New Peanut Allergy Guidelines for High Risk Children

11 Nov 2016 --- The American College of Allergy, Asthma and Immunology (ACAAI) has announced that it will give presentations at the Annual Scientific Meeting to offer guidance on how to approach the introduction of peanut-containing foods to children with an allergy risk.

The presentations will be based on soon to be released guidelines, and will aim to help parents who may be confused about how and when to introduce peanut-containing foods to their infants.

The new guidelines were authored by an expert panel of food allergy researchers, physicians, nurses and lay organization representatives from many fields, who reviewed existing evidence and made comprehensive recommendations.

“The first step is determining if your child is at high-risk for peanut allergy,” says Amal Assa'ad, MD, chair of the ACAAI Food Allergy Committee and a co-author of the guidelines.

“Before introducing peanut-containing foods to a high-risk infant, the infant should be seen by their primary health care provider who will determine if referral to an allergist for testing and/or in-office introduction is needed.”

According to the guidelines, an infant at high risk of developing peanut allergy is one with severe eczema and/or egg allergy.

The guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants, after determining that it is safe to do so.

“If your child is determined to be at risk, and then is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we don't yet know if they're truly allergic,” says allergist Matthew Greenhawt, MD, MBA, MSc, ACAAI Fellow, incoming ACAAI Food Allergy Committee chair, and a co-author of the guidelines.

“Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods.”

A positive test alone is a poor indicator of allergy, and studies have shown infants who are peanut-sensitized aren't necessarily allergic.

“Infants sensitized to peanuts showed the most benefit from early introduction of peanut-containing foods in the Learning Early About Peanut allergy (LEAP) study,” says Dr. Greenhawt.

“Some allergists caring for a child who has a large positive skin test may decide not to do an in-office challenge,” he explains.

“Instead, they might advise that the child avoids peanuts completely due to the strong chance of a pre-existing peanut allergy.”

“Other allergists may proceed with a peanut challenge after explaining the risks to the parents.”

Children with mild to moderate eczema who have already started solid foods do not need an evaluation, and can have peanut-containing foods introduced at home by their parents at around 6 months of age.

Children with no eczema or egg allergy can be introduced to peanut-containing foods at home as well, according to the family's preference.

The new guidelines offer several methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. However, medical professionals caution that it is extremely important that parents understand the choking hazard posed by whole peanuts and to not give whole peanuts to infants.

“The soon to be released updated guidelines on preventing peanut allergy are sponsored by the National Institute of Allergy and Infectious Diseases,” says Dr. Greenhawt.

“The guidelines are an important step toward changing how people view food allergy prevention, particularly for peanut allergy.”

“They also offer a way for parents to introduce peanut-containing foods to reduce the risk of developing peanut allergy.”

The authors recognized early introduction of peanut-containing foods may seem to depart from recommendations for exclusive breastfeeding through six months.

One recent study showed introduction of peanuts did not affect the length or frequency of breastfeeding, and did not negatively influence growth or nutrition.

“This is a very exciting development for those of us who have been treating an increasing number of kids with peanut allergies in the past 25 years,” says Dr. Assa'ad.

“To be able to offer parents a way of reducing the risk of their children developing peanut allergies is remarkable and of real importance.”