Guidance on Exposing Babies Early to Peanuts Not Catching On

Allergies & Asthma

NEW ORLEANS — Although 2017 government-endorsed guidelines called for introducing peanuts in infancy in order to minimize risk of future allergy, few parents are getting that message from their pediatricians, survey results indicate.

Among 3,062 parents of young children participating in the survey earlier this year, only 58% recalled any discussion with their child’s pediatrician about when to begin feeding peanut-containing foods. And of those having such discussions, just 40% said they received an actual recommendation in line with those guidelines, reported Christopher Warren, PhD, of the Northwestern University Feinberg School of Medicine in Chicago.

That’s fewer than one-quarter of survey participants getting such recommendations, Warren told attendees at a poster presentation at the American College of Allergy, Asthma, and Immunology annual meeting.

Although the barriers to translating the 2017 guidance into actual at-home practice aren’t clear and are likely multifold, efforts to educate primary care physicians (PCPs) and provide them with “very patient-friendly materials” for parents on early peanut introduction would help, Warren told MedPage Today.

The 2017 guidelines represented an enormous change from earlier practice. Because peanut allergy is so disruptive for children and caregivers (including their daycare facilities and schools), and because its prevalence has been rising, it was long thought (and codified in a guideline from 2000) that young children should just avoid exposure as much as possible. But the prospective, randomized LEAP trial from 2015 demolished that belief, or should have — it found that exposing infants to peanuts by 11 months of age cut allergy risk at age 5 by more than 85% versus an avoidance regime.

Thus, the 2017 guidance called for introducing foods with peanut protein before 11 months and earlier — by age 6 months — in infants already showing signs of atopy.

The question then became, are PCPs and parents aware of and following these guidelines?

Warren and colleagues developed a survey for participants in two pre-existing participant panels, asking three main questions: did they have discussions with their child’s pediatrician about when to begin offering peanut-containing foods; were they aware of the 2017 guideline; and what recommendations about peanut introduction, if any, did the physician provide?

Participants also provided sociodemographic information and data on their own and their children’s medical history, including allergies and eczema. For the parents participating, their children ranged in age from 7 months to 3.5 years.

The survey cohort was reasonably diverse (49% white, 14% Black, 28% Hispanic), with about one-third reporting household income under $30,000 and 19% with incomes of $100,000 or more. Just over 40% had a high school education or less, while 33% had at least a bachelor’s degree.

Among parents, 37% had some type of allergic condition such as asthma, atopy, or food or environmental allergy. For their children, 78% had no signs of atopy or allergy.

Parents of children with atopy more often reported that they had discussions with the pediatrician about when to introduce peanuts (70%), and were somewhat more likely to have been given a guideline-consistent recommendation about it (46%).

But parental awareness of the 2017 guideline was mostly lacking across the board. Only 18% of parents of atopic children, and 13% overall, said they had heard of it.

The survey also asked parents to recall whether they had received specific types of physician recommendation. It listed nine in all, from beginning at 4 months of age, 6 months of age, 7-11 months, and so on, up to waiting until age 3 years.

“Never” was also an option, and indeed, roughly 6% of the parents who said they had any type of discussion of the issue also said that is what the pediatrician recommended. About 7% reported being told to start whenever they wished, and a similar number said allergy testing was recommended before introducing any peanut products.

Warren was not particularly concerned about the latter recommendations because none were especially common. Rather, his point was that, for whatever reason, the importance of early peanut introduction did not seem to be getting through to most parents.

He acknowledged that survey participants, like all real-life people, may not accurately recall what their physicians said, especially since new parents tend to be bombarded with do’s and don’ts during clinic visits. He also told MedPage Today that probably “a substantial minority” of physicians are aware of the guidelines but, because they represented such a big shift from prior received wisdom, are adopting a wait-and-see attitude before jumping on board.

Nevertheless, he said there likely remains a knowledge gap among many pediatricians that needs to be remedied.

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    John Gever was Managing Editor from 2014 to 2021; he is now a regular contributor.

Disclosures

Warren disclosed no relationships with industry.

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