Early Introduction of Peanut in a Solo Allergy Practice

Abstract

We aim to report our experience with peanut challenges for early introduction of peanut in a solo allergy practice. In the spring of 2015 we wrote all offices whose patients we had seen in the past to encourage them to send patients suitable for early peanut introduction. All referred patients has PST to peanut, egg, milk, wheat and soy. Patients with a negative PST to peanut were asked to begin peanut at home. However some families opted for an in office challenge (Group 1) Patients with a positive PST to peanut were offered an open graded challenge (group 2). Between 5-15 and 6-18, 37 infants had a peanut challenge. The mean age at challenge was 6.6 months. Group 1 had 9 infants and 100% passed their challenge. However 3 (33%) of the infants subsequently developed a positive PST and clinical symptoms of peanut allergy. Group 2 had 28 infants. Nineteen children passed the graded challenge and 7 failed (36%).The mean wheal size for all infants was 4.7mm. Four of the seven who failed had a PST > 8mm. No infants in group 2 developed peanut allergy in follow up. Eleven of the infants (30%) were referred from one pediatric dermatology practice. Infants with a negative PST were at high risk of becoming peanut allergic with time suggesting that careful follow is required. A PST greater than 8mm posed a risk for failing. A single pediatric dermatology practice accounted for 30% of referrals