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VIDEO: New early peanut introduction guidelines must undo ‘years of misconceptions’

BOSTON — Physicians should not be afraid of the challenge of early introduction of peanut into an infant’s food intake, according to David R. Stukus, MD, associate professor of pediatrics within the division of allergy/immunology, and director of the complex asthma clinic at Nationwide Children’s Hospital.

“We don’t need to achieve perfection, but we do need to make progress,” Stukus told Healio Internal Medicine. “And if we’re able to implement this on a wide scale, then we can potentially put a halt to the dramatic rise in peanut allergy that we have seen over the last couple of decades.”

Physicians held the belief that the avoidance of allergenic foods, including peanut, until later in life would prevent allergy from developing, Stukus said.

However, as Stukus mentioned, there has been tremendous evidence over the last decade that supports the early introduction of peanut to infants before 11 months.

As new evidence has emerged, updated guidelines were published that recommend feeding all infants peanut material that is age appropriate – never whole or partial peanuts to prevent choking.

The problem with new guidelines, Stukus said, is they take too long and require too much time and effort to implement into daily practice.

“Anytime it comes to feeding guidelines ... the science behind it changes quite a bit,” he said. “Evidence and our understanding grows over years and decades. Previously, we recommended no dairy till 1, no eggs till 2 and no nuts or seafood till 3 – and that was based on expert consensus without great evidence to support that. Well, those guidelines were flip-flopped and reversed a few years later, but unfortunately the early guidelines were the ones that took hold and that’s still what a lot of primary care providers, as well as families, are believing to be true. We have a lot of years of misconceptions to undo here, so that’s part of the problem.”

BOSTON — Physicians should not be afraid of the challenge of early introduction of peanut into an infant’s food intake, according to David R. Stukus, MD, associate professor of pediatrics within the division of allergy/immunology, and director of the complex asthma clinic at Nationwide Children’s Hospital.

“We don’t need to achieve perfection, but we do need to make progress,” Stukus told Healio Internal Medicine. “And if we’re able to implement this on a wide scale, then we can potentially put a halt to the dramatic rise in peanut allergy that we have seen over the last couple of decades.”

Physicians held the belief that the avoidance of allergenic foods, including peanut, until later in life would prevent allergy from developing, Stukus said.

However, as Stukus mentioned, there has been tremendous evidence over the last decade that supports the early introduction of peanut to infants before 11 months.

As new evidence has emerged, updated guidelines were published that recommend feeding all infants peanut material that is age appropriate – never whole or partial peanuts to prevent choking.

The problem with new guidelines, Stukus said, is they take too long and require too much time and effort to implement into daily practice.

“Anytime it comes to feeding guidelines ... the science behind it changes quite a bit,” he said. “Evidence and our understanding grows over years and decades. Previously, we recommended no dairy till 1, no eggs till 2 and no nuts or seafood till 3 – and that was based on expert consensus without great evidence to support that. Well, those guidelines were flip-flopped and reversed a few years later, but unfortunately the early guidelines were the ones that took hold and that’s still what a lot of primary care providers, as well as families, are believing to be true. We have a lot of years of misconceptions to undo here, so that’s part of the problem.”

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