This month, the National Institute of Allergy and Infectious Diseases published new guidelines for when peanut should be given to infants. The hope is that fewer children will develop peanut allergy as a result of these new recommendations
The revision of its guidelines for the introduction of allergenic foods was prompted by the startling results of a study published in 2015 called the LEAP (Learning Early about Peanut Allergy) trial. In this study children between 4 and 11 months of age who were considered to be at high risk for developing allergy to peanut were divided into two groups. One group was given peanut to eat on a regular basis while the other group avoided peanut-containing food. At 60 months of age both groups underwent a food challenge with peanut.
The peanut food challenge was positive in 13.7 % of the children that avoided peanut but only 1.9% in the group that ate peanuts regularly. In children that had a positive allergy skin test reaction to peanut before the study, the results were even more impressive. There was a 70% reduction in the prevalence of peanut allergy in the group given peanut compared with the peanut avoidance group. In other words, children who were given peanut-containing foods to eat on a regular basis at a young age were significantly less likely to develop peanut allergy.
Here are the New Guidelines
- In children who have severe eczema, egg allergy (defined as a history of an allergic reaction to egg and a positive allergy skin prick or a positive oral egg food challenge result), or both, either a blood test or skin test for peanut should be performed. If the peanut allergy test is positive, the child should be referred to an allergy specialist for evaluation and possible oral food challenge with peanut.
- Children who have mild to moderate eczema (not severe) should have peanut-containing foods introduced at around 6 month of age
- In children who do not have eczema or history of food allergy, peanut should be introduced in an “age appropriate manner in accordance with family preferences and cultural practices”
Take Home Message
There is strong evidence that early introduction of allergenic foods such as peanut protects children from developing food allergy and delaying introduction of allergenic foods may increase the risk of severe food allergy.
Children who do not have severe eczema or a clear history of egg allergy SHOULD NOT have a blood test for food allergy. The high rate of false positive results in these tests may delay the introduction of allergenic foods and can therefore cause the problem they are trying to prevent.
Children with a history of severe eczema or egg allergy (or any other food allergy) should be referred to an allergy specialist for further evaluation.
Brian Millhollon, MD