New Guidelines Facilitate Virtually-Supported Peanut Introduction for Babies

A new report reveals that the use of a virtual home introduction option for infants at high-risk of developing peanut allergies is a viable option for families during COVID-19. The September report was published in the Journal of Allergy and Clinical Immunology-In Practice.

“Virtually supported home food introduction now provides a new method to prevent the development of peanut allergy,” Girish Vitalpur, MD, pediatric allergist at Riley Children’s Hospital in Indiana, who was not involved with the report, tells Verywell. He says that “this process has been successful with patients and providers.”  

Typically, experts recommend that peanut introduction among children with a high risk for allergy should be conducted in person by a healthcare professional. But due to COVID-19 precautions, many parents have postponed doctor visits and delayed treatments, limiting the opportunity for peanut introduction in a medically-supervised environment.

If a baby is considered at-risk for developing a peanut allergy because of a family history of allergy, an existing egg allergy, severe eczema, or another risk factor, the American Academy of Allergy Asthma and Immunology says peanut introduction should occur early and often to reduce the risk of developing a peanut allergy.

“For peanut foods specifically, we know that introducing peanut foods to infants at high-risk, starting at around 4 to 6 months of age, can reduce the risk of developing peanut allergies by as much as 86%,” Sherry Coleman Collins, MS, RD, LD, registered dietitian of the National Peanut Board, tells Verywell.

Recently-published North American guidelines for the management of allergies during the COVID-19 pandemic include adjustments such as virtual visits or postponing appointments. Although it appears to be acceptable to delay treatment for some allergic conditions, the guideline notes that the possibility of a peanut allergy in a high-risk infant requires a timely assessment and active management upon diagnosis. In other words, it is not recommended to delay peanut introduction in babies at risk for an allergy. 

“High-risk infants have a narrow window of time during which they can safely be introduced to peanuts and, hopefully, prevent the development of a peanut allergy,” Vitalpur says. 

A Safe Option For Peanut Introduction During COVID

Pre-COVID-19, healthcare providers followed protocol to introduce just enough peanut protein to an at-risk baby to help minimize allergy risk in an office setting, with a plan in place if an allergic reaction occurred. But with people avoiding physical encounters, in-office introduction protocols are not consistently taking place.

A solution to the current challenge may be utilizing a virtual health platform. The new report outlines certain steps to allow for early introduction of peanuts for at-risk babies without requiring them to leave their home or compromising their safety:

• Families undergo a virtual consultation, where the baby’s medical history, risk factors, and readiness for a food challenge is assessed. 
• If a family decides to undergo a virtual introduction, the physician prescribes an epinephrine autoinjector and rupatadine, to be obtained before the virtually-supported introduction in the event that an anaphylactic reaction occurs. 
• While using the virtual platform and under the supervision of the physician, babies are introduced to peanut protein in a specific quantity (up to 2 grams of peanut in incremental doses in a 45 to 60 minute timeframe).  

While using this platform, families can contact their physician immediately with questions or concerns, or if the child experienced a reaction.

How And When To Introduce Peanuts To Babies

If you have a baby who is at-risk for developing peanut allergy, the American Academy of Pediatrics stands by the recommendation to introduce your baby to peanuts between 4 and 6 months. Being mindful that many families do not realize that a baby is considered at-risk, it is wise to consider not delaying introduction in most situations. 

“Introducing a variety of foods, including commonly-allergenic foods like peanut products, should be part of normal infant feeding," Collins says. "Other research has shown that introducing peanuts starting around 6 months is protective, even in infants that have no known risk for developing peanut allergies."

Developmental readiness should be assessed when determining when to feed your baby solid foods. Being able to sit independently and no longer having the tongue-thrust reflex are tell-tale signs that your baby is ready to chow down. 

If your doctor has not advised performing your baby’s peanut introduction under a physician’s supervision, you will have some fun including this nutritious legume into your baby’s diet on your own. 

Don’t start off by serving your little one intact peanuts, as these can be choking hazards. Thinned peanut butter (using water) or peanut powder mixed with baby food are age-appropriate options for them to enjoy. As your baby gets older, they can explore items like toast strips with a thin spread of creamy peanut butter, peanut puff snacks, and pureed fruit and peanut butter blended baby food pouches. Using creamy peanut butter in recipes like muffins and pasta dishes is another convenient method.

There are several risk factors for developing allergies, many of them being out of anybody’s control. But if you want to make a strong effort to reduce the risk of your baby developing allergies, especially if your baby is considered at-risk, taking steps like exclusively breastfeeding and introducing allergenic foods early and often may be the ticket to avoiding allergies in the future.