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New guidelines prompt parents to introduce nuts earlier

Photo: New guidelines prompt parents to introduce nuts earlier
The percentage of Melbourne parents feeding their babies peanut products has tripled since new guidelines were released in 2016, a Murdoch Children’s Research Institute study has found.

Australian infant feeding guidelines changed in 2016 to recommend introducing peanuts before a child turns one because of new evidence that this reduced the risk that a child would develop peanut allergy.

Published in The Journal of Allergy and Clinical Immunology*, MCRI’s EarlyNuts study found that 89 per cent of parents fed their child peanut products by 12 months (median six months) in 2017- 2018. This was up from 28.4 per cent in MCRI’s 2007-2011 HealthNuts study.

Lead author, Victoria Soriano was surprised by the results, saying she did not expect such a big change so quickly. She is now investigating whether the change has led to less allergies in children.
Food allergies affect up to one in ten Australian infants.

Ms Soriano says she used data from EarlyNuts, a population-based, cross-sectional study which so far involves 860 Melbourne infants aged 12 months. It used similar methods to HealthNuts, a 2007-2011 study of 5300 children that was conducted as advice about introducing potential allergens was changing.

“Before HealthNuts, Australian parents were advised not to introduce peanut products before 12 months,” Ms Soriano says. “In around 2008, Australian infant feeding guidelines removed advice to delay the introduction of peanut and other allergenic foods because there was increasing evidence that delaying their introduction did not prevent food allergy.

“However, most parents continued to wait. In 2015 a landmark randomised controlled trial showed that introducing peanut in the first year greatly reduced the risk of peanut allergy in children with eczema or egg allergy. In 2016, a recommendation was added to introduce peanut to all infants before 12 months.”

EarlyNuts found that within two years of this advice, 88% of infants had eaten peanut before 12 months and 76 per cent of these had consumed peanut more than four times in their first 12 months, and 28 per cent were eating it more than once a week.

Early introduction was also common among children with eczema (83.5%).

Co-author MCRI’s Jenny Koplin says four per cent of all children reacted to the peanut in the first hour of being introduced to it. This was mostly a skin or gut reaction (3.7 per cent).

“This figure was slightly higher than HealthNuts’ 2.4 per cent, probably due to the higher proportion of children now trying peanut. There was no increase in severe reactions such as wheezing,” Dr Koplin said Peanut was defined as any food containing peanut, such as peanut butter, satay or nut bars. Egg included cooked egg, egg in baked products and other foods such as custard or mayonnaise.

“There has been a striking shift towards earlier peanut introduction, with a three-fold increase in peanut introduction by age one in 2018 compared to 2007-11,” the study found.

“Most parents are now introducing their infants to peanut and egg by 12-months-old, much earlier than a decade ago. We will be able to assess the important question of the effect of earlier introduction of allergenic foods on challenge-proven food allergy prevalence in the population at the completion of the current EarlyNuts study.”

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