What Infant Health Professionals Need to Know about Introducing Peanut Foods to Prevent Allergy

Approximately 50% of all babies born in the U.S. today are eligible for the Women Infant and Children (WIC) supplemental feeding and nutrition program. This safety net feeding program helps protect the health of women and children at risk for malnutrition and hunger, including providing nutrition education. The National Peanut Board (NPB) and the Egg Nutrition Center (ENC) have been collaborating to help ensure that health professionals have the latest information about introducing common allergens in infancy to help prevent food allergies, so it made sense to work together to provide an education session for this year’s National WIC Association bi-annual breastfeeding and nutrition education conference. At this year’s virtual event, Sherry Coleman Collins, registered dietitian presented a session focused on this important topic.

In the session for WIC nutritionists, Coleman Collins provided an overview of the latest guidelines as well as the compelling research supporting the introduction of peanut and other commonly allergenic foods to infants. The latest guidelines from the National Institutes of Allergy and Infectious Diseases (NIAID) recommend introducing peanut foods as early as 4-6 months depending on risk. Specifically, babies with severe eczema or egg allergy or both should see their pediatrician before introducing peanut foods for an evaluation. If given the all clear, parents should proceed with introducing peanut foods as directed by their healthcare professional. Those with milder eczema may discuss with the pediatrician if desired and plan to introduce peanut foods at about 6 months. Finally, those with no known risk should begin introducing peanut foods at or after 6 months. In all cases, peanut foods should be introduced in an infant-safe way, early in the day so they can be observed for 2 hours, and when an infant is well. Resources including the NIAID guidelines and PreventPeanutAllergies.org were included as places where attendees could find more details on when and how to introduce peanut foods.

The session also reviewed groundbreaking studies such as the LEAP Study (which found an up to 86% reduction in peanut allergies among high-risk infants who ate peanut foods between 4-11 months), the EAT study (which found a lower risk of developing allergies among breastfed infants who ate six different common allergens in infancy starting at 3 months old) and the CHILD study (which reported a significantly higher likelihood of sensitization and probable clinical allergy in a general population sample by age 3 when common allergens were not introduced in the first year). In addition, a study by Feeney, et al. of the impact of early introduction of peanut on nutrition and growth shows that breastfeeding duration is not affected. The limitations of this study is that results are based on self-reported intake and subject to potential errors in reporting as well as possible misreporting of dietary intakes by participants and missing nutritional data on food tables in the UK. However, there is no other practical way to obtain this information. Each of these studies provide compelling data that shows the efficacy and safety of feeding babies these foods. Importantly, there were very few significant adverse events related to feeding infants potential allergens.

During the presentation, participants were provided details on resources available for WIC staff from the WICWorks website, an online repository of educational resources for WIC educators. In addition, she gave an overview of the new Dietary Guidelines for Americans (DGA) scientific report, specifically focusing on the section reviewing the latest research and recommendations for the early introduction of peanut foods. In addition, the DGA committee, responsible for the report, called out eggs as another common allergen that has shown moderate evidence to result in lower risk for allergy when introduced in infancy. For the rest of the commonly allergenic foods, the DGA committee shared that there was little or a lack of equivocal evidence about when or how to introduce those foods to infants, except to share the American Academy of Pediatrics’ guidance that indicates there is no evidence that withholding these allergens prevents food allergies.

Reaching participants in the WIC program and encouraging successful adoption of early introduction of peanut foods has the potential to prevent tens of thousands of cases of peanut allergies every year. These educators have a key opportunity to reach millions of caregivers each year to help reduce the risks of developing peanut and other food allergies through the simple intervention of introducing commonly allergenic foods early.

For more information and resources about the early introduction of peanut foods to prevent a potential peanut allergy, visit PreventPeanutAllergy.org. Registered dietitians and physician assistants can learn more and earn free continuing education credits with this webinar, LEAPing Past Food Allergies: How and When to Introduce Common Food Allergens.