allergy history and/or severe eczema) should introduce peanuts into their baby’s diet at 4-6 months.
      3. Breastfeeding alone is not enough to prevent food allergies, although it may help prevent eczema.
      4. Feeding your baby hydrolyzed formula will not reduce your baby’s food allergy risk.

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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.

      See the FDA Peanut Allergy Qualified Health Claim at the bottom of our homepage.

      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.

       

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