Guidelines to help parents introduce peanut-containing products to infants to prevent peanut allergies aren’t being discussed. New research presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting shows pediatricians are not only not having the discussion, they’re not referring high-risk babies for testing prior to peanut introduction.
“Our study revealed that although pediatricians have been introduced to the new guidelines, they’re not yet putting them into practice,” says allergist Bryce Hoffman, MD, ACAAI member and lead author. “We sent surveys to 188 pediatricians, and received 79 back. Of those, 38 percent had a score of 1 or less (4 equals highest, 0 equals lowest) when it came to following the guidelines. In addition, 44 percent reported not referring high-risk children, those with egg allergy and/or severe eczema, for peanut allergy testing.”
If a child is determined to be high risk, the guidelines recommend evaluation by an allergy specialist, which may involve peanut allergy testing, followed by trying a peanut containing product for the first time in the allergist’s office. If the child is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, that positive test alone does not determine if they’re truly allergic. Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods.
“We recognize the idea of introducing peanut-containing foods to infants between 4-6 months is scary — especially for parents,” says allergist David Stukus, MD, ACAAI member. Dr. Stukus is presenting on the topic of “Convincing Wary Caregivers, Colleagues and Staff of Why Early Introduction Works” at the ACAAI Annual Scientific Meeting. “We need to work with pediatricians — the first physicians who care for most babies — to help them become comfortable putting the guidelines into practice. We need to overcome the current barriers so all physicians who deal with infants understand that early introduction could lead to a new generation of children who have far less peanut allergy.”
Moderate risk children — those with mild to moderate eczema who have already started solid foods — do not need an evaluation. These infants can have peanut-containing foods introduced at home by their parents starting around 4-6 months of age. Low risk children with no eczema or egg allergy can be introduced to peanut-containing foods according to the family’s preference, also around 4-6 months.