UK Edition
Children need peanuts from early age to prevent allergy, new guidance says
Parents should expose children to peanuts from early age to prevent the growing burden of allergy, new UK guidance is expected to say, after the US amended its guidelines.
The government’s Scientific Advisory Committee on Nutrition (SCAN), which advises Public Health England and the NHS, is currently reviewing advice on peanuts as part of a wide ranging report on child nutrition and is due to report this summer.
But it is likely to follow recommendations made by the Food Standards Agency’s Committee on Toxicity which recently warned that the ‘deliberate exclusion or delayed introduction of specific allergenic foods may increase the risk of allergy’.
On Thursday the National Institute of Health in the US updated its own guidelines saying that infants should be exposed to peanut-containing food from as early as four months to desensitise their immune system.
The announcement was welcomed by British experts who said that eating nuts early could substantially reduce the number of allergies.
“The USA leads, as is often the case, where others follow and as a practicing paediatrician I welcome this new guidance,” said Alastair Sutcliffe, professor of Paediatrics, of University College London.
“This is in a sense the opposite of previous practice where such nuts were thought to be best avoided, despite the fact that nut allergies are rare in Mediterranean countries.”
The allergy epidemic is growing annually in the UK, with number of sufferers increasing by five per cent each year. In 2011/2012 here were 18,471 hospital admissions for allergies in England, but that had grown to 25, 093 by 2015/2016 and the number of cases of life-threatening anaphylactic shock has risen six fold in 20 years.
Rates of peanut allergy have risen in recent decades and one in 50 school-age children in the UK is now affected by the condition.
Current NHS weaning guidance suggests that parents should offer nut based food from the age of six months to see if children are allergic, but does not recommend keeping up the exposure.
The new US guidance advises that babies with a high risk of developing peanut allergy - because they have eczema or egg allergy - should begin eating peanuts from four to six months, while all youngsters should ‘have peanut-containing foods freely introduced into their diets’ once they had started eating solids.
Michael Walker, member of the European Academy of Allergy and Clinical Immunology said: “This is sensible advice that I am sure UK authorities will wish to think about.
“UK parents should consult their GP, bringing attention to the American guidelines if necessary, before attempting peanut allergy prevention in their infant themselves.”
The change came about following the results of several trials including the UK’s Learning Early About Peanut Allergy (Leap) study which showed that regular peanut consumption begun in infancy and continued until the age of five led to an 81 per cent reduction in the development of allergy in high risk children.
"Peanut allergy has literally become an epidemic in recent years, and now we have a clear roadmap to prevent many new cases moving forward,” said allergist Dr Stephen Tilles, president of the American College of Allergy, Asthma and Immunology (ACAAI).
“The Leap study that paved the way for the updated guidelines has had a dramatic impact on day-to-day patient care. In fact, during my career as an allergist I cannot think of a single publication with more of an impact."
Allergy UK said it was clear that there was an ‘important window of opportunity’ for introducing allergenic foods.
Holly Shaw, Nurse Adviser at Allergy UK said: “At Allergy UK we know that weaning infants can be a particularly worrying time for parents.
“If parents are concerned about the introduction of peanut into their infant’s diet, and specifically those who have existing allergy such as eczema, asthma or a food allergy, it is important that it is done in a safe and age appropriate way, for example not giving an infant whole peanuts as they pose a choking risk.
“Most importantly, they should discuss their concerns and be guided by a health professional on the best way to introduce peanuts into the diet.”
However, Public Health England said until guidelines were changed in the UK, parents should stick to the current NHS advice, and never feed whole nuts to under fives as it could be a choking hazard.
Dr Alison Tedstone, chief nutritionist at PHE, said: “The Scientific Advisory Committee on Nutrition is currently reviewing the guidance on feeding infants under one, so it takes into account the latest, robust evidence.
“In the meantime, parents should follow our existing guidelines: we recommend babies are breastfed exclusively for around the first six months, after which a wide range of solid foods should be introduced alongside continued breastfeeding or infant formula feeding.”