Pediatric provider knowledge of early peanut introduction recommendations

Abstract

Peanut allergy affects approximately 2% of children in the United States. 1 Gupta R.S. Springston E.E. Warrier M.R. et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011; 128: e9-e17 Crossref PubMed Scopus (973) Google Scholar Delayed introduction of allergenic foods was recommended by the American Academy of Pediatrics in 2000 in an effort to reduce the incidence of allergic disease. 2 American Academy of PediatricsCommittee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000; 106: 346-349 PubMed Google Scholar This recommendation was withdrawn in 2008 owing to insufficient evidence, and no specific guidance was provided on the timing of allergenic food introduction. 3 Greer F.R. Sicherer S.H. Burks A.W. American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008; 121: 183-191 Crossref PubMed Scopus (857) Google Scholar In January 2017, evidence-based recommendations for the early introduction of peanut were made. 4 Togias A. Cooper S.F. Acebal M.L. 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. Allergy Asthma Clin Immunol. 2017; 13: 1 Crossref Scopus (25) Google Scholar The results of the Learning Early About Peanut (LEAP) trial suggest that early introduction of peanut may prevent peanut allergy among high-risk infants. 5 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1226) Google Scholar Currently, the guidelines of the National Institute of Allergy and Infectious Diseases (NIAID) recommend the introduction of peanut around 6 months of age in infants with mild to moderate eczema. For infants with severe eczema, egg allergy, or both, it is recommended to strongly consider testing for peanut sensitivity, and if appropriate, introduce peanut as early as 4 to 6 months of age. 4 Togias A. Cooper S.F. Acebal M.L. 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. Allergy Asthma Clin Immunol. 2017; 13: 1 Crossref Scopus (25) Google Scholar