Early Peanut Introduction Deemed Safe to Prevent Allergy, Some Parents Unaware or Hesitant

Updated National Institutes of Health (NIH) guidelines issued in 2017 recommended that parents expose their infants to peanuts as young as 4 months of age to prevent peanut allergy, which was a significant reversal in the approach to the prevention of peanut allergies. Since the announcement, the earlier introduction of peanuts has been more common among US parents and caregivers; however, a new study examining the impact and implementation of these guidelines conducted by Northwestern University and the Ann & Robert H. Lurie Children’s Hospital of Chicago shows that more work is necessary to effectively communicate these guidelines.

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A survey of US parents and caregivers showed that only 13% were aware of the change in guidelines. Additionally, 48% had begun feeding their children peanuts early, regardless of whether they were aware of the updated guidelines.

“There’s still a lot of room for growth in terms of educating families and clinicians about these guidelines,” said Waheeda Samady, MD, associate professor of pediatrics at Northwestern University Feinberg School of Medicine and director of clinical research at Northwestern’s Center for Food Allergy Asthma Research, in a press release.

Survey respondents were asked whether they had exposed their children to peanuts either before (around 4-6 months of age) or after 7 months (between 7 months and 1 year of age). The results showed that 17% had introduced them before 7 months, with 42% doing so after. Peanut introduction had occurred earlier among parents and caregivers who were aware of the updated guidelines, with 31% introducing peanuts to their children before 7 months of age.

Peanut introduction at an early age is not well known among groups with less access to health care information, the survey indicated. The study authors found that the main factors preventing parents and caregivers from introducing peanuts to their children at an early age included access barriers and systemic racism (information is less known or less accessible to non-White and less educated, lower-income parents), primary care providers not presenting this information in a timely way, and public health messages about peanut reactions. The study found that having a pediatrician’s recommendation was the strongest factor influencing a parent or caregiver’s decision to introduce peanuts early.

“We have to get to all the pediatricians, not just those who work in academic or affluent areas,” Samady said, “but we need to think outside that box as well.”

Her recommendation is that information surrounding the updated guidelines should be shared at community centers, daycares, or supplemental nutrition programs for women, infants, and children.

The study found that 13% of parents who were aware of the new guidelines were White, higher education and higher income, or had a child with eczema or a food allergy. Despite this, fear of potential reaction was the main cause of parents delaying introduction, with 33% opting not to introduce.

Only 1.4% of infants and children were reported to have had a reaction upon introduction. The study found that any mild reactions that occurred were either dermatological (e.g., rash) or gastroenterological (e.g., vomiting).

“Previous studies have found that, on average, infant reactions are much milder than older kids’ reactions. Based on this, I would say you should be more concerned about your older child, not your five-month-old. Statistically, reactions are much milder younger in life,” Samady said in the press release. “The perception amongst US parents and caregivers about how common reactions are in children is much higher than the reality.”

Reference

Northwestern University. Early peanut introduction gaining traction among US parents, but more work needed. News release. July 21, 2023. Accessed on July 25, 2023. https://www.eurekalert.org/news-releases/996256