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Preventing a Peanut Allergy

How to Introduce Peanut to your Child Safely

A study published this year in the New England Journal, the LEAP study, has changed the thought process regarding how and when to introduce peanut to children at risk for peanut allergy. The study demonstrated that there was a significant decrease in the prevalence of peanut allergy when children began ingesting peanut prior to 11 months of age.   There are some key points that parents should be aware of so that they can make the best choice regarding how to approach the introduction of peanut to their child.

The study defined high risk as having severe eczema, egg allergy or both. Other known risk factors for peanut allergies that were not identified in the study are a family history of food allergy, especially in a sibling, and food allergies other than egg.

A substantial number of these high risk children (about 9%) were excluded from the study because they had an allergy skin test that was considered large enough to make it highly probable that they already had a peanut allergy. Children with small positive skin tests but not reactive to peanut with ingestion were included in the study.

For the children included in the study there was a significant reduction in the prevalence of peanut allergy.  Overall there was a prevalence of approximately 17% in the avoidance group versus a <5% prevalence in the peanut consumption group.

Recommendations:

  1. If your child is high risk, obtain a skin test from an allergist before introducing peanut to be sure that s/he does not already have a significant peanut allergy. If the skin test is negative then options for introduction would be at home cautiously or with an oral food challenge in a physician supervised setting, depending on your healthcare provider’s recommendations. If the skin test is positive, discuss the size of the skin test and if a physician supervised food challenge would be indicated. Children with small positive skin tests who tolerated the peanut during a food challenge were less likely to develop a peanut allergy if they consumed peanut regularly.
  2. For children with no significant risk factors for peanut allergy, it may be okay to introduce peanut without skin testing but please consult with your child’s healthcare provider. Remember that peanut allergies can occur in patients without clear risk factors for peanut allergy.
  3. Review signs and symptoms of a food allergic reaction/anaphylaxis with your child’s healthcare provider. Have a plan in place regarding identification and treatment of an allergic reaction.
  4. Once peanut has been successfully introduced into a child’s diet it is important to continue the peanut regularly with a quantity of at least a teaspoon two to three times per week. If the peanut is not given regularly, it is possible that tolerance could be lost and that an allergic reaction could develop.

For more detailed information regarding the peanut study please refer to the following reference:

Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy.  N Eng J Med 2015;372;9 803-13. NEJM.ORG

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