Evolution of Guidelines on Peanut Allergy and Peanut Introduction in Infants

Abstract

ood allergies constitute a major public health concern, and the prevalence of food allergies over the past decade has doubled. [1][2][3][4] Foods that most commonly cause allergic reactions include milk, eggs, peanuts, tree nuts, shellfish, fish, wheat, and soy. [2][3][4][5][6][7][8][9] Peanuts account for the most food-induced anaphylaxis and fatal reactions. 4,10,11 Furthermore, the reported prevalence of peanut allergy has nearly tripled in the last 10 years. 2,4,6,9 Peanut allergy occurs early in life, and based on published reports, 18.3% to 21.5% of children may outgrow their peanut allergy. 12,13 Thus, the persistence of peanut allergy is a concerning issue.Since the 1990s, studies have provided evidence that led to guidelines on the timing of peanut introduction. In 1999 and 2000, guidelines from the European Society for Pediatric Allergology and Clinical Immunology, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), 14 and the American Academy of Pediatrics (AAP) Committee on Nutrition 15 suggested delaying the introduction of peanut. However, because of the increasing prevalence of peanut allergy, more studies, including the more recent Learning Early About Peanut Allergy (LEAP) 16 study and the Effect of Avoidance on Peanut Allergy After Early Peanut Consumption (LEAP-On) 17 study, report convincing evidence suggesting that early peanut introduction can help reduce the incidence of peanut allergy (Table ). These studies highlight the potential of an early peanut introduction to prevent peanut allergy and provide evidence to support recent recommendations on the timing of peanut introduction.This review discusses the earlier guidelines, highlights challenges to those guidelines, and reviews the new recommendations on early peanut introduction.

Peanut (Arachis hypogaea L.): A Prospective Legume Crop to Offer Multiple Health Benefits Under Changing Climate

“…In this context, modified U.S. guidelines for the prevention of peanut allergy 2017 have been published (Foong, Brough, Chan, & Fox, ) which suggest peanut early exposure to children can reduce these allergies. New evidence suggests early incorporation of peanut into the diet of infants instead of avoiding it (Suggested readings Allen, ; Anvari, Chokshi, Kamili, & Davis, ; Chen, Welch, & Laubach, ; Du Toit et al., ; Sicherer, Sampson, Eichenfield, & Rotrosenet, ). Above all, peanut allergies prevention guidelines have been published (Volerman & Cifu, ), and several ways to prevent/manage peanut allergies have also been proposed (see review articles by Allen, ; Chen et al., ).…”

Advances in food allergy in 2017

“…In 2017, expert societies began releasing updated infant feeding guidelines in response to these data. 41 In the United States, the NIAID-sponsored guidelines were based on the specific inclusion criteria and screening schema of the LEAP study, recommending introduction of peanut-containing foods as early as 4 to 6 months for infants with severe eczema or egg allergy and at about 6 months for infants with milder eczema, and further recommending screening for the highest-risk infants before introduction ( Fig 5). 42 Other countries have taken a different approach.…”

Childhood food allergies

“…Before proceeding to the hypothesis and the evidence that bears on, it will be useful to have in mind the foods that cause most allergic reactions, and to discuss underlying variables that help determine which make the short list. In the USA, eight foods are responsible for ∼90% of childhood food allergies: peanuts, tree nuts, cow’s milk, chicken eggs, wheat, soy, fish and shellfish [ 2 ]. Other developed countries have similar lists.…”

“…In 2000, the American Academy of Pediatrics and similar organizations in Europe recommended strict avoidance of peanuts while pregnant; avoidance of peanuts, tree nuts and fish while breastfeeding and for infants themselves avoidance of all major allergenic foods prior to reaching 1 year of age, with two caveats: no eggs until age two, and no peanuts, tree nuts or fish until 3 years old [ 2 ].…”

“…Childhood food allergies are a rapidly growing public health problem. Their prevalence in the USA increased by 50% between 1997 and 2011, and peanut allergies, which can be particularly severe and persistent, more than tripled between 1997 and 2017 [ 1 , 2 ]. Other developed countries have experienced similar upward trends, and as less developed countries expand their economies they also are beginning to see increases [ 3 , 4 ].…”