Healthcare Practitioners

The Dietary Guidelines for Americans (DGAs) released December 2020 included a critical insight for healthcare providers and new parents to help bring an end to a public health challenge simply by being intentional about when and what we feed infants.

The new DGAs reinforce that in order to reduce the risk of food allergies babies should be fed infant-safe potentially allergenic foods once they’ve eaten a few other complementary foods successfully – starting at around 6-months of age but not before 4 months of age. This recommendation is particularly important when it comes to helping prevent peanut allergies.

As a healthcare practitioner, you have an essential role in helping this information reach parents and families to help curb the prevalence of peanut allergies. Anyone who works with new parents knows that they can be fraught with concerns. Sometimes these are well-founded and overcoming them can be easy. Yet, other times their concerns have been inflated by misinformation whether through parenting websites, social media filled with scary anecdotes or invalid sources, leading to parents with no known risk for having babies with food allergies to become fearful and preoccupied with infant feeding.

When communicating this information to parents and caregivers there are five key points to keep in mind:

1. Food allergies affects approximately 5% of children, which means that most children will not develop food allergies (1).
2. However, research shows that waiting until after 12 months to introduce peanut increases the likelihood of developing a peanut allergy (2).
3. Always introduce potential allergens to a healthy baby early in the day, and when parents can keep an eye on him or her for at least two hours. Start with just a small amount of infant-safe food – such as peanut butter thinned with a little warm water, breastmilk or formula – and wait 10 minutes. If there’s no reaction, continue to feed until the baby has eaten the full portion or is no longer interested in eating (3).
4. Infants are at low risk for severe reactions when peanut foods are introduced in infancy, according to the experts (4).
5. Once a peanut has been safely introduced, it should be kept in the diet regularly (5).

Keep in mind that early introduction of potential allergens is the best practice when it comes to prevention at this point. When we think about the number of babies born each year, this simple advice, when acted upon, has the potential to prevent a lifetime of anxiety, increased healthcare burden, and all the other issues that go along with managing a food allergy. The power of prevention is in our hands – get comfortable with the new recommendations, encourage parents to act on them, and help reduce food allergies in future generations.

References

(1) “Food Allergy.” National Institute of Allergy and Infectious Diseases, U.S. Department of Health and Human Services, www.niaid.nih.gov/diseases-conditions/food-allergy. Accessed 8 Feb. 2024.

(2) Simons, Elinor, et al. “Timing of introduction, sensitization, and allergy to highly allergenic foods at age 3 years in a general-population Canadian cohort.” The Journal of Allergy and Clinical Immunology: In Practice, vol. 8, no. 1, Jan. 2020, https://doi.org/10.1016/j.jaip.2019.09.039.

(3) Appendix D Instructions for Home Feeding of Peanut Protein for Infants at Low Risk of an Allergic Reaction to Peanut, National Institute of Allergy and Infectious Diseases, www.niaid.nih.gov/sites/default/files/addendum_guidelines_peanut_appx_d.pdf. Accessed 8 Feb. 2024.

(4) Increasing Awareness of the Low Risk of Severe Reaction at Infant Peanut Introduction: Implications During COVID-19 and BeyondAbrams, Elissa M. et al. The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 10, 3259 - 3260. https://www.jaci-inpractice.org/article/S2213-2198(20)30876-X/fulltext.

(5) Addendum Guidelines for the Prevention of Peanut Allergy in the United States, National Institute of Allergy and Infectious Diseases, www.niaid.nih.gov/sites/default/files/addendum-peanut-allergy-prevention-guidelines.pdf. Accessed 8 Feb. 2024.