Food Allergy Guidelines Updated to Include Advice on Preventing Peanut Allergy

By Joe Elia

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Comprehensive advice on preventing peanut allergy has been added to the 2010 guidelines issued by the National Institute of Allergy and Infectious Diseases (NIAID). The addenda appear in the Journal of Allergy and Clinical Immunology and elsewhere.

The recommendations include the following:

• Infants with severe eczema, egg allergy, or both should have peanut-containing foods introduced as early as 4 to 6 months, following allergy testing.

• For infants with only mild-to-moderate eczema, peanut introduction should occur at around 6 months.

• Infants without eczema or any food allergy should eat solid foods containing peanuts "in accordance with family preferences and cultural practices."

The addenda include extensive tables detailing how to introduce peanut-containing foods as well as a figure showing how to risk-stratify patients based on peanut-specific IgE levels and skin prick test results.

The NIAID convened its expert panel to write the guidelines after publication of the LEAP study, which found that cautious introduction of peanuts into the diets of infants at risk reduced the prevalence of allergy by over 70%, relative to peanut avoidance.