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    Guidelines recommend early peanut introduction

    Allergies may be mitigated by exposure in infancy

    Lawrence F. Eichenfield, M.D.Clinical guidelines released January 5 are banking on recent research suggesting that peanut allergies can be prevented by introducing peanut-containing foods into the diet during infancy.

    The addendum to the 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel features three guidelines for infants at different levels of risk for developing peanut allergy—all of which take in account whether or not infants have eczema.

    “We know that children with atopic dermatitis [AD] have a higher rate of developing food allergies than those without AD--with about 15 percent of milder AD patients having one clinically relevant food allergy (meaning a consistent clinical reaction, not just a positive test to food) by a few years of age, and around 40 percent of the more severe patients,” Lawrence F. Eichenfield, M.D., professor of dermatology and pediatrics, chief of pediatric and adolescent dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, tells Dermatology Times. Dr. Eichenfield represented the American Academy of Dermatology (AAD) on the coordinating committee for the new clinical guidelines on the prevention of peanut allergy and was a member of the expert panel. “It is important to recognize this connection, and that the xerosis and impaired skin barrier associated with eczema may allow more sensitization to allergens through the skin. Dermatologists can help to guide families to an understanding of eczema, stressing skin directed therapy and relating to them the information on how early feeding may prevent food allergies from developing.”

    The recommendations

    The first of the three guidelines focuses on infants with severe eczema, egg allergy or both and are, therefore, believed to be at high risk of peanut allergy. To reduce the risk of developing peanut allergy, health care providers should recommend that parents feed these infants peanut-containing foods as early as ages four to six months. Dermatologists and other providers might elect to perform tests to help determine how to safely introduce peanuts into infants’ diets, according to guideline one.

    The second guideline recommends that infants with mild or moderate eczema can reduce their risk for peanut allergy by having peanuts introduced into their diets at about six months of age. And for infants without eczema or food allergies, parents can freely introduce peanut-containing foods in infants’ diets.

    Parents should feed infants other solid foods before peanut-containing foods in all cases, according to the guidelines.

    The National Institutes of Health (NIH) sponsored the expert panel representing 26 professional organizations, advocacy groups and federal agencies to develop the Addendum Guidelines. The panel referred to results from the landmark Learning Early About Peanut Allergy (LEAP) study, published February 2015 in the New England Journal of Medicine, which showed infants with severe eczema, egg allergy or both who regularly consumed peanut-containing foods in infancy through five years of age were 81 percent less likely to develop peanut allergy than infants who avoided exposure to peanuts in their diets.

    “The population at highest risk is children in the first year of life with severe atopic dermatitis, a population cared for by many dermatologists, as well as those with egg allergy. Early evaluation (with serum IgE screening) or referral to allergy (specifically for skin testing for peanut) is important to allow this group of patients to benefit from the tolerance that can be developed with early feeding,” Dr. Eichenfield says.

    Next: Putting the guidelines to practice

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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