The Journal of Allergy and Clinical Immunology (JACI), part of the American Academy of Allergy, Asthma & Immunology (AAAI), has published an interim guide for early peanut introduction and prevention of peanut allergy. The guide is meant to fill in until the official guidelines are updated this summer.
The Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants is in response to recent evidence that early introduction of peanuts is beneficial. The JACI paper references a LEAP study demonstrating successful reductions in peanut allergy development in high-risk infants when peanuts were introduced with complementary foods early. This went against standard assumptions, which were to delay allergen-potential foods. (Read more about that here.)
What does the new guide say?
Aimed at healthcare providers, the guidelines recommend that caution be taken. With new evidence, however, healthcare providers should recommend introduction of peanut-containing products in high-risk infants early in life, between 4 and 11 months of age, in a controlled environment.
This recommendation is stressed for infants with early-onset atopic disease (severe eczema, egg allergy). Further, if this is the case, an allergist should conduct other testing and evaluation to pinpoint potential trouble early.
The recommendation is for an observed, controlled peanut challenge in high-risk infants, but caution is given in that the LEAP trial in question did not vary dosages or otherwise address possible minimum exposures or the “tolerance effect” some may have. The latter is the ability for some small children to “tolerate” without visible reaction some levels of allergen despite having an allergic reaction.
Above all, the JACI publication stresses the need for healthcare provider intervention rather than potentially dangerous parent-conducted interventions.