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Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants

      The purpose of this brief communication is to highlight emerging evidence to existing guidelines regarding potential benefits of supporting early, rather than delayed, peanut introduction during the period of complementary food introduction in infants. This document should be considered as interim guidance based on consensus among the following organizations: American Academy of Allergy, Asthma & Immunology, American Academy of Pediatrics, American College of Allergy, Asthma & Immunology, Australasian Society of Clinical Immunology and Allergy, Canadian Society of Allergy and Clinical Immunology, European Academy of Allergy and Clinical Immunology, Israel Association of Allergy and Clinical Immunology, Japanese Society for Allergology, Society for Pediatric Dermatology, and World Allergy Organization. More formal guidelines regarding early-life, complementary feeding practices and the risk of allergy development will follow in the next year from the National Institute of Allergy and Infectious Diseases-sponsored Working Group and the European Academy of Allergy and Clinical Immunology.

      Key words

      Abbreviations used:

      EAACI (European Academy of Allergy and Clinical Immunology), LEAP (Learning Early About Peanut Allergy), NIAID (National Institute of Allergy and Infectious Diseases), NNT (Number needed to treat), SPT (Skin prick test)
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      References

        • Nwaru B.I.
        • Hickstein L.
        • Panesar S.S.
        • Muraro A.
        • Werfel T.
        • Cardona V.
        • et al.
        The epidemiology of food allergy in Europe: a systematic review and meta-analysis.
        Allergy. 2014; 69: 62-75
        • Osborne N.J.
        • Koplin J.J.
        • Martin P.E.
        • Gurrin L.C.
        • Lowe A.J.
        • Matheson M.C.
        • et al.
        Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants.
        J Allergy Clin Immunol. 2011; 127: 668-676
        • Venter C.
        • Hasan Arshad S.
        • Grundy J.
        • Pereira B.
        • Bernie Clayton C.
        • Voigt K.
        • et al.
        Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK.
        Allergy. 2010; 65: 103-108
        • Sicherer S.H.
        • Muñoz-Furlong A.
        • Godbold J.H.
        • Sampson H.A.
        US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.
        J Allergy Clin Immunol. 2010; 125: 1322-1326
        • Soller L.
        • Ben-Shoshan M.
        • Harrington D.W.
        • Fragapane J.
        • Joseph L.
        • St Pierre Y.
        • et al.
        Overall prevalence of self-reported food allergy in Canada.
        J Allergy Clin Immunol. 2012; 130: 986-988
        • Amoah A.S.
        • Obeng B.B.
        • Larbi I.A.
        • Versteeg S.A.
        • Aryeetey Y.
        • Akkerdaas J.H.
        • et al.
        Peanut-specific IgE antibodies in asymptomatic Ghanaian children possibly caused by carbohydrate determinant cross-reactivity.
        J Allergy Clin Immunol. 2013; 132: 639-647
        • Du Toit G.
        • Roberts G.
        • Sayre P.H.
        • Bahnson H.T.
        • Radulovic S.
        • Santos A.F.
        • et al.
        Randomized trial of peanut consumption in infants at risk for peanut allergy.
        N Engl J Med. 2015; 372: 803-813
        • Greer F.R.
        • Sicherer S.H.
        • Burks A.W.
        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: 183-191
        • Muraro A.
        • Halken S.
        • Arshad S.H.
        • Beyer K.
        • Dubois A.E.
        • Du Toit G.
        • et al.
        EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy.
        Allergy. 2014; 69: 590-601
        • de Silva D.
        • Geromi M.
        • Halken S.
        • Host A.
        • Panesar S.S.
        • Muraro A.
        • et al.
        Primary prevention of food allergy in children and adults: systematic review.
        Allergy. 2014; 69: 581-589
        • Fleischer D.M.
        • Spergel J.M.
        • Assa'ad A.H.
        • Pongracic J.A.
        Primary prevention of allergic diseases through nutritional interventions.
        J Allergy Clin Immunol Pract. 2013; 1: 29-36
        • Chan E.S.
        • Cummings C.
        • Canadian Paediatric Society, Community Paediatrics Committee and Allergy Section
        Dietary exposures and allergy prevention in high-risk infants: a joint statement with the Canadian Society of Allergy and Clinical Immunology.
        Paediatr Child Health. 2013; 18: 545-554
        • Agostoni C.
        • Decsi T.
        • Fewtrell M.
        • Goulet O.
        • Kolacek S.
        • Koletzko B.
        • et al.
        Complementary feeding: a commentary by the ESPGHAN committee on nutrition.
        J Pediatr Gastroenterol Nutr. 2008; 46: 99-110
      1. Australasian Society of Clinical Immunology and Allergy (ASCIA). ASCIA infant feeding advice. Available at: http://www.allergy.org.au/images/stories/aer/infobulletins/2010pdf/ASCIA_Infant_Feeding_Advice_2010.pdf. Accessed April 2, 2015.

      Linked Article

      • Correction
        Journal of Allergy and Clinical ImmunologyVol. 136Issue 6
        • Preview
          With regard to the article in the August 2015 issue entitled “Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants” (J Allergy Clin Immunol 2015;136:258-61), the authors report an error on page 260 in Box 2. The first statement in Box 2 should read “Smooth peanut butter (2 teaspoons) mixed with milk or with mashed or pureed fruit.” The authors regret the error.
        • Full-Text
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      • How to apply the LEAP study
        Journal of Allergy and Clinical ImmunologyVol. 137Issue 1
        • Preview
          In the August 2015 issue of Journal of Allergy and Clinical Immunology, Fleischer et al provided a “Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants”1 as interim guidance to clinicians regarding the clinical application of results from the seminal Learning Early About Peanut Allergy (LEAP) study, which demonstrated that early ingestion of peanut protein in infants at high risk to develop peanut allergy dramatically reduces the development of such allergy.
        • Full-Text
        • PDF
      • Look before you LEAP: Risk of anaphylaxis in high-risk infants with early introduction of peanut
        Journal of Allergy and Clinical ImmunologyVol. 136Issue 3
        • Preview
          As a result of the compelling results of the Learning Early About Peanut Allergy (LEAP) study,1 a new consensus communication on early peanut introduction has recently been published.2 This communication states that “healthcare providers should recommend introducing peanut-containing products to high risk infants early in life (between 4 and 11 months of age)” and that “The clinician may perform an observed peanut challenge for those with evidence of a positive peanut skin test to determine if they are clinically reactive, before initiating at-home peanut introduction.” The inference is that initiation of peanut products can be performed safely in a medically unsupervised setting if skin prick test (SPT) responses to peanut are completely negative.
        • Full-Text
        • PDF
      • Early or not delayed complementary feeding?: This is the question
        Journal of Allergy and Clinical ImmunologyVol. 137Issue 1
        • Preview
          Six months after the publication of 2 important articles1,2 about the possible role of the early introduction of foods in preventing the development of allergies in high-risk children, we wanted to express some considerations on how they can be perceived and interpreted by clinicians in clinical practice.
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