The approach toward preventing peanut allergies has changed dramatically in recent years. Now the US Food and Drug Administration has approved the first commercial product, called Hello, Peanut!, to help inform the public that early peanut introduction and regular consumption can reduce the risk of peanut allergies in young children.
The Hello, Peanut! introduction kit offers convenience in the form of packets of peanut powder blended with oat given in increasing quantities for seven days, as long as children tolerate it well. After which maintenance packets are recommended for use up to three times a week. The introduction kit is $25, and the maintenance kit sells for $20 for eight packets.
The FDA decision was informed by the landmark Learning Early About Peanut Allergy study published in 2015. It showed that high-risk children who regularly consumed peanuts in infancy had far fewer peanut allergies by age 5 than their counterparts who avoided peanuts over the same span of time. This understanding led to new guidelines published in 2017 by National Institutes of Health about giving peanuts to babies to protect against peanut allergies.
Infants who have severe eczema or egg allergy are considered to be at high-risk of developing a peanut allergy. By offering peanuts early in life – between 4 and 6 months of age – and continuing with regular consumption, we can prevent the onset of peanut allergies in many of these children. High-risk children should see their doctor before parents introduce peanut protein in any form. The physician may decide to do skin or blood testing. If the test is negative, age-appropriate peanut products can be given at home. However, if a child tests positive, introduction to peanuts is done under clinical supervision. If the child is deemed already allergic to peanuts, the guidelines recommend strict avoidance of peanut and ready access to epinephrine auto-injectors.
The expert panel also suggests that infants diagnosed with mild to moderate eczema should have the introduction of age-appropriate peanut-containing foods around 6 months of age, according to the family’s dietary preferences, to reduce the risk of peanut allergies. For infants at low risk, such as those without eczema or any food allergy, parents should follow their pediatrician’s guidance on introducing age-appropriate solid foods and peanut products according to the family’s dietary routines and preferences.
So do parents need a product like Hello, Peanut for children? Not necessarily. Parents can introduce peanut protein using creamy peanut butter. Whole peanuts, on the other hand, are a choking hazard for young children and should not be consumed. For babies, dilute 2 teaspoons of smooth peanut butter with previously tolerated breast milk, infant formula, or pureed fruit to the desired consistency, because undiluted peanut butter could present a choking hazard.
Another way to give peanut protein is through Bamba snacks, which can be purchased widely and contain peanut protein. If the child tolerates it well, continued regular consumption at least three times a week is advised. Additional feeding precautions should be considered for safety. The initial peanut feeding should be performed when the child is healthy and at home, not at a daycare center or restaurant, and allowing at least two hours to watch for any signs of an allergic reaction. Severe allergic symptoms may include any of the following alone or in combination: vomiting, swelling, hives, repetitive coughing/wheezing, difficulty breathing, change in skin color, and sudden tiredness. If such an event occurs, seek immediate medical attention.
The good news here is that we now have compelling evidence that early introduction and regular consumption of peanut protein to high-risk babies can reduce the odds of developing peanut allergies, which is a persistent food allergy and the leading cause of death related to food-induced anaphylaxis in the United States. It’s very exciting that we have the potential to significantly bring down the numbers of peanut allergies and related anaphylactic events over the next decade.
Trong Le, MD, is a pediatric allergist at Nemours/Alfred I. duPont Hospital for Children and a clinical associate professor at the Sidney Kimmel Medical College of Thomas Jefferson University.