New US guidelines developed for the prevention of peanut allergy

By Kate Bass, B.Sc.Jan 6 2017

Recommendations for introducing peanut-containing foods to infants, compiled by an expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, were published this week.

The guidelines are intended to help prevent the development of peanut allergy. They provide specific recommendations for infants with differing risk levels for developing peanut allergy.

Peanut allergy occurs when an individual's immune system becomes hypersensitive to peanut and raises an extreme allergic reaction whenever peanut is detected. An allergic reaction typically causes a range of symptoms, commonly including itchiness, sneezing, swelling, abdominal pain. However, a severe allergic reaction can also lower blood pressure and lead to cardiac arrest.

Rapid onset of a severe allergic reaction is called anaphylaxis and can be fatal. Even small traces of peanut in the environment can elicit a severe allergic response, so people with peanut allergy must ensure that they do not eat foods or enter environments containing peanut. People with a history of serious allergy carry an adrenalin pen at all times to control the allergic response in case of accidental peanut contact.

The LEAP Study, published in 2015 in the New England Journal of Medicine, showed that the development of peanut allergy could be prevented. Among more than 600 infants studied, the prevalence of peanut allergy at age 5 years was reduced by 81% in infants with a history of allergy who were randomised to eat peanut compared with those randomised to avoid peanut.

The 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States have thus been updated to reflect this with the addition of an addendum covering the prevention of peanut allergy.

The new addendum guidelines were compiled by an expert panel comprising specialists from a variety of relevant clinical, scientific and public health professional organisations. The recommendations were based on published food allergy prevention research and their own expert opinions.

The addendum guidelines recommend that peanut is introduced into an infant's diet at different ages depending on their level of risk for developing peanut allergy. Those at high risk (eg, already have severe eczema and/or egg allergy) should start to consume peanut-containing foods at the age of 4‑6 months, whereas infants without eczema or any food allergy can have peanut-containing foods introduced into their diets at any age.

The guidelines also offer several peanut-containing recipes and advice on how to introduce age-appropriate peanut-containing foods. They also highlight that whole peanuts should be avoided due to the risk of choking.

NIAID Director Anthony Fauci MD commented:

Living with peanut allergy requires constant vigilance. Preventing the development of peanut allergy will improve and save lives and lower health care costs. We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”