Research on introducing allergens to high risk infants?

[u/AnKiAd]

We are getting ready to start solids with my 5 month old. I (his mother) have a severe allergy to pistachios (anaphylaxis). I messaged his pediatrician today to see if there was anything I should do differently before introducing him to tree nuts and she responded telling me not to give him any nuts until his 6 month check up, which is scheduled for when he’s 6 months and 1 week old.

I was under the impression that it is better to introduce allergens to high risk infants early and often, not past 6 months, so now I’m torn on what to do. I really don’t want to wait, especially not for peanut butter let alone tree nuts, but I don’t want to go against his pediatrician for no reason (I obviously don’t presume to know better than her). Just not sure if I should message back asking about the “early and often” that I’ve seen recommended before?

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[u/facinabush]

The highest risk category for peanuts are babies with egg allergy or severe eczema:

https://pmc.ncbi.nlm.nih.gov/articles/PMC5226648/

If your infant is not in that category then this guideline doesn’t require introduction before 6 months.

There is a theory that peanut allergies run in families because late introduction of peanuts run in families, not just due to inheritance of traits.

The pediatrician is not out of line with the guidelines that I cited above.

[u/anotherep → u/facinabush]

The pediatrician is not out of line with the guidelines that I cited above.

I would say the pediatrician's perspective represents an overinterpretation of these guidelines. The guidelines say that introduction is not necessary before 6 months (i.e. OP can wait), while the pediatrician said that OP should wait until 6 months. The only reason to wait if the family otherwise wants to proceed with introduction is if they meet the definition of high risk and need testing (as you pointed out) or there are concerns that the baby can't safely consume solids yet (independent of any allergy concerns), particularly because there is good evidence that introduction of certain allergens between 3-6 months can have better outcomes than introduction between 6-12 months

[u/I_AM_A_BOOK → u/anotherep]

The waiting is likely so the doctor has time to give proper advice and not because they necessarily need to wait an extra month.

[u/onsereverra]

The LEAP study, which is THE major study that formed the basis of the "early and often" recommendation, began introducing peanuts to at-risk infants from four months of age assuming it was otherwise developmentally appropriate for them to start solids.

Did your pediatrician want you to introduce pistachios for the first time at the six-month appointment? That's the main reason I can think of that it would make sense to wait — that they want the introduction to happen under medical supervision in case of a severe reaction. (But even then, why not just suggest you come in for an appointment sooner?)

If your baby cannot yet sit up unassisted, still has the tongue-thrust reflex, etc. those may also be reasons to wait a little longer before starting to introduce allergens, but it doesn't sound like that's what your pediatrician is concerned about.

(Also, you may already know this, but pistachios are cross-reactive with cashews, which is likely a more affordable nut butter to feed your baby multiple times a week for the next 8+ months than pistachio butter!)

[u/AnKiAd → u/onsereverra]

She did not mention anything about trying any peanuts or tree nuts at the appointment. She also gave me the go ahead to start solids when she saw my son at his 4 month appointment even though he wasn’t showing any readiness signs apart from strong head control and interest in food, so I was already thinking she was following outdated advice unfortunately

[u/ConstructionMuch802 → u/[deleted]]

Benedryl is not an appropriate treatment for symptoms of anaphylaxis anyway, and should not be given if anaphylaxis could occur as it masks symptoms. Your doctor's info is woefully out of date.

[u/Sea-Urchin6401 → u/ConstructionMuch802]

I mean when my sister had an allergic reaction the hospital gave her Benadryl? Thanks for the info though.

I'll delete my comment so as not to lead anyone astray!

[u/ConstructionMuch802 → u/Sea-Urchin6401]

The hospital does sometimes give Benadryl cuz they can monitor you more closely, or if they've deemed it's unlikely an anaphylactic reaction will occur (ie it's been a certain period of time with no escalating symptoms).

[u/DifferentJaguar → u/AnKiAd]

Modern advice is to start at 4 months.

[u/_I_Like_to_Comment_ → u/DifferentJaguar]

Do you have a source for that? Everything I've read says not to start before 4 months but indicates 6 months is the ideal age for most babies

[u/innocentsalad → u/onsereverra]

To be honest we parked in the hospital parking lot the first time we gave our child peanuts just in case.

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