Introducing allergenic foods to infants and children

New guidelines on early introduction of peanuts for infants at high risk of allergy has been jointly issued by 10 professional groups, including the American Academy of Pediatrics and the American Academy of Allergy, Asthma & Immunology. These were published on February 2017 in Annals of Allergy, Asthma & Immunology, and are based on data from the randomized Learning Early About Peanut Allergy (LEAP) trial, published in February 2015 in The New England Journal of Medicine.

Most infant feeding guidelines recommend exclusive breastfeeding for the first 6 months to be ideal, but few women meet that goal, and many who do breastfeed their babies for 6 full months still start early introduction of solid around age 4 months. The ‘old’ recommendations for already allergic infants were to avoid peanut (and other allergens), since peanut is a well-known allergen. However, LEAP found that high-risk infants who received peanut products had a significantly lower risk of developing peanut allergy by age five than infants who completely avoided peanut products.

Infants who get a taste of eggs and peanuts starting when they’re as young as 4 months old may have a lower risk of developing allergies to those foods than babies who try them later. For peanuts, offering infants a sample between 4 and 11 months was associated with 71% lower odds of peanut allergies than waiting longer. The highest risk infants (those with severe eczema and/or egg allergy) be introduced to peanut as early as 4-6 months of age, following successful feeding of other solid foods to ensure the infant is developmentally ready. Allergy testing is strongly advised prior to peanut introduction for this group as per the following graphic adapted from addendum guidelines, but always remember to consult with your pediatrician:

peanut allergy graphic

*To minimize a delay in peanut introduction for children who may test negative, testing for peanut-specific IgE may be the preferred initial approach in certain health care settings. Food allergen panel testing or the addition of sIgE testing for foods other than peanuts is not recommended due to poor positive predictive value.

**Skin prick test

***Oral food challenge

 

References:

Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel is available at http://www.annallergy.org/article/S1081-1206(16)31164-4/fulltext and is co-published in the Journal of Allergy and Clinical Immunology and other journals.

N Engl J Med 2015; 372:803-813

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