Early peanut introduction without routine testing seems safe for all children
The authors noted that there is evidence that recommending early introduction of peanut without prior testing is safe and effective in increasing early peanut introduction to infants, even those at high risk.
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A review of international guidelines indicates that it is generally considered safe to recommend early introduction of peanut without routinely testing for peanut allergy, even in children who are at high risk of peanut allergy.
Australian investigators noted that the initial American Academy of Allergy, Asthma, and Immunology guideline recommended allergy testing before peanut ingestion, particularly for those at high risk of peanut allergy. However, a recent US/Canadian consensus statement removed this recommendation, considering a high rate of false positives, low rates of reported severe reaction on first ingestion of peanut in those younger than 12 months, and limited access to oral food challenges (OFCs) in many countries. Both the UK guidelines and the US/Canadian consensus statement indicate that allergy testing should be done only when provisions for definitive diagnosis via OFCs are available.
The authors noted that there is evidence, primarily from Australia, that recommending early introduction of peanut without prior testing is safe and effective in increasing early peanut introduction (and its health benefits) to infants, even those at high risk. However, an increase in early introduction of peanut has not led to a robust reduction in peanut allergy prevalence. A population-based study in Australia that compared allergy outcomes 10 years apart found that between 2007 and 2011, only 28% of infants were introduced to peanut by 12 months of age. Even though this proportion increased to 89% in 2018 to 2019, peanut allergy prevalence dropped insignificantly, from 3.1% to 2.6%.
Thoughts from Dr Farber
We do need to do a better job of introducing peanuts earlier to children to undo years of teaching parents (without evidence) otherwise. Not having to refer high-risk children, such as those with eczema or a positive family history, to an allergist and/or to do testing ourselves will make this much easier to accomplish.
For more from the August, 2023 issue of Contemporary Pediatrics®, click here.
Reference:
Koplin JJ, McWilliam V, Soriano VX, Peters RL. Early peanut introduction: to test or not to test? Ann Allergy Asthma Immunol.2023;130(5):565-570. doi:10.1016/j.anai.2023.02.004
