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

Abstract

BackgroundFood allergy is an important public health problem because it affects children and adults, can be severe and even life-threatening, and may be increasing in prevalence. Beginning in 2008, the National Institute of Allergy and Infectious Diseases, working with other organizations and advocacy groups, led the development of the first clinical guidelines for the diagnosis and management of food allergy. A recent landmark clinical trial and other emerging data suggest that peanut allergy can be prevented through introduction of peanut-containing foods beginning in infancy.ObjectivesPrompted by these findings, along with 25 professional organizations, federal agencies, and patient advocacy groups, the National Institute of Allergy and Infectious Diseases facilitated development of addendum guidelines to specifically address the prevention of peanut allergy.ResultsThe addendum provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider’s office or at home. The addendum guidelines provide the background, rationale, and strength of evidence for each recommendation.ConclusionsGuidelines have been developed for early introduction of peanut-containing foods into the diets of infants at various risk levels for peanut allergy.

The unmet provision of allergy services in Hong Kong impairs capability for allergy prevention – implications for the Asia Pacific region

“…3,[4][5][6]16,17,[47][48][49][50][51][52] However, the logistic difficulties and resource implications for implementing early introduction of peanut (let alone multiple foods) to prevent allergy are enormously challenging even for countries that are well served by allergists. 53 Hong Kong and many countries in the Asia Pacific are simply not equipped in terms of expertise, manpower and facilities to test the new hypotheses comprehensively or to take advantage of these major public health advances in allergy.…”

“…16 Based on such important, groundbreaking results, most international guidelines on infant feeding have already been revised. [4][5][6] The LEAP study prompted world-wide interest in whether early introduction of other foods could also prevent allergy development. Perkin et al studied more than 1,300 infants who were randomly assigned to the introduction of 6 allergenic foods (peanut, cooked egg, cow's milk, sesame, whitefish and wheat) or to the standard UK recommendation of exclusive breast feeding to 6 months.…”

“…The findings suggest that despite some progress, Hong Kong is currently still unlikely to be able to fully deliver the marked changes required to implement international guidelines on preventing allergies. [3][4][5][6] Hong Kong's experience may parallel those of other Asian Pacific countries, many of which face similar challenges.…”

Can Hong Kong take advantage of recent advances in allergy prevention?

“…International guidelines on infant feeding are being revised. [12][13][14] It is a moot point whether Hong Kong has the infrastructure required to exploit these transformative opportunities to improve public health in allergy.…”

Breastfeeding, Childhood Asthma, and Allergic Disease

“…The early introduction of peanut significantly decreased peanut allergy development among high-risk children and modulated immune responses to peanuts. In response to these findings, guidelines have recently changed in relation to peanut allergy in the United States [34] .…”