June 4, 2015
Interim Guidance on Early Peanut Introduction and Prevention of Peanut Allergy Published by JACI
Document is a global collaboration to better inform healthcare providers regarding the potential benefits of early peanut introduction
MILWAUKEE, WI – While an update to the National Institute of Allergy and Infectious Diseases (NIAID) food allergy guidelines is due to begin this summer, a "Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-Risk Infants" has been published today by The Journal of Allergy and Clinical Immunology, an official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).
Why is this consensus communication important?
The results of the Learning Early About Peanut (LEAP) study provided new evidence to support early, rather than delayed, peanut introduction during the period complementary foods are first given to infants. Specifically, the LEAP study demonstrated a successful 11 to 25% absolute reduction in the risk of developing peanut allergy in high-risk infants (and a relative risk reduction of up to 80%) if peanut was introduced between 4 and 11 months. It is important to note that children with lesser risk factors for peanut allergy were excluded from the LEAP study, so there is no prospective, randomized data that speaks to the benefit or risk of early peanut introduction in the general to low-risk populations.
“This consensus communication addresses the need for interim guidance to help physicians integrate the LEAP study findings to other similar high-risk children while food allergy guidelines undergo updates,” said AAAAI President Robert F. Lemanske, Jr., MD, FAAAAI.
What guidance does it give regarding early peanut introduction and complementary feeding practices?
In addition to summarizing the LEAP study findings, the consensus communication offers the following interim guidance to assist healthcare providers across the globe in their clinical decisions:
• There is now scientific evidence (Level 1 evidence from a randomized controlled trial) that healthcare providers should recommend introducing peanut-containing products into the diet of high-risk infants early on in life, between 4 to 11 months of age, in countries where peanut allergy is prevalent, since delaying the introduction of peanut may be associated with an increased risk of developing peanut allergy.
• Infants with early-onset atopic disease, such as severe eczema or egg allergy in the first 4 to 6 months of life (see Text Box 1 in the consensus communication for example LEAP criteria), may benefit from evaluation by an allergist or physician trained in managing allergic diseases in this age group to diagnose any food allergy and assist in implementing these suggestions regarding the appropriateness of early peanut introduction. Evaluation of such patients may consist of performing peanut skin testing and/or in-office observed peanut ingestion, as deemed appropriate after discussion with the family. The clinician may perform an observed peanut challenge for those with evidence of a positive peanut skin test to determine if they are clinically reactive before initiating at-home peanut introduction. Both such strategies were used in the LEAP study protocol.
• Adherence in the LEAP trial was excellent (92%) with infants randomized to consume peanut ingesting a median of 7.7 g peanut protein (interquartile range: 6.7 – 8.8 g)/week during the first 2 years of the trial compared to a median of 0 g in the avoidance group (see Text Box 2 in the consensus communication for examples of peanut-containing foods utilized in the LEAP trial). While the outcome of the LEAP regimen was excellent, the study does not address use of alternative doses of peanut protein, minimal length of treatment necessary to induce the tolerogenic effect, or potential risks of premature discontinuation or sporadic feeding of peanut.
The document also cites the importance of intervention by healthcare providers. Otherwise, such high-risk infants might remain at risk for delayed introduction of solid and allergenic foods into their diets due to the widely held belief that these foods may worsen eczema.
Who collaborated to produce the consensus communication?
The AAAAI, American Academy of Pediatrics, American College of Allergy, Asthma & Immunology, Australasian Society of Clinical Immunology and Allergy, Canadian Society of Allergy & Clinical Immunology, European Academy of Allergy and Clinical Immunology, the Israel Association of Allergy and Clinical Immunology, the Japanese Society for Allergology, Society for Pediatric Dermatology, and the World Allergy Organization
More information on food allergy is available at the AAAAI website. The full "Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-Risk Infants" can be found here.
The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 6,800 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.