Local Expert Explains New Guidelines on When Kids Should First Try Peanuts


Forget everything you thought you knew about when first to expose children to peanuts. New guidelines from the National Institute of Allergy and Infectious Diseases refute older recommendations issued in 2000 by the American Academy of Pediatrics (AAP).

Now scientists recommend children at highest risk of peanut allergies—infants with severe eczema and/or egg allergy—be exposed to peanuts earliest, between 4 and 6 months of age. Those at lowest risk (no eczema and no food allergies) should try peanuts by the time they’re 6 months old. Formerly, all parents were advised to wait until children were 3 to introduce them to peanuts. Even which infants are considered “at risk” has changed. Previously, a family history of allergies was the primary risk factor. Now, severe eczema and egg allergies are considered red flags.

Why does it matter when children are first exposed to peanuts? Blame the skyrocketing increase of food allergies among U.S. children—about a 50 percent jump since 1991, according to the Centers for Disease Control and Prevention. There’s also the fact that peanuts, one of the leading sources of food allergies, can be fatal.

To make sense of the change in recommendations, we tapped Johns Hopkins allergy expert Corinne Allison Keet, M.D., M.S., Ph.D.

“The initial guidelines were not based on much evidence,” says Keet, associate professor of Pediatrics at Johns Hopkins.

More recently, scientists have discovered stronger evidence, primarily from the LEAP (Learning Early About Peanut Allergy) study. The London-based study included 640 infants at “high risk” (severe eczema and allergy to eggs) for developing peanut allergies. Consuming peanuts regularly from infancy, subjects were 81 percent less likely to develop a peanut allergy by age 5. The landmark study appeared in the New England Journal of Medicine.

Keet says while medical experts don’t know exactly why eating peanuts regularly from infancy minimizes the risk of developing an allergy, they hypothesize the immune system develops tolerance through increased exposure, sensing peanuts aren’t foreign or “dangerous.”

“There’s a lot of research being done right now…it’s a very exciting time for food allergies,” Keet says.

Keet and associates at The Johns Hopkins Division of Pediatric Allergy and Immunology are recruiting subjects for a study to determine whether certain infants should be screened for peanut allergy before being exposed to peanuts. Interested families whose infants are 4-11 months of age with eczema, food allergy or a family history of peanut allergy can call 410-502-4198 or email [email protected] for more information.






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