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

Fleischer, David M.; Sicherer, Scott H.; Greenhawt, Matthew; Campbell, Dianne E.; Chan, Edmond S.; Muraro, Antonella; Halken, Susanne; Katz, Yitzhak; Ebisawa, Motohiro; Eichenfield, Lawrence F.; Sampson, Hugh A.; Lack, Gideon; Toit, George Du; Roberts, Graham; Bahnson, Henry T.; Feeney, Mary; Hourihane, Jonathan; Spergel, Jonathan M.; Young, Michael C.; As'aad, Amal; Allen, Katrina J.; Prescott, Susan L.; Kapur, Sandeep; Saito, Hirohisa; Agache, Ioana; Akdiş, Cezmi A.; Arshad, Hasan; Beyer, Kirsten; Dubois, Anthony; Eigenmann, Philippe; Fernández-Rivas, M; Grimshaw, Kate; Hoffman-Sommergruber, Karin; Høst, Arne; Lau, Susanne; O’Mahony, Liam; Mills, Clare; Papadopoulos, N; Venter, Carina; Agmon‐Levin, Nancy; Kessel, Aaron; Antaya, Richard J.; Drolet, Beth A.; Rosenwasser, Lanny J.

doi:10.1016/j.jaci.2015.06.001

Cited by 169 publications

(76 citation statements)

References 15 publications

(21 reference statements)

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“…These findings are reassuring in the context of new consensus communications to feed peanut early to high-risk, atopic infants. (6-8) Interestingly, we found that despite peanut consumers making different food choices to peanut avoiders, both achieved nutritional priorities of energy and protein homeostasis. This occurs through a trade-off between carbohydrate and fat contributions to energy intake.…”

Section: Discussionmentioning

confidence: 85%

“…However, clinicians should still emphasize that whole peanuts and chunks of peanut butter are a choking hazard in young children and should not be consumed before 5 years of age. (6-8,13)…”

Section: Discussionmentioning

confidence: 99%

“…(6-8) This advice may in time be extended to encompass all children regardless of their risk of peanut allergy. Whilst regular consumption of peanut from an early age appears to be an effective strategy for the prevention of peanut allergy in high-risk infants as well as in infants recruited from a general population, there could be unexpected consequences for growth and nutrition.…”

Section: Introductionmentioning

confidence: 99%

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Impact of peanut consumption in the LEAP Study: Feasibility, growth, and nutrition

Feeney

Toit

Roberts

et al. 2016

Journal of Allergy and Clinical Immunology

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BACKGROUND Early introduction of peanut is an effective strategy to prevent peanut allergy in high-risk infants; however, feasibility and effects on growth and nutritional intake are unknown. OBJECTIVE To evaluate the feasibility of introducing peanut in infancy and explore effects on growth and nutritional intake up to 60 months of age. METHODS In the Learning Early About Peanut Allergy (LEAP) trial, 640 atopic infants aged 4-11 months were randomly assigned to consume (6g peanut protein/week) or avoid peanut until 60 months of age. Peanut consumption and early feeding practices were assessed by questionnaire. Dietary intake was evaluated with prospective food diaries. Anthropometric measurements were taken at all study visits. RESULTS Peanut was successfully introduced and consumed until 60 months with median peanut protein intake of 7.5g/week (IQR 6.0-9.0) in the consumption group compared to 0g in the avoidance group. Introduction of peanut in breastfeeding infants did not affect the duration of breastfeeding. There were no differences in anthropometric measurements or energy intakes between groups at any visits. Regular peanut consumption led to differences in dietary intakes. Consumers had higher intakes of fat and avoiders had higher carbohydrate intakes; differences were greatest at the upper quartiles of peanut consumption. Protein intakes remained consistent between groups. CONCLUSIONS Introduction of peanut proved feasible in infants at high-risk of peanut allergy and did not affect the duration of breastfeeding nor impact negatively on growth or nutrition. Energy balance was achieved in both groups through variations in intakes from fat and carbohydrate while protein homeostasis was maintained.

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Section: Discussionmentioning

confidence: 85%

“…However, clinicians should still emphasize that whole peanuts and chunks of peanut butter are a choking hazard in young children and should not be consumed before 5 years of age. (6-8,13)…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of peanut consumption in the LEAP Study: Feasibility, growth, and nutrition

Feeney

Toit

Roberts

et al. 2016

Journal of Allergy and Clinical Immunology

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“…The significant protective effect against rhinitis was seen only in the validation cohort and is difficult to interpret, as this cohort’s rhinitis definition does not differentiate between atopic and non-atopic symptoms. With the publication of the LEAP study(46) and the Consensus statement on peanut introduction(47) changes in the timing of introduction of solid foods is recommended, particularly the introduction of solid foods and peanuts before 6 months of age. This paper is reassuring in the fact that 6 months exclusive breasting does not seem to be important for allergy prevention.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease

Bion

Lockett

Soto‐Ramírez

et al. 2016

Allergy

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Background WHO guidelines advocate breastfeeding for six months, and EAACI recommends exclusive breastfeeding for 4–6 months. However, evidence for breastfeeding to prevent asthma and allergic disease is conflicting. We examined whether following recommended breastfeeding guidelines alters the long-term risks of asthma, eczema, rhinitis, or atopy. Methods The effect of non-exclusive (0, >0–6, >6 months), and exclusive breastfeeding (0, >0–4, >4 months) on repeated measures of asthma (10, 18 years), eczema, rhinitis, and atopy (1-or-2, 4, 10, 18 years) risks were estimated in the IoW cohort (n=1456) using log-linear models with generalised estimating equations. The Food Allergy and Intolerance Research (FAIR) cohort (n=988), also from the IoW, was examined to replicate results. Results Breastfeeding (any or exclusive) had no effect on asthma and allergic disease in the IoW cohort. In the FAIR cohort, any breastfeeding for >0–6 months protected against asthma at 10 years (RR=0.50, 95%CI=0.32–0.79, p=0.003) but not other outcomes, while exclusive breastfeeding for >4 months protected against repeated rhinitis (RR=0.36, 95%CI=0.18–0.71, p=0.003). Longer breastfeeding was protective against late-onset wheeze in the IoW cohort. Conclusion The protective effects of non-exclusive and exclusive breastfeeding against long-term allergic outcomes were inconsistent between these co-located cohorts, agreeing with previous observations of heterogeneous effects. Although breastfeeding should be recommended for other health benefits, following breastfeeding guidelines did not appear to afford consistent protection against long-term asthma, eczema, rhinitis or atopy. Further research is needed into the long-term effects of breastfeeding on allergic disease.

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“…They found that peanut consumption was effective in reducing the prevalence of peanut allergy both in children who were not sensitized to peanuts (primary prevention) and in those who were sensitized (secondary prevention) in comparison with controls. Consequently, a consensus communication [4] recommended early introduction of peanut to prevent peanut allergy in children at risk. However, the term early seems to be inappropriate and it may be misinterpreted, since findings by Du Toit et al [1] do not imply that current weaning plan should be modified [5].…”

Section: Reviewmentioning

confidence: 99%

Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology

et al. 2016

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This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves’ disease and Hashimoto’s thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease.

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

Cited by 169 publications

References 15 publications

Impact of peanut consumption in the LEAP Study: Feasibility, growth, and nutrition

Impact of peanut consumption in the LEAP Study: Feasibility, growth, and nutrition

Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease

Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology

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