Recent findings from the Learning Early About Peanut Allergy (LEAP) study (see In the News, June 2016) and others have prompted experts to recommend the following schedule and individualized assessment of infants' readiness for safe introduction of peanuts into the diet to prevent allergy:

* High-risk infants who have experienced severe eczema, egg allergy, or both should be evaluated by an allergist, after which, based on test results, peanut-containing foods can be introduced as early as four to six months of age.

* Infants with mild-to-moderate eczema should start eating peanut-containing foods at about six months of age.

* Infants with no eczema or food allergy can have peanut-containing foods whenever solid foods are introduced into their diet.

Peanut allergy is the leading cause of death from food-induced anaphylaxis in the United States. The prevalence of peanut allergy grew from 0.4% of children in 1999 to 2% of children in 2010. The new Addendum Guidelines for the Prevention of Peanut Allergy in the United States were developed by an expert panel of 26 specialists from clinical, scientific, and public health areas.

The guidelines recommend a first dose of 2 g of peanut protein and provide recipes for this. For example, 2 tsp smooth peanut butter can be thinned with 2 to 3 tsp hot water, then mixed to a desired consistency with cereal or pureed fruits or vegetables.

"Plain peanut butter or whole peanuts should never be given to infants because of choking risks," first author Alkis Togias, MD, told AJN. Togias added that nurses can be instrumental in implementing the new peanut allergy prevention guidelines by educating parents on when and how to introduce peanuts and, in cases where infants have exhibited allergies to foods, evaluating the severity of eczema or other reactions. Togias also noted that infants should be introduced to other solid foods before starting peanut-containing foods.

About 6 to 7 g of peanut protein per week, offered over three or more feedings, can safely be fed to infants. When peanut-containing foods are first introduced, infants should be watched for allergic reactions such as lip swelling, hives, or vomiting.-Carol Potera

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