APPENDIX D. INSTRUCTIONS FOR 

HOME FEEDING OF PEANUT PROTEIN 

FOR INFANTS AT LOW RISK OF AN 

ALLERGIC REACTION TO PEANUT 

These instructions for home feeding of peanut protein are provided 

by your doctor. You should discuss any questions that you have with 

your doctor before starting. These instructions are meant for feeding 

infants who have severe eczema or egg allergy and were allergy 

tested (blood test, skin test, or both) with results that your doctor 

considers safe for you to introduce peanut protein at home (low risk 

of allergy).

General Instructions 

1. Feed your infant only when he or she is healthy; 

do not do the feeding if he or she has a cold, 

vomitng, diarrhea, or other illness.

2. Give the frst peanut feeding at home and 

not at a day care facility or restaurant. 

3. Make sure at least 1 adult will be able to focus all of his or 

her atenton on the infant, without distractons from other 

children or household actvites.

4. Make sure that you will be able to spend at least 2 hours 

with your infant afer the feeding to watch for any signs of an 

allergic reacton.

Feeding Your Infant 

1. Prepare a full porton of one of the peanut-containing foods 

from the recipe optons below.

2. Ofer your infant a small part of the peanut serving on the tp 

of a spoon. 

3. Wait 10 minutes. 

4. If there is no allergic reacton afer this small taste, then slowly 

give the remainder of the peanut-containing food at the 

infant’s usual eatng speed.

What are symptoms of an allergic reacton? What should I look for?

• Mild symptoms can include:

○ a new rash 

or 

○ a few hives around the mouth or face 

• More severe symptoms can include any of the following alone 

or in combinaton:

○ lip swelling 

○ vomitng

○ widespread hives (welts) over the body

○ face or tongue swelling 

○ any difculty breathing

○ wheeze 

○ repettve coughing

○ change in skin color (pale, blue)

○ sudden tredness/lethargy/seeming limp

If you have any concerns about your infant's response to peanut, seek 

immediate medical atenton/call 911.

24 ADDENDUM GUIDELINES FOR THE PREVENTION OF PEANUT ALLERGY IN THE UNITED STATES 
Four Recipe Options, Each Containing Approximately 2g of Peanut Protein 

Note: Teaspoons and tablespoons are US measures (5 and 15 mL for a level teaspoon or tablespoon, respectvely).

Option 1: Bamba (Osem, Israel), 21 pieces (approximately 2 g of 

peanut protein)

Note: Bamba is named because it was the product used in the 

LEAP trial and therefore has proven efcacy and safety. 

Other peanut puf products with similar peanut protein 

content can be substtuted.

a. For infants less than 7 months of age, sofen the Bamba 

with 4 to 6 teaspoons of water. 

b. For older infants who can manage dissolvable textures, 

unmodifed Bamba can be fed. If dissolvable textures are 

not yet part of the infant's diet, sofened Bamba should

be provided. 

Option 2: Thinned smooth peanut buter, 2 teaspoons (9-10 g of 

peanut buter; approximately 2 g of peanut protein)

a. Measure 2 teaspoons of peanut buter and slowly add 

2 to 3 teaspoons of hot water. 

b. Str untl peanut buter is dissolved, thinned, and 

well blended. 

c. Let cool. 

d. Increase water amount if necessary (or add previously 

tolerated infant cereal) to achieve consistency comfortable 

for the infant. 

ADDENDUM GUIDELINES FOR THE PREVENTION OF PEANUT ALLERGY IN THE UNITED STATES 25
Option 3: Smooth peanut buter puree, 2 teaspoons (9-10 g of 

peanut buter; approximately 2 g of peanut protein)

a. Measure 2 teaspoons of peanut buter.

b. Add 2 to 3 tablespoons of pureed tolerated fruit or 

vegetables to peanut buter. You can increase or reduce 

volume of puree to achieve desired consistency. 

Option 4: Peanut four and peanut buter powder, 2 teaspoons 

(4 g of peanut four or 4 g of peanut buter powder; 

approximately 2 g of peanut protein)

Note: Peanut four and peanut buter powder are 2 distnct 

products that can be interchanged because they have a 

very similar peanut protein content. 

a. Measure 2 teaspoons of peanut four or peanut

buter powder.

b. Add approximately 2 tablespoons (6-7 teaspoons) of 

pureed tolerated fruit or vegetables to four or powder. 

You can increase or reduce volume of puree to achieve 

desired consistency. 

26 ADDENDUM GUIDELINES FOR THE PREVENTION OF PEANUT ALLERGY IN THE UNITED STATES