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Three-fold increase in early peanut introduction following new guidelines in Australia

Published online: August 8, 2019

Up to 10% of one-year-old infants are diagnosed with food allergy. After an accumulation of observational data, a sentinel trial in 2015 found that introducing peanut by age 11 months could prevent peanut allergy. This prompted guideline changes in 2016 recommending introducing peanut before a baby turns 12 months. Australia, contrary to the USA, does not recommend babies undergo allergy screening before introducing foods. However, there was no data on whether parents were following this new and important advice.

In an original article published in The Journal of Allergy and Clinical Immunology (JACI), Soriano et al. aimed to assess the subsequent impact of Australian guidelines on the timing of peanut introduction. Researchers questioned a population-representative sample of 860 families with one-year-old babies from Melbourne, Australia in the EarlyNuts study led by the Murdoch Children’s Research Institute. Families were asked about their infant’s diet, history of eczema and food reactions, lifestyle factors and family history of allergy. Answers were compared to a similar study conducted 10 years earlier called HealthNuts.

By comparing the HealthNuts and EarlyNuts studies, researchers saw that by 2018, only two years after the guideline changes, introduction of peanut products by age one had increased more than 3-fold compared to 10 years ago. Most infants (89%) were now introduced to peanut before 12 months compared to only 28% in 2007-2011. By 12 months, 76% of these babies had eaten peanut products multiple times, with a third eating them regularly (at least twice per week). Initial results showed similar numbers of reported peanut reactions (i.e. not a conclusive diagnosis) compared to before the guideline change, with around 4% of infants having a reported reaction within one hour of eating peanut. Most reactions were mild skin or gut symptoms, with no evidence of an increase in more severe reactions.

This is the first evaluation of infant feeding practices following the adoption of changes in feeding guidelines internationally in 2016 to recommend early introduction of peanut. The results show a dramatic shift towards earlier introduction of peanut. The next step is to assess the important question of whether this shift has reduced the prevalence of peanut allergy in the population. This will be examined at the completion of the EarlyNuts study in early 2020.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract