Risk Of Peanut Allergy Research Articles

Whole Blood Transcriptomics Identifies Differences in Innate Immune Pathway Expression in Infants at Risk for Peanut Allergy.

Whole Blood Transcriptomics Identifies Differences in Innate Immune Pathway Expression in Infants at Risk for Peanut Allergy.

Milk and egg allergy are associated with increased risk of peanut allergy at age 1 in Australia

Milk and egg allergy are associated with increased risk of peanut allergy at age 1 in Australia

Sex Differences in Whole Blood Gene Expression in Infants at High Risk for Peanut Allergy

Sex Differences in Whole Blood Gene Expression in Infants at High Risk for Peanut Allergy

Risk subgroups and intervention effects among infants at high risk for peanut allergy: A model for clinical decision making.

The Learning Early About Peanut Allergy (LEAP) trial showed that early dietary introduction of peanut reduced the risk of developing peanut allergy by age 60 months in infants at high risk for peanut allergy. In this secondary analysis of LEAP data, we aimed to determine risk subgroups within these infants and estimate their respective intervention effects of early peanut introduction. LEAP raw data were retrieved from ITNTrialShare.org. Conditional random forest was applied to participants in the peanut avoidance arm to select statistically important features for the classification and regression tree (CART) analysis to group infants based on their risk of peanut allergy at 60 months of age. Intervention effects were estimated for each derived risk subgroup using data from both arms. Our main model was generated based on baseline data when the participants were 4-11 months old. Specific IgE measurements were truncated to account for the limit of detection commonly used by laboratories in clinical practice. The model found infants with higher predicted probability of peanut allergy at 60 months of age had a similar relative risk reduction, but a greater absolute risk reduction in peanut allergy with early introduction of peanut, than those with lower probability. The intervention effects were significant across all risk subgroups. Participants with baseline peanut sIgE ≥0.22 kU/L (n = 78) had an absolute risk reduction of 40.4% (95% CI 27.3, 51.9) whereas participants with baseline peanut sIgE<0.22 kU/L and baseline Ara h 2 sIgE <0.10 kU/L (n = 226) had an absolute risk reduction of 6.5% (95% CI 2.6, 11.0). These findings were consistent in sensitivity analyses using alternative models. In this study, risk subgroups were determined among infants from the LEAP trial based on the probability of developing peanut allergy and the intervention effects of early peanut introduction were estimated. This may be relevant for further risk assessment and personalized clinical decision-making.

Epidermal differentiation complex genetic variation in atopic dermatitis and peanut allergy

Deleterious variation in the epidermal differentiation complex (EDC) on chromosome 1 is a well-known genetic determinant of atopic dermatitis (AD) and has been associated with risk of peanut allergy (PA) in population-based studies. Our aim was to determine the effect of genetic variation in the EDC on AD trajectory and risk of PA in early life. Genome sequencing was used to measure genetic variation in the EDC in the Learning Early about Peanut Allergy (LEAP) study participants. Association tests were done to identify gene- and variant-level predicted deleterious variation associated with AD severity by using the Scoring Atopic Dermatitis (SCORAD) tool (n= 559) at baseline and each follow-up visit, as well as PA and food allergy in peanut avoiders (n= 275). Predicted deleterious variants included missense variants that were frameshift insertions, frameshift deletions, stop-gain mutations, or stop-loss mutations. Associations between variant load, SCORAD score, and PA were tested by using linear and generalized linear regression models. The genes FLG, FLG2, HRNR, and TCHH1 harbored the most predicted deleterious variation (30, 6, 3, and 1 variant, respectively). FLG variants were associated with SCORAD score at all time points; 4 variants (R1798X, R501X, S126X, and S761fs) drove the association with SCORAD score at each time point, and higher variant load was associated with greater AD severity over time. There was an association between these variants and PA, which remained significant independent of baseline AD severity (odds ratio= 2.63 [95% CI= 1.11-6.01] [P= .02]). Variation in FLG predicted to be deleterious is associated with AD severity at baseline and longitudinally and has an association with PA independent of baseline severity.

Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy

Earlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction. To investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy. In this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes. Randomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)-mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence. Primary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods. Of 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was -26 cases (95% CI, -34 to -13 cases) per 1000 population. There was moderate-certainty evidence from 5 trials (4703 participants) that introduction of multiple allergenic foods from 2 to 12 months of age was associated with increased withdrawal from the intervention (RR, 2.29; 95% CI, 1.45-3.63; I2 = 89%). Absolute risk difference for a population with 20% withdrawal from the intervention was 258 cases (95% CI, 90-526 cases) per 1000 population. There was high-certainty evidence from 9 trials (4811 participants) that introduction of egg from 3 to 6 months of age was associated with reduced risk of egg allergy (RR, 0.60; 95% CI, 0.46-0.77; I2 = 0%) and high-certainty evidence from 4 trials (3796 participants) that introduction of peanut from 3 to 10 months of age was associated with reduced risk of peanut allergy (RR, 0.31; 95% CI, 0.19-0.51; I2 = 21%). Evidence for timing of introduction of cow's milk and risk of cow's milk allergy was very low certainty. In this systematic review and meta-analysis, earlier introduction of multiple allergenic foods in the first year of life was associated with lower risk of developing food allergy but a high rate of withdrawal from the intervention. Further work is needed to develop allergenic food interventions that are safe and acceptable for infants and their families.

B Cell Mechanisms of Tolerance in Infants at Risk for Peanut Allergy

IL-10-producing cells and allergen-specific IgG4 are associated with food tolerance. However, B cell responses to IL-10 and the role of regulatory, IL-10-producing B cells in the context of food allergy have not been well-studied, particularly in infants.

A LEAP FORWARD IN EVALUATION OF PEANUT ALLERGY IN A CHILD WITH SEVERE ATOPIC DERMATITIS

<h3>Introduction</h3> Children with atopic dermatitis (AD) are at higher risk of peanut allergy. However, children with AD may have more elevated measures of sensitization including serum IgE (sIgE) and skin prick testing (SPT) at baseline without necessarily having clinical allergy. Here we describe the case of a child who despite having AD and significantly elevated sIgE and SPT to peanut, passed an oral food challenge (OFC). <h3>Case Description</h3> Our patient is a 16 month-old who presented for evaluation of severe eczema and food allergy. He introduced peanut in the form of Bamba at home, which coincided with an atopic dermatitis flare, although cutaneous symptoms were not noted to be immediate. An intensive skin care regimen was initiated with clinical improvement. SPT to peanut was positive with a wheal of 7 × 5 mm. His total sIgE was 10,229 kU/L, sIgE to peanut was 39.7 kUA/L and sIgE to Ara h 2 was 1.72 kUA/L. A 5 dose OFC to peanut butter was negative. His parents were instructed to incorporate peanut butter into his diet regularly. <h3>Discussion</h3> Given the importance of early exposure in preventing the development of clinical allergy, it may be worth considering an OFC for children without clear history of immediate type 1 hypersensitivity reactions to peanuts, even with elevated measures of sensitization. Close attention to skin care is also necessary prior to OFC so that a cutaneous reaction to the culprit food is not confused with a background eczema flare that may have occurred without food exposure.

DEVELOPING AN INFANT ATOPIC DERMATITIS SCORECARD FOR PEDIATRIC CLINICIANS

<h3>Introduction</h3> Accurate diagnosis and categorization of infant atopic dermatitis (AD) is necessary for assessing risk prior to early peanut introduction. AD assessment tools were primarily developed for research purposes and not for clinical use. Objective:To develop an infant AD scorecard with a focus on diverse skin tones to assist pediatric clinicians with AD assessments. <h3>Methods</h3> Parents of children with AD diagnosis were contacted and consented to provide high-resolution standardized photographs of their infant's AD lesions. Two dermatologists reviewed all images and determined AD severity using the Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD). An instructional video about AD and how to use the scorecard was developed and presented to pediatric clinicians. <h3>Results</h3> Overall, photographs of 13 children were obtained: 6 children were photographed by research staff and 7 provided images of their infants using the same standardized photographic protocol. Two pediatric dermatologists evaluated 58 infant's images, with 84% agreement on first-pass severity categorization. Of these, 14 images were selected representing 2 White, 2 Black, 1 mixed race, and 2 Hispanic/LatinX infants. These images were used to develop the final scorecard which included 5 mild, 5 moderate, and 4 severe cases of AD. Overall, 189 pediatricians completed an educational module on AD categorization and vIGA-AD scorecard. Initial feedback surveys (N=14) 64.3% reported the training was "very effective." Observation of utilization and effectiveness of the scorecard and training is ongoing. <h3>Conclusion</h3> Development of an infant AD scorecard can assist pediatric providers in assessing peanut allergy risk prior to early introduction.

