When is it safe to introduce peanuts in a toddler’s diet?

We have asked our own doctor Inessa R. Bachove, MD

Statistics account for nearly 2 million children suffering from peanut allergy in the US. The most allergenic foods are called the “Big 8”: eggs, soy, milk, wheat, fish, shellfish, peanuts, tree nuts. Sesame has been added recently.
Is it only fair that parents of children and toddlers ask what age is it safe to introduce peanuts in their diet? Or, for that matter, is it safe at all?
There isn’t a one answer fits all, and NIAID’s (National Institute of Allergy and Infectious Diseases) new guidelines for peanut allergy prevention provide three stages of introduction.

HIGH RISK: 4 to 6 months old under the allergist/immunologist supervision for moderate-to-severe eczema (the most common symptom) and/or an egg allergy or children with immediate family or relative allergic. First feeding at home isn’t recommended, and must be supervised.

MODERATE: 6 months old for mild-to-moderate eczema parents may introduce peanut-containing foods. However if peanut is not a part of the family’s diet or nutritional preference, then do not feel compelled to introduce peanut at such an early age.

LOW RISK: with no eczema or other food allergies, introduction at home with other solid foods is safe.

Must be noted that, especially with cases 1 and 2, infant’s care provider and allergist must be consulted to diagnose eczema or any other symptoms of food allergy.

How to prevent food allergies from developing in infants and children.

• In children with symptoms (allergic rhinitis, atopic dermatitis, or asthma) or biological siblings and/or parents diagnosed with allergies, introduce solid foods one at a time under the pediatrician/specialist supervision. Maintaining a diary is recommended and a slow introduction process of 3 to 5 days distance between new foods.
• Restricting the mother’s diet during pregnancy and breastfeeding with an overall well child is not recommended, it’s not a proven means to prevent allergies. Breast milk is usually safe and strengthens the child’s immune system.
• Introducing the most allergenic foods during  the same 4 to 6 months period together with less allergenic foods is also recommended.

Some medical advancements:  a “peanut patch” and a “sublingual epinephrine film”  have received a fast track status from the FDA.

Resources:

• https://www.aaaai.org/conditions-and-treatments/library/allergy-library/prevention-of-allergies-and-asthma-in-children
• https://www.niaid.nih.gov/sites/default/files/peanut-allergy-prevention-guidelines-parent-summary.pdf