The National Institute of Allergy and Infectious Diseases (NIAID) has issued clinical guidelines recommending introduction of peanut-containing foods during infancy to limit the risk of developing peanut allergy. Published Jan. 5, 2017 in the Journal of Allergy and Clinical Immunology, the new NIAID Addendum Guidelines for the Prevention of Peanut Allergy in the United States reflect findings from the LEAP and LEAP-On clinical trials co-funded by FARE.
Widespread adherence to the new guidelines may have the potential to significantly reduce the prevalence of peanut allergy.
For children at high risk of peanut allergy, 2015’s LEAP (Learning Early About Peanut Allergy) study revealed that eating peanut products regularly from infancy onward led to an 81 percent reduction in the development of peanut allergy by age 5, compared to children at similar risk who avoided peanuts during the first five years of life. Peanut allergy developed in 3.2 percent of the children who ate peanut versus 17.2 percent of children who avoided peanut. A 2016 follow-up study, LEAP-On (Persistence of Oral Tolerance to Peanut), showed that the allergy protection conferred by early peanut consumption persisted even after the children avoided peanut from ages 5 to 6.
Following publication of the LEAP study, an expert panel convened to reassess guidance on peanut introduction. FARE CEO James R. Baker, Jr., MD, and FARE Board Member Maria Acebal served on the coordinating committee that reviewed the new guidelines. The new NIAID Addendum Guidelines, tailored to healthcare providers, divide children into three risk groups and outline the following recommendations:
- Children with severe eczema, egg allergy, or both are at highest risk for peanut allergy. For these children, the expert panel advises introducing peanut as early as 4 to 6 months of age under the guidance of their healthcare provider, following introduction of other age-appropriate foods. Prior to peanut introduction, the panel recommends that doctors consider conducting a blood test for peanut-specific IgE, a skin prick test, or both. Results from these screening tests can help the doctor determine whether peanut should be introduced at home, in a doctor’s office, or through an oral food challenge in a specialized facility.
- For children with mild or moderate eczema, the panel recommends introduction of age-appropriate peanut-containing foods around age 6 months, following introduction of other solid foods. Peanut introduction can take place at home without an in-office evaluation, but medically supervised feeding is also an option.
- For children without eczema or food allergy, age-appropriate peanut-containing foods can be introduced consistent with family preferences and cultural practices. For this large group of infants, peanut is not treated differently from other foods.
The NIAID press release reports that infants should start other solid foods before they are introduced to peanut-containing foods in all cases.
Past guidelines issued in 2000 by the American Academy of Pediatrics recommended that children at high-risk for food allergy avoid allergenic foods during infancy. More recently, NIAID’s 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States suggested that the introduction of solid foods, including potentially allergenic foods, should not be delayed beyond ages 4 to 6 months, because evidence that food avoidance could lower allergy risk was insufficient. NIAID’s 2017 Addendum Guidelines are now consistent with LEAP trial findings that for high-risk infants, early peanut introduction can lower the odds of developing peanut allergy. Both LEAP and the Addendum Guidelines note that early introduction of peanut does not prevent peanut allergy in all cases.
While the 2017 addendum guidelines are directed primarily to health care providers, NIAID has also released a summary of the new guidelines for parents and caregivers. More information about the LEAP study is available in a 2015 Q&A with Dr. James Baker, FARE’s CEO and Chief Medical Officer.