AN EMR INTERVENTION TO IMPROVE EARLY INTRODUCTION OF PEANUTS IN INFANTS AT COMMUNITY-BASED HEALTH CLINICS

<h3>Introduction</h3> Infant peanut introduction is a recommended childhood feeding practice, following the landmark LEAP study showing that early introduction of peanut dramatically reduced rates of peanut allergy in high-risk infants. However, counselling about early introduction at infant well visits may not be happening systematically in all primary care settings. <h3>Methods</h3> In April 2019, we introduced an EMR screening tool in our general pediatrics clinics to discuss peanut allergy risk factors and early peanut introduction at well visits between 4-11 months. A retrospective chart review was undertaken, comparing all infants seen for 4-11 month old well visits in the year following the intervention (April 2019-March 2020) versus the year prior to the intervention (April 2018-March 2019). <h3>Results</h3> A total of 379 charts were screened, 179 pre-intervention and 200 post-intervention. There were no statistically significant differences in baseline characteristics in the pre-intervention and post-intervention groups, including age, sex, and comorbid egg allergy and eczema. Post-intervention, there was a statistically significant increase in discussion of early peanut introduction. 7 infants were screened pre-intervention, while 56 were screened after (p<0.001). There was a statistically significant increase in documentation of peanut in the diet by 12 months, with 5 documented pre-intervention and 23 post-intervention (p=0.001). <h3>Conclusion</h3> While introduction of the EMR screening tool increased discussion of early peanut introduction in community-based clinics, most infants still didn't have documentation of counselling on early peanut introduction in their medical records. Further interventions to improve rates of early peanut introduction are necessary to minimize development of peanut allergy.

Association Between Earlier Introduction of Peanut and Prevalence of Peanut Allergy in Infants in Australia

Randomized clinical trials showed that earlier peanut introduction can prevent peanut allergy in select high-risk populations. This led to changes in infant feeding guidelines in 2016 to recommend early peanut introduction for all infants to reduce the risk of peanut allergy. To measure the change in population prevalence of peanut allergy in infants after the introduction of these new guidelines and evaluate the association between early peanut introduction and peanut allergy. Two population-based cross-sectional samples of infants aged 12 months were recruited 10 years apart using the same sampling frame and methods to allow comparison of changes over time. Infants were recruited from immunization centers around Melbourne, Australia. Infants attending their 12-month immunization visit were eligible to participate (eligible age range, 11-15 months), regardless of history of peanut exposure or allergy history. Questionnaires collected data on demographics, food allergy risk factors, peanut introduction, and reactions. All infants underwent skin prick tests to peanut and those with positive results underwent oral food challenges. Prevalence estimates were standardized to account for changes in population demographics over time. This study included 7209 infants (1933 in 2018-2019 and 5276 in 2007-2011). Of the participants in the older vs more recent cohort, 51.8% vs 50.8% were male; median (IQR) ages were 12.5 (12.2-13.0) months vs 12.4 (12.2-12.9) months. There was an increase in infants of East Asian ancestry over time (16.5% in 2018-2019 vs 10.5% in 2007-2011), which is a food allergy risk factor. After standardizing for infant ancestry and other demographics changes, peanut allergy prevalence was 2.6% (95% CI, 1.8%-3.4%) in 2018-2019, compared with 3.1% in 2007-2011 (difference, -0.5% [95% CI, -1.4% to 0.4%]; P = .26). Earlier age of peanut introduction was significantly associated with a lower risk of peanut allergy among infants of Australian ancestry in 2018-2019 (age 12 months compared with age 6 months or younger: adjusted odds ratio, 0.08 [05% CI, 0.02-0.36]; age 12 months compared with 7 to less than 10 months: adjusted odds ratio, 0.09 [95% CI, 0.02-0.53]), but not significant among infants of East Asian ancestry (P for interaction = .002). In cross-sectional analyses, introduction of a guideline recommending early peanut introduction in Australia was not associated with a statistically significant lower or higher prevalence of peanut allergy across the population.

Relevance of Early Introduction of Cow's Milk Proteins for Prevention of Cow's Milk Allergy.

Food allergy incidence has increased worldwide over the last 20 years. For prevention of food allergy, current guidelines do not recommend delaying the introduction of allergenic foods. Several groundbreaking studies, such as the Learning Early About Peanut Allergy study, showed that the relatively early introduction of this allergenic food between 4–6 months of age reduces the risk of peanut allergy. However, less is known about the introduction of cow’s milk, as many children already receive cow’s-milk-based formula much earlier in life. This can be regular cow’s milk formula with intact milk proteins or hydrolyzed formulas. Several recent studies have investigated the effects of early introduction of cow’s-milk-based formulas with intact milk proteins on the development of cow’s milk allergy while breastfeeding. These studies suggest that depending on the time of introduction and the duration of administration of cow’s milk, the risk of cow’s milk allergy can be reduced (early introduction) or increased (very early introduction followed by discontinuation). The aim of this narrative review is to summarize these studies and to discuss the impact of early introduction of intact cow’s milk protein—as well as hydrolyzed milk protein formulas—and the development of tolerance versus allergy towards cow’s milk proteins.

