By Martha Tarpay, MD – Allergy, Asthma, & Clinical Research Center

There has been a concern about the increasing incidence of peanut allergy. The prevalence of peanut allergy quadrupled over the last 13 years. Our recommendations regarding the prevention and management have changed over the years:

In 2000 the American Academy of Pediatrics (AAP) recommended avoidance of peanut and peanut products until age 3 in high risk children (severe eczema, egg allergy, or both). Generally families in the USA avoided giving peanut to their children until age 2-3 years, even if they were not at high risk for peanut allergy. Avoidance of peanut until 3 years of age did not decrease the rising incidence of peanut allergy.

In 2008 the AAP retracted the 2000 recommendation. This change of recommendation was supported by an observational study that found 10x higher incidence of peanut allergy in Jewish children living in the UK than it was in Jewish children living in Israel. Children in Israel eat peanut containing snacks during the first year of life, while peanut was avoided in children below 2-3 years of age in the UK. This study suggested that early introduction of peanut in infant’s diet may lead to the prevention of peanut allergy. This theory was tested in the LEAP (Learning Early about Peanut Allergy) study. In the LEAP study children with eczema or egg allergy who had no or slight sensitivity to peanut were divided into 2 groups; peanut products were given regularly to one group, while the other avoided them. At 5 years of age peanut challenge revealed 17.2% peanut allergy in the peanut avoidance group in comparison with 3.2% in the consumption group.

Based on the above mentioned studies we expect new guidelines should be forth coming. There are still many unanswered questions. In the meantime, infants at high risk for peanut allergy should have skin testing for peanut between 4 months and 8 months of age. If the test is negative the infant should be started on peanut products. If the skin test shows mild sensitivity the patient should have peanut challenge, if it is negative the patient should be started on the peanut containing diet.

From: Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High –risk Infants.