Recent guidelines recommend early peanut introduction, beginning around 4-6 months in infants with severe eczema and/or egg allergy and around 6 months for all other infants. Peanut allergy affects an estimated 2% of children in the U.S. and it is often lifelong and associated with life threatening anaphylaxis. Recently a teenager died of anaphylaxis after eating a cookie with peanuts inside of it.
20-25% of cases may resolve by 4 years of age. There are at least 2 potential treatments that have completed a phase 3 clinical trial, although such treatments are costly, provide a limited spectrum of protection and none have received FDA approval as of yet.
Oral immunotherapy studies notes that although therapy is associated with protective effects, it carries significant risk of adverse events during the process and limited evidence of any long term sustained nonresponsive effects. There is no current long lasting treatment for peanut allergy.
Recent studies have shown that peanut allergy may be prevented through early oral peanut exposure in the first year of life, followed by consistent feeding after.
However past recommendations was to avoid peanuts and tree nuts until children were at least 3 years of age, which has led to confusion. In a recent study published in the June 2018 Annals of Allergy, Asthma and Immunology, Greenhawt et al, sought to determine the levels of support for early allergenic solid food recommendations among new and expecting caregivers of infants at risk for peanut allergy.
Among those who were surveyed were caregivers who had infants or were expecting:
- 29% had no or vague awareness of the new guidelines
- 61% had no or minimal concern for their child developing food allergy
- Only 31% expressed willingness for early peanut introduction before or around 6 months of age, with 40% reporting willingness to introduce peanut after 11 months of age (similar to tree nuts and seafood).
- 60% reported willingness to introduce egg before 8 months of age.
- Approximately 50% were unwilling to allow skin testing or oral challenges before 11 months of age.
Among new and expecting caregivers, there is poor current understanding, willingness and questionable support for early allergenic solid food recommendations, including testing before introduction. There needs to be a broader formal implementation planning to facilitate early allergen introduction and maximize its preventative benefits. These barriers need to be overcome to prevent the development of food allergy. Doctors need to address parental concerns in a timely manner for peanut to be introduced in the window of opportunity. Consumption of peanut within the first few months of life is safe and protective against peanut allergy. Coordinated effort between pediatricians and allergists will develop an effective strategy.