Multiple FLG variants drive eczema severity in the LEAP study participants

Filaggrin (FLG) is a well-known genetic determinant of eczema and is associated with risk of peanut allergy (PA) in population-based studies. There are gaps in our understanding of its association with the trajectory of eczema in young children, and the interplay with PA risk.

The association between environmental greenness and the risk of food allergy: A population-based study in Melbourne, Australia.

While exposure to environmental greenness in childhood has shown mixed associations with the development of allergic disease, the relationship with food allergy has not been explored. We investigated the association between exposure to environmental greenness and challenge-confirmed food allergy in a large population-based cohort. The HealthNuts study recruited 5276 12-month-old infants in Melbourne, Australia, who underwent skin prick testing to peanut, egg, and sesame; infants with a detectable wheal underwent food challenges to determine food allergy status. Environmental greenness was estimated using the normalized difference vegetation index (NDVI) for five buffer zones around the infant's home address: at the home, 100m, 500m, 800m, and 1600m radial distances. Environmental greenness was categorized into 3 tertiles and mixed effects logistic regression models quantified the association between greenness and the risk of food allergy, adjusting for confounding and accounting for clustering at the neighborhood level. NDVI data were available for n=5097. For most buffer zones, medium and high greenness, compared to low greenness, was associated with an increased risk of peanut allergy (eg, 100m tertile 2 aOR 1.89 95% CI 1.22-2.95, tertile 3 aOR 1.78 95% CI 1.13-2.82). For egg allergy, the effect sizes were smaller (100 m tertile 2 aOR 1.52 95% CI 1.16-1.97, tertile 3 aOR 1.38 95% CI 1.05-1.82). Socioeconomic status (SES) modified the association between greenness and peanut allergy, but not egg allergy; associations were apparent in the low SES group but not in the high SES group (p for interaction 0.08 at 100m). Air pollution (PM2.5) also modified the associations between environmental greenness and food allergy, with associations present in high air pollution areas but not low (p for interaction at 100m 0.05 for peanut and 0.06 for egg allergy.) CONCLUSION: Increased exposure to environmental greenness in the first year of life was associated with an increased risk of food allergy. Increased greenness may correlate with higher pollen levels which may trigger innate immune responses skewing the immune system to the Th2-dependent allergic phenotype; additionally, some pollen and food allergens are cross-reactive. Given the mixed data on greenness and other allergies, the relationship appears complex and may also be influenced by confounding variables outside those that were measured in this study.

HLA alleles and sustained peanut consumption promote IgG4 responses in subjects protected from peanut allergy.

We investigated the interplay between genetics and oral peanut protein exposure in the determination of the immunological response to peanut using the targeted intervention in the LEAP clinical trial. We identified an association between peanut-specific IgG4 and HLA-DQA1*01:02 that was only observed in the presence of sustained oral peanut protein exposure. The association between IgG4 and HLA-DQA1*01:02 was driven by IgG4 specific for the Ara h 2 component. Once peanut consumption ceased, the association between IgG4-specific Ara h 2 and HLA-DQA1*01:02 was attenuated. The association was validated by observing expanded IgG4-specific epitopes in people who carried HLA-DQA1*01:02. Notably, we confirmed the previously reported associations with HLA-DQA1*01:02 and peanut allergy risk in the absence of oral peanut protein exposure. Interaction between HLA and presence or absence of exposure to peanut in an allergen- and epitope-specific manner implicates a mechanism of antigen recognition that is fundamental to driving immune responses related to allergy risk or protection.

Real-world peanut OIT in infants may be safer than non-infant preschool OIT and equally effective

Early introduction of peanut reduces the risk for peanut allergy, as noted in the landmark Learning Early About Peanut Allergy study1; however, some infants fail primary prevention and still develop peanut allergy.2 There is evidence that preschoolers tend to have milder, more modifiable food allergy,3 which may make them excellent candidates for immunotherapy.4 Real-world data from our group have shown peanut oral immunotherapy (P-OIT) to be particularly safe and effective in preschoolers (aged <70 months),5,6 but there was no specific focus on infants (aged <12 months).

