Authors’ Response

Abstract

We thank Dr Eidelman and his colleagues for their comment on our Perspectives article,1 which was written to discuss the recent AAP-endorsed “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.”2 We point out that the guidelines were a consensus document from representatives of 25 stakeholder groups, including the AAP (also with input from the Section on Breastfeeding). Briefly, Eidelman and colleagues believe from their reading of our review that we were indicating that infants with no known allergy risk factors (no eczema or any food allergy) be fed peanut at 4 to 6 months of age.We confirm that the guidelines2 do not suggest that infants with no risk factors (Guideline 3) ingest peanut at 4 to 6 months of age (which would broach the recommendation for exclusive breastfeeding to 6 months). The guidelines only suggest that infant-safe forms of peanut be introduced as early as 4 to 6 months for high-risk infants (Guideline 1), as described specifically in the guidelines (severe eczema, egg allergy, or both). The guidelines provide the rationale for this breach in the length of exclusive breastfeeding for these high-risk infants,3,4 which is also discussed in our review.1We are somewhat surprised by the misunderstanding described by Eidelman in reading our review. The table we show, which was taken from the guidelines, provides a progression from introducing peanut as early as 4 to 6 months for those at high risk to 6 months for moderate risk and then age appropriate for those with no special risk (Guideline 3). A presumption that those with no eczema or food allergy would be treated like high-risk infants and fed peanut earlier than those with mild-to-moderate eczema seems entirely counterintuitive. Nonetheless, the legend to the table refers the reader to the guidelines for a full discussion. We also provide an extensive discussion to address why Guideline 1 about high-risk infants is justified despite broaching recommendations regarding exclusive breastfeeding to age 6 months, a discussion not applicable for moderate-to-low–risk infants, for whom there is no recommendation to feed peanut as early as 4 to 6 months of age. Lastly, when Eidelman and colleagues quote our comments about Guideline 3, they fail to contextualize it with our commentary denoting that peanut be introduced together with other solid foods.Eidelman and colleagues, by nature of their comments, have also seemed to misconstrue our invited Perspectives article to be tantamount to a policy statement. Of course, it is not. We hope that our comments above have clarified for them that it was a review and commentary on the Addendum Guidelines and aimed to alert readers to the potential of reducing the risk of peanut allergy through a simple dietary approach.