New guidelines encourage us to introduce peanuts to all kids much earlier. Plus, the FDA recently approved a drug aimed at lessening the severity of allergic reactions from peanuts. Here's what you need to know.

baby being spoonfed
Credit: Andy Lim/Shutterstock

In March 2019, the American Academy of Pediatrics (AAP) released new guidelines for introducing kids to peanuts in the hopes of decreasing the prevalence of this widespread allergy.

The study says babies should be given peanuts early in order to prevent allergic reactions. In fact, multiple reports in the past decades have shown the benefit of introducing peanuts to high-risk babies when they are between 4 to 6 months old (with proper medical supervision). Infants with less of a risk can start these foods at 6 months or older, following the pattern of the family’s normal diet.

Previously, kids in danger of developing an allergy were supposed to avoid any contact with peanuts for the first three years of their lives, according to Hugh Sampson, M.D., director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai and a Parents advisor.

Then, in 2008, the AAP said that babies should not be refrained from eating allergens like peanuts, milk, and eggs. Being introduced to these allergens wouldn’t prevent them from developing eczema, skin conditions, and food allergies, according to the report.

But the March 2019 guidelines state that high-risk children should have peanuts in their diet much sooner. In turn, the babies will hopefully have less of a risk of developing allergies in the future.

So how can a parent know if their baby might be at high risk of developing a peanut allergy? Two main signs your little one could be ready for a peanut intervention are egg allergies or severe eczema, according to the National Institute of Allergy and Infectious Diseases (NIAID). Talk to your pediatrician if your child has either or both conditions; your doctor can do an allergy test to find out the best timing for introducing peanuts.

Whole peanuts are a choking hazard for infants and small children, says Drew Bird, M.D., director of the Food Allergy Center at Children's Health in Dallas. For your baby's first bites, you can stir a small amount of peanut powder into a puree or spread a thin layer of peanut butter on toast.

The sticky consistency of thick peanut butter can also be hard for little mouths to handle, so Dr. Bird recommends two teaspoons of smooth peanut butter mixed with two teaspoons of warm water for babies just starting solids.

It's also important to keep serving your child peanuts once they've been introduced. "Foods that are in the diet more frequently are less likely to cause problems down the road," Dr. Bird explains. He also stresses that children who have already been diagnosed with a peanut allergy should continue to use the same caution around peanut products as always.

If your child does have an allergic reaction, symptoms may include swelling lips, coughing, vomiting, or rashes that look like mosquito bites around the mouth or other parts of the body, and they would begin almost immediately after eating. If your child has a reaction, call your doctor immediately.

A New Drug for Peanut Allergies

If a child does develop a peanut allergy, parents constantly worry about accidental exposure to the allergen. A new drug, however, seeks to ease your concerns.

In January 2020, the U.S. Food and Drug Administration (FDA) approved a drug called Palforzia, produced by Aimmune Therapeutics, Inc. This oral immunotherapy works by exposing kids to peanuts in three sequential doses, which helps build up a tolerance to the allergen. The goal is reducing the severity of anaphylaxis and other allergy symptoms over time.

Palforzia use is supported for those "aged 4 through 17 years with a confirmed diagnosis of peanut allergy," according to a press release from the FDA. The medication is in the form of pull-apart capsules, and the powder inside can be emptied into semisolid foods (yogurt, applesauce, etc.)

It's important to note that children must still avoid peanuts after taking Palforzia.

“Peanut allergy affects approximately 1 million children in the U.S. and only 1 out of 5 of these children will outgrow their allergy. Because there is no cure, allergic individuals must strictly avoid exposure to prevent severe and potentially life-threatening reactions,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research, in the FDA press release.

“Even with strict avoidance, inadvertent exposures can and do occur. When used in conjunction with peanut avoidance, Palforzia provides an FDA-approved treatment option to help reduce the risk of these allergic reactions in children with peanut allergy," he adds.

During testing, individuals reports side effects like vomiting, nausea, abdominal pain, itching, and tingling in the mouth. Anaphylaxis may occur in rare occasions. People with uncontrolled asthma shouldn't use the drug.