Age and Eczema Severity, but Not Family History, Are Major Risk Factors for Peanut Allergy in Infancy

Since the publication of the Learning Early About Peanut Allergy (LEAP) study in 2015 and the addendum guidelines for the prevention of peanut allergy in 2017, there has been controversy regarding the need and value of performing screening tests in infants at a high risk of developing peanut allergy.In the study, the researchers included 321 infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the following risk factors for the development of peanut allergy: moderate to severe eczema, another food allergy, and/or a first-degree relative with peanut allergy.After a careful history regarding risk factors and a physical examination focused on eczema severity, the infants underwent peanut skin-prick testing and, depending on the skin-prick test wheal size, a graded oral peanut challenge or an observed feeding with a full serving of peanut.The median age of the participants was 7.2 months, and 58% were boys. A total of 78 had eczema only, 11 had other food allergies only, 107 had a family history only, and 125 had multiple risk factors. Overall, 37 (11%) were found to have a peanut allergy, including 18% of 195 with eczema, 19% of 59 with other food allergies, and 4% of 201 with a family history. Only 1% of 115 with a family history and no eczema had a peanut allergy. Among those with eczema, older age (odds ratio [OR]: 1.3; 95% confidence interval [CI]: 1.04 to 1.68 per month), higher severity of atopic dermatitis (OR: 1.19; 95% CI: 1.06 to 1.34 per 5 points on the Scoring Atopic Dermatitis), Black (OR: 5.79; 95% CI: 1.92 to 17.4, compared with White), or Asian American race (OR: 6.98; 95% CI: 1.92 to 25.44) and suspected or diagnosed other food allergy (OR: 3.98; 95% CI: 1.62 to 9.80) were associated with peanut allergy.In the study, researchers found that peanut allergy is common in infants with moderate to severe eczema and/or a history of other food allergies, whereas family without eczema is not a major risk factor. This strongly suggests that there is value in screening those with significant eczema and/or other food allergies. Even within the first year of life, introduction at later ages is associated with a higher risk of peanut allergy among those with eczema, supporting introduction of peanut as early as possible.With this study, the authors provide new and valuable information on an important and timely topic. First, there is value in screening infants at high risk, especially those with severe eczema with or without other food allergies. Second, as was suggested by the LEAP study, earlier introduction appears to be important for these infants at the highest risk. The window of protection may truly be closing by 6 to 7 months of age. Third, and one of the most common questions encountered in day to day practice, family history of peanut allergy without other risk factors does not impart increased risk, providing reassurance that those infants to do need to be tested before peanut introduction.

Clinical Documentation of Peanut Allergy Prevention in an Academic Learning Health System

Consensus guidelines recommend early peanut introduction (EPI) as an effective strategy for preventing peanut allergy. Real-world practice patterns of EPI guidance are poorly understood. We aimed to described EPI practice patterns within an academic learning health system. We queried the health system’s central data repository to identify individuals eligible to receive EPI guidance from 1/6/2017 - 03/30/2020: persons less than 12 months of age at the time of a clinical encounter for either a health supervision visit or a problem-based visit related to eczema. We used the Electronic Medical Record Search Engine (EMERSE) to search clinical notes for the word “peanut.” These were manually reviewed for EPI documentation and other practice pattern characteristics. Of a total of 18,149 individuals, 152 (0.8%, mean age 6.4 months) had clinical documentation of EPI guidance (72% clinical note, 20% patient instructions, 5% both, 3% telephone note). EPI guidance was performed by 61 providers among 6 specialties (43% pediatrics, 40% family medicine, 15% allergy/immunology, 2% other) in 24 unique practices. Of those who received EPI guidance, the following comorbid diagnoses and/or characteristics were documented: 35% eczema, 11% egg allergy, 21% family history of food allergy, 31% topical corticosteroid use. Twenty percent were referred to an allergist for peanut allergy risk assessment and 12% had a peanut IgE obtained. Clinical documentation of EPI counseling is low. Further dissemination and implementation efforts are needed to encourage providers to prioritize EPI and increase standard utilization of consensus guidelines.

Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy

Whether to screen high-risk groups before early peanut introduction is controversial. We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH). Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding. A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA. PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.

Peanut oral food challenges and subsequent feeding of peanuts in infants

The prevalence of peanut allergy has increased in recent years and affects approximately 1% to 3% of children in the United States.1 Peanut allergy presents a significant burden to caregivers and patients due to the anaphylaxis risk, lifelong allergy, increased financial costs, and worse quality of life. On the basis of the results of the Learning Early About Peanut Allergy (LEAP) study, the National Institute of Allergy and Infectious Diseases (NIAID) updated food allergy guidelines in 2017 to introduce peanut as early as 4 to 6 months of age into infant diets as a way to reduce the risk of peanut allergy.