New guidelines emphasize the early introduction of peanut-containing foods to infants.
Peanut allergy is a growing health problem that can affect children and adults. Unfortunately, it can be severe and even life-threatening.
Guidelines issued this week by National Insitute of Allergy and Infectious Diseases (NIAID) emphasize the early introduction of peanut-containing foods to infants to prevent the development of peanut allergy. The guidelines are an addendum to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States, which is endorsed by 26 professional organizations including the American Academy of Pediatrics.
NIAID collaborated with various organizations beginning in 2008 to develop clinical guidelines for the diagnosis and management of food allergy. The recent landmark clinical study Learning Early About Peanut Allergy demonstrated that regular peanut consumption started in infancy and continued until 5 years of age resulted in an 81% reduction in development of peanut allergy in infants at high risk. High risk was defined as having severe eczema, egg allergy, or both. Evidence demonstrates that these conditions increase the risk of developing peanut allergy.
The guidelines define severe eczema as persistent or frequently-recurring eczema requiring prescription-strength topical corticosteroids, calcineurin inhibitors, or other anti-inflammatory medications. Patients are considered to be diagnosed with an egg allergy if they have a history of an allergic reaction to egg and a skin prick test (SPT) wheal diameter of 3 mm or greater with egg white extract, or a positive oral egg food challenge result.
It is important for clinicians to educate patients that other solid foods should be introduced prior to starting peanut-containing foods. Peanut-containing foods should be introduced as 6 to 7 grams over 3 or more feedings. Also, infants younger than 5 years of age should not consume whole peanuts due to the risk of choking.
Let parents know to look for mild symptoms such as signs of a new rash or hives around the mouth or face. Encourage parents to keep a food diary and to avoid introducing any new foods at the same time as peanut-containing foods. If the infant develops mild symptoms within 2 hours of eating peanut-containing foods after a week a more, then a pediatrician should be contacted. Educate parents about signs of anaphylaxis, which include shortness of breath, tongue swelling, lip swelling, and vomiting. In the case of anaphylaxis, parents should seek emergency medical attention immediately.
There are 3 separate guidelines for infants based on the risk level for peanut allergy development (See Table).
Table: Guidelines for Introducing Peanut-Containing Foods
Peanut introduction age
Severe eczema, egg allergy, or both
Strongly consider evaluation with peanut-specific immunoglobulin E, SPT, or both; introduction of peanut-containing foods based on results and may need to be conducted at healthcare provider’s office under direct supervision
4 to 6 months
Mild to moderate eczema
Introduce peanut-containing foods
Around 6 months
No eczema or any food allergy
Introduce peanut- containing foods
Age appropriate peanut-containing foods freely introduced in diet with other solid foods
Pharmacists can play an important role in educating parents about the new guidelines through collaboration with pediatricians.
Togias A, Cooper SF, Acebal ML, et al. 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. J Allergy Clin Immunol. 2017;doi:http://dx.doi.org/10.1016/j.jaci.2016.10.010.