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New rules for the prevention, screening and diagnosis of food allergies

If you have a high-risk baby, your pediatrician or allergist might do a blood test to measure specific antibodies to peanuts. If the test is negative, you can be reassured that a peanut allergy is unlikely and go ahead and introduce it. If it is positive, you should see an allergist for further testing, said Dr Fleischer.

An allergist may do a skin test, which involves placing a small amount of a food protein under the skin and watching for a reaction in the form of a raised, swollen “papule”. A very large papule means your child is more likely to have an allergic reaction, but it’s also not a perfect test. The only way to truly diagnose a food allergy is to see what happens when your baby eats the food, and more and more allergists are doing “food challenges” with babies in their offices, where they are offering small amounts. of food and watch carefully for signs. of a reaction, with the ability to treat the child if necessary.

As an example, Dr Fleischer said he once saw a very large papule after a peanut skin test on an 8 month old patient with severe eczema. The papule was large enough that many allergists simply diagnosed it as a peanut allergy. But Dr Fleischer gave the baby a feeding challenge with a small amount of peanuts, and he didn’t react. He told the parents to continue giving him peanuts regularly at home, and the child, who was 3 when he last met, can now completely tolerate peanuts. Dr Fleischer thinks it is likely that this child would have developed an allergy without this exposure, given his eczema and reactive skin test.

Government guidelines recommend that if your baby is at high risk (if he has severe eczema or an egg allergy), you should introduce peanut products as early as 4-6 months. If your baby is at intermediate risk (defined as mild to moderate eczema), guidelines recommend giving her peanut products around 6 months. If your baby is at low risk and doesn’t have eczema, you can take a more relaxed approach, introducing peanut products with other solid foods when you prefer.

The recommendation to introduce peanut products early to high-risk babies was based on one study (the LEAP study), and the exact way to translate these results is somewhat controversial. Some experts, including Dr Fleischer, argue that parents shouldn’t insist on introducing peanuts and other allergens so early, noting that some babies won’t be ready to eat solids at this age. The important thing is to make peanuts and other allergens a regular part of your baby’s diet for at least the first year, Dr Fleischer said.

Start by introducing a few purees of fruits and vegetables, and once your baby has mastered them, you can try peanut products, said allergy dietitian Dr Carina Venter, Ph.D., RD. food and associated. professor of pediatrics at the University of Colorado, Denver School of Medicine. She helped write government guidelines, including convenient and safe recipes for feeding babies peanuts, as whole or partial nuts pose a choking hazard and should not be offered to children under the age of 5. . For example, you can mix 2 teaspoons of smooth peanut. butter in 2 to 3 teaspoons of hot water (allowing it to cool before feeding it); or in 2 to 3 tablespoons of fruit or vegetable puree. Start with a small amount of this mixture on the end of a spoon, then wait 10 minutes for signs of a reaction. If tolerated, you can offer the rest of the portion.

NIAID guidelines recommend feeding 2 grams of peanut protein (in the form of 2 teaspoons of peanut butter or peanut flour, or 21 pieces of Bamba peanut puffs, for example) about three times per week, as was used in the LEAP study. But Dr Venter said the most important thing is to keep peanuts as part of your diet. “We don’t want to be worried about the dosage,” she said. “Babies get sick, they don’t want to eat, some days they want to eat a lot more, some days they only eat a little.” And you want to enjoy feeding your baby, not stress about it, she added.

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