Baptist Pediatric Emergency Physician Shares Thoughts on Peanut Allergy Recommendations

A recent New York Times article shared new guidelines from the National Institute of Allergy and Infectious Diseases recommending giving babies pureed food or finger foods containing peanut powder or extract before they are six months old – and for babies prone to allergies, perhaps earlier based on a doctor’s recommendation. We sat down with Dr. Miguel Rodriguez, Pediatric Emergency Medicine Physician and Medical Director of the Pediatric Emergency Room at the Spence and Becky Wilson Baptist Children’s Hospital, to get his thoughts on these recommendations and how parents should be using them.

Recent research suggests feeding children peanuts early and often can help prevent an allergy later on in life. Can you expand on this evidence and share your own recommendations for how to begin if a parent chooses to go this route?

According to the National Institute of Allergy and Infectious, new findings about the pediatric allergy clinical trials suggest the earlier you introduce peanuts and or it’s substrates to patients, the better they do in the future with potential peanut allergies.  The study supported a 70% relative reduction in the occurrence of peanut allergies when early introduction of peanuts to the diet were implemented with low risk subjects.

All patients with severe eczema or egg allergies, or both, are considered high-risk subjects and should get peanut IGE serum sturdies or peanut skin prick tests conducted prior to the implementation of peanut products to their diet.  All patients with serum IGE studies who show a less than 0.35 serum IGE peanut allergy level should be referred to a subspecialist, such as an allergist or immunologist.

A peanut skin prick test where a subject had a 0-2 mm reaction will have a low-risk reaction and 95% will not have peanut allergies. Their options are to introduce peanuts at home or have supervised feedings in the office based on the preference of the provider or parent.  Those which have a 3 to 7mm reaction run the risk of an allergic reaction varied from moderate to high. Their options are to supervise feedings in their primary care provider’s office or do a graded oral peanut food challenge with a specialized physician, such as an allergist or immunologist.

All patients with a greater than 8mm reaction are considered highly allergic to peanuts.  Recommended continual evaluation should be conducted by an allergist or immunologist.

What are some of the most common symptoms of an allergy that a parent should look out for?

Mild symptoms can include:

• A new rash or a few hives around the mouth or face
• Lip swelling
• Vomiting
• Widespread hives or welts over the body
• Face and tongue swelling
• Any difficulty breathing
• Wheezing
• Repetitive coughing
• Any change in skin color (pale or blue)
• Sudden tiredness/seemingly limp.

If a parent does choose to give their child peanuts in this way, how can they be sure they are doing it as safely as possible?

For a home feeding of peanut protein for infants at low risk of an allergic reaction to peanuts:

1. Feed your infant only if he or she is healthy. Do not do the feeding if he or she has a cold, vomiting, diarrhea, or other illness.
2. Give the first peanut feeding at home and not a daycare facility or restaurant.
3. Make sure at least one adult will be able to focus all of his or her attention on the infant without distractions from other children or household activities.
4. Make sure that you are able to spend at least two hours with your infant after the feeding to watch for any signs of allergic reaction.

To feed your infant:

1. Prepare a full portion of one or more of peanut containing foods.
2. Offer your infant a small part of the peanut serving on the tip of a spoon.
3. Wait 10 minutes.  If there is no reaction as the small portion is given, continue gradually feeding the remaining serving of the peanut containing food at the infants typical feeding pace.  Whole nuts should not be given to children less than five years of age and peanut butter directly from the spoon or in lumps/dollops should not be given to children less than four years of age.

If a parent thinks their child may be having a reaction, what immediate steps should be taken?

Call 911 or seek medical attention immediately from your primary care provider, subspecialist, or a pediatric emergency room.