Early Peanut Intro Benefits Some Infants, Interim Guidelines Say

By Anne Harding

NEW YORK (Reuters Health) - Interim guidance on early introduction of peanuts for infants at high risk of allergy has been jointly issued by 10 professional groups, including the American Academy of Pediatrics and the American Academy of Allergy, Asthma & Immunology.

The statement, published online August 31 in Pediatrics, is based on data from the randomized Learning Early About Peanut Allergy (LEAP) trial, published in February in The New England Journal of Medicine (http://bit.ly/1DOGMl9).  

LEAP found that high-risk infants who received peanut products had a significantly lower risk of developing peanut allergy by age five than infants who completely avoided peanut products.

The infants were considered to be at high risk of peanut allergy because they already had severe egg allergy or eczema, or both, said Dr. Scott Sicherer of the Icahn School of Medicine at Mount Sinai in New York City in email to Reuters Health.

Sicherer is a coauthor of the consensus document and an American Academy of Pediatrics spokesperson.

All study participants underwent a skin prick test to determine peanut sensitivity, and 76 who developed wheals larger than 5 mm in diameter were excluded from the study, leaving 542 infants with a negative skin prick test and 98 who developed wheals of 1 to 4 mm.

"The 'old' common sense approach might be to assume such already allergic infants should avoid peanut, since peanut is a well known allergen," Dr. Sicherer explained. However, intention-to-treat analysis found that 17.2% of children in the peanut avoidance group developed peanut allergy by five years of age, versus 3.2% of the peanut consumption group.

"This interim guidance suggests that doctors consider mimicking the study by allergy skin testing infants fitting this special high-risk group and then possibly introducing peanut, for example initially under medical supervision. Doing this would require some special expertise, like that of an allergist," Dr. Sicherer said. "Also, peanut butter and peanuts are choking hazards for infants, so families have to be guided about safe forms of peanut."

Previous expert panels have not recommended that peanut protein be avoided for healthy infants, Dr. Sicherer noted. "This article addresses infants with pre-existing allergic problems where doctors may have otherwise advised avoidance without additional consideration," he said. "There are some caveats - we don't know exactly how the study approach will translate to a routine approach off of a study."

More detailed guidelines on infant complementary feeding and allergy risk are being developed by the National Institute of Allergy and Infectious Diseases-sponsored Working Group and the European Academy of Allergy and Clinical Immunology, and are expected to be released in the next year.

SOURCE: http://bit.ly/1fTjbqV

Pediatrics 2015.

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