The National Institute of Allergy and Infectious Diseases has published addendum guidelines along with findings from the LEAP study that demonstrate that introducing peanut-containing foods early may reduce the risk for allergy.
“Living with peanut allergy requires constant vigilance. Preventing the development of peanut allergy will improve and save lives and lower health care costs,” Anthony S. Fauci, MD, NIAID director, said in a press release. “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”
Data from the 2015 LEAP NIAID-funded study suggesting that early introduction of peanut-containing foods could reduce the risk for peanut allergy in children propelled researchers to write the supplemental guidelines to the 2010 guidelines for the diagnosis and management of food allergy in the United States.
In the LEAP clinical trial, 640 infants aged between 4 months to 11 months with severe eczema, egg allergy or both were randomly assigned peanut introduction based on wheal measurements from a skin prick test. Those who began peanut consumption and continued through 5 years represented an 81% reduced risk for peanut allergy.
“The LEAP study clearly showed that introduction of peanut early in life significantly lowered the risk of developing peanut allergy by age 5,” Daniel Rotrosen, MD, director of NIAID’s division of allergy, immunology and transplantation, said in a press release. “The magnitude of the benefit and the scientific strength of the study raised the need to operationalize these findings by developing clinical recommendations focused on peanut allergy prevention.”
An expert panel consisting of 26 members from clinical, scientific and public health fields reviewed additional literature published between 2010 and 2016 using the search terms food allergy, milk allergy, peanut allergy, eczema and atopic dermatitis in PubMed prior to forming one expert opinion and drafting guidelines. They assigned grades high, moderate or low based on how the research would affect the body of evidence and recommend change to 64 relevant abstracts.
The expert panel recommended parents and clinicians introduce peanut-containing foods to infants after they have begun consuming solid foods in descending order of allergy risk:
- Infants at high-risk for developing peanut allergy due to a diagnosis of severe eczema or egg allergy be introduced to peanut-containing foods at 4 to 6 months to reduce development risk;
- Infants at moderate risk due to a diagnosis of mild or moderate eczema should be introduced to peanut-containing foods at 6 months to reduce the risk for peanut allergy; and
- Infants without a diagnosis of eczema or food allergy should be introduced to peanut-containing foods at any time.
“If your child is determined to be high risk, the new guidelines recommend evaluation by an allergy specialist, which may involve peanut allergy testing, followed by trying peanut for the first time in the specialist’s office,” Matthew Greenhawt, MD, MBA, MSc, ACAAI Food Allergy Committee chair, allergist and co-author of the guidelines, said in a press release. “If a child is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we still do not know if they are truly allergic.
“Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods.” – by Kate Sherrer
Disclosures: The researchers report no relevant financial disclosures.