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Update on Early Introduction of Peanut to Prevent Allergy Development: Challenges with Implementation

  • Irene Mikhail
  • Ben T. Prince
  • David R. StukusEmail author
Food Allergy (E Kim, Section Editor)
  • 49 Downloads
Part of the following topical collections:
  1. Topical Collection on Food Allergy

Abstract

Purpose of Review

This review summarizes the evidence leading towards the development of new guidelines that recommend early introduction of peanut to prevent the development of peanut allergy. It also reviews the current understanding of challenges faced with implementation of these recommendations on a widespread basis.

Recent Findings

Prior recommendations to avoid feeding allergenic foods to infants have been updated and reversed. This paradigm shift in advice has created an opportunity on a population level to try and halt the recent increase in prevalence of peanut allergy. However, challenges with implementation of these new guidelines exist in many areas.

Summary

While evidence supports the early introduction of peanut to prevent allergy development, the application and challenges faced with these recommendations are not fully understood. Persistent efforts from pediatricians and allergists, as well as acceptance from parents, will be necessary in order to make a significant impact on the prevalence of peanut allergy.

Keywords

Peanut allergy Early introduction Prevention Food allergy Infant feeding Quality improvement 

Abbreviations

EAT

enquiring about tolerance

IgE

immunoglobulin E

LEAP

learning early about peanut

NIAID

National Institute of Allergy and Infectious Disease

OFC

oral food challenge

PDSA

Plan Do Study Act

QI

quality improvement

SPT

skin prick test

UK

United Kingdom

US

United States

Notes

Compliance with Ethical Standards

Conflict of Interest

Dr. Stukus was a member of the expert panel and coauthor of the 2017 NIAID Addendum guidelines for early introduction of peanut to prevent allergy. This was unpaid and his role does not serve as a conflict of interest. Drs. Mikhail and Prince declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9–17.CrossRefGoogle Scholar
  2. 2.
    Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS Data Brief. 2013;1–8.Google Scholar
  3. 3.
    Peters RL, Allen KJ, Dharmage SC, Koplin JJ, Dang T, Tilbrook KP, et al. Natural history of peanut allergy and predictors of resolution in the first 4 years of life: a population-based assessment. J Allergy Clin Immunol. 2015;135:1257–66.e1–2.CrossRefGoogle Scholar
  4. 4.
    Avery NJ, King RM, Knight S, Hourihane JO. Assessment of quality of life in children with peanut allergy. Pediatr Allergy Immunol. 2003;14:378–82.CrossRefGoogle Scholar
  5. 5.
    King RM, Knibb RC, Hourihane JO. Impact of peanut allergy on quality of life, stress and anxiety in the family. Allergy. 2009;64:461–8.CrossRefGoogle Scholar
  6. 6.
    American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106:346–9.CrossRefGoogle Scholar
  7. 7.
    Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183–91.CrossRefGoogle Scholar
  8. 8.
    Toit Du G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122:984–91.CrossRefGoogle Scholar
  9. 9.
    • Toit Du G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803–13. COMMENT: Pivotal LEAP trial demonstrating for the first time that early introduction and ongoing ingestion of peanut can prevent peanut allergy development. CrossRefGoogle Scholar
  10. 10.
    Fleischer DM, Sicherer S, Greenhawt M, Campbell D, Chan E, Muraro A, et al. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants. J Allergy Clin Immunol. 2015;136(2):258–61.CrossRefGoogle Scholar
  11. 11.
    • Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR, Beck LA, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017;139:29–44. COMMENT: U.S. addendum guidelines that detail recommendations for how and when to introduce peanut to infants. CrossRefGoogle Scholar
