More and more children and adults are being diagnosed with peanut allergy in the U.S. in the past few decades. Peanut allergy was estimated to affect about 0.4% of children and 0.7% of adults in 1999. By 2010, the prevalence increased to about 2% of all children. Peanut allergy is the leading cause of death related to food allergies in U.S.
Until a few years ago, it was thought that delaying the introduction of allergenic foods to at-risk children reduced the likelihood of the development of food allergies. However, a recent landmark study published in 2015 called LEAP (Learning Early About Peanut Allergy) provided evidence to the contrary. Based on the new findings, the National Institute of Allergy and Infectious Diseases amended the previous recommendations and issued new guidelines favoring early introduction of peanut products in children at risk for the development of peanut allergy.
It is known that infants diagnosed with eczema and/or allergies to eggs are at higher risk of developing peanut allergies. These children were the focus of the new guidelines. Though it is possible that other groups of children with a family history of food allergies and/or history of allergic reactions to other foods such as milk, soy, wheat, etc. also are more likely to develop peanut allergy, these children were not included in the current recommendations due to lack of enough evidence at this time.
In infants with no eczema or any food allergy, peanut products should be introduced in their diet in accordance with family preferences.
In infants with mild to moderate eczema with no other food allergy, peanut-containing foods should be introduced at about 6 months of age. Other solid foods should be introduced before peanut-containing foods to ensure that the infant is developmentally ready. These infants may have dietary peanut introduced at home, though some caregivers and healthcare providers may desire an in-office supervised feeding, evaluation, or both.
1. Severe eczema (defined as those with persistent and recurrent flare-ups of eczema needing prescription-strength medications)
2. Egg allergy (defined as those with a history of a reaction to egg and a positive skin prick test or a positive oral egg food challenge)
3. Both 1 and 2 above need to be tested for possible peanut allergy as follows:
1. If the blood test shows no peanut specific IgE antibody, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.
2. If the blood test shows elevated peanut IgE antibody, the children need prick skin testing with peanut antigen by an allergist.
A. If the skin test shows a wheal of 0 to 2 mm. in diameter, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.
B. If the skin test reveals a wheal of 3 to 7 mm. in diameter, a supervised in-office feeding or a graded oral food challenge with peanut should be undertaken. In the case of no adverse reaction, peanut-containing foods should be introduced in their diet. In the case of an adverse reaction, peanut products should be strictly avoided.
C. If the skin test’s wheal diameter is 8 mm. or larger, these infants should avoid peanut products and should continue to be evaluated and managed by an allergist.
Infants, who are candidates for the introduction of peanut-containing foods at 4 to 6 months of age, should receive about 2 grams of peanut protein in the first feeding. Subsequently, they should also be regularly fed about 6 grams of peanut protein per week, divided in 3 or more feedings.
It is hoped that this strategy will help in development of tolerance to peanut products and will substantially reduce the likelihood of the development of peanut allergy which can be very serious and even fatal.
Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area. The allergists are trained and very familiar performing prick skin testing as well as oral food challenges in the appropriate individuals. Black & Kletz Allergy diagnoses and treats both adults and children. We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations. The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line. If you are concerned that you or your child has a peanut allergy or any other type of food allergy, please call us to schedule an appointment. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the needs of allergy and asthma sufferers in the Washington, DC metro area for more than 50 years.