  12. 12.
    Ebisawa M, Ito K, Fujisawa T. Committee for Japanese Pediatric Guideline for Food Allergy, The Japanese Society of Pediatric Allergy and Clinical Immunology, The Japanese Society of Allergology. Japanese guidelines for food allergy 2017. Allergol Int. 2017;66:248–64.CrossRefGoogle Scholar
  13. 13.
    Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008–25.CrossRefGoogle Scholar
  14. 14.
    Joshi PA, Smith J, Vale S, Campbell DE. The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines. Med J Aust. 2019;210:89–93.CrossRefGoogle Scholar
  15. 15.
    • Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016;374:1733–43. COMMENT: EAT study also demonstrating reduction in peanut allergy among unselected cohort of infants through early introduction. CrossRefGoogle Scholar
  16. 16.
    Toit Du G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016;374:1435–43.CrossRefGoogle Scholar
  17. 17.
    Tang MLK, Koplin JJ, Sampson HA. Is skin testing or sIgE testing necessary before early introduction of peanut for prevention of peanut allergy? J Allergy Clin Immunol Pract. 2018;6:408–13.CrossRefGoogle Scholar
  18. 18.
    Koplin JJ, Peters RL, Dharmage SC, Gurrin L, Tang MLK, Ponsonby A-L, et al. Understanding the feasibility and implications of implementing early peanut introduction for prevention of peanut allergy. J Allergy Clin Immunol. 2016;138:1131–2.CrossRefGoogle Scholar
  19. 19.
    O'Connor C, Kelleher M, O’B Hourihane J. Calculating the effect of population-level implementation of the Learning Early About Peanut Allergy (LEAP) protocol to prevent peanut allergy. J Allergy Clin Immunol. 2016;137:1263–1264.e2.CrossRefGoogle Scholar
  20. 20.
    Greenhawt M, Chan ES, Fleischer DM, Hicks A, Wilson R, Shaker M, et al. Caregiver and expecting caregiver support for early peanut introduction guidelines. Ann Allergy Asthma Immunol. 2018;120:620–5.CrossRefGoogle Scholar
  21. 21.
    Soriano VX, Peters RL, Ponsonby AL, Dharmage SC, Perrett KP, Field MJ, et al. Earlier ingestion of peanut following changes to infant feeding guidelines: The EarlyNuts Study. J Allergy Clin Immunol. 2019.  https://doi.org/10.1016/j.jaci.2019.07.032.CrossRefGoogle Scholar
  22. 22.
    Abrams EM, Singer AG, Soller L, Chan ES. Knowledge gaps and barriers to early peanut introduction among allergists, pediatricians, and family physicians. J Allergy Clin Immunol Pract. 2019 Feb;7(2):681–4.CrossRefGoogle Scholar
  23. 23.
    Mikhail IJ, Prince B, Stukus D. A quality improvement initiative to increase referrals to an early peanut. J Allergy Clin Immunol. 2018;141(2):AB253.CrossRefGoogle Scholar
  24. 24.
    Stukus DR, Prince BT, Mikhail I. Implementation of guidelines for early peanut introduction at a pediatric academic center. J Allergy Clin Immunol Pract. 2018;6(5):1784–6.CrossRefGoogle Scholar
  25. 25.
    Amigo MA, Mikhail IJ, McLaughlin EM, Stukus DR, Prince BT. Change in peanut skin prick testing over time in infants at risk for food allergy who continue to avoid peanut. J Allergy Clin Immunol. 2019;143(2):AB261.CrossRefGoogle Scholar
  26. 26.
    Shaker M, Stukus D, Fleischer DM, et al. “To screen or not to screen”: comparing the health and economic benefits of early peanut introduction strategies in five countries. Allergy. 2018;73(8):1707–14.CrossRefGoogle Scholar
  27. 27.
    Fleischer MD, Conover-Walker MK, Christie L, et al. Peanut allergy: recurrence and its management. J Allergy Clin Immunol. 2004;114:1195–201.CrossRefGoogle Scholar
  28. 28.
    Tapke DE, Stukus DR, Prince BT, Scherzer R, Mikhail I. Implementation of early peanut introduction guidelines among pediatricians. J Allergy Clin Immunol. 2019;143(2):AB273.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Irene Mikhail
    • 1
  • Ben T. Prince
    • 1
  • David R. Stukus
    • 1
    Email author
  1. 1.Nationwide Children’s Hospital, Division of Allergy and ImmunologyThe Ohio State University College of MedicineColumbusUSA

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