Food allergies are a growing health concern with a significant increase in reported prevalence. Allergic reactions to food can produce life-threatening anaphylaxis. Peanut allergy in particular is a significant public health problem with no proven treatment nor a cure at the present time.
Peanut allergy often remains a life-long problem for many individuals, as less than 25% of peanut allergic patients are expected to regain tolerance. Current recommendations for management include strict avoidance and a prescription for an auto-injectable form of epinephrine.
The increase in prevalence of peanut allergy occurred during a period of time when there was conflicting guidance regard- ing preventative measures for the development of peanut allergy.
Prior to the year 2000, there were no guidelines regarding the timing for the introduction of peanut-containing products nor were there any purposeful strategies to delay the introduction of peanut-containing products to try to prevent the development of allergic disease. But in 2000, the American Academy of Pediatrics recommended that “solid foods should not be introduced into the diet of high-risk infants until 6 months of age…and peanuts…until years of age.”
This recommendation was reversed in 2008. At that time, AAP recommended that “the introduction of solid foods not be delayed past 4-6 months of age”. However they did not make any updated recommendations regarding the introduction of peanut-containing products.
The Learning Early About Peanut allergy (LEAP) study demonstrated that peanut-containing products can be safely introduced to high-risk infants between the ages of 4 to 11 months and that there is a monumental potential for peanut allergy prevention.
The National Institutes of Allergy and Infectious Diseases (NIAID) recently published an addendum guideline regarding the prevention of peanut allergy in the US based on the findings from the LEAP study. [Togias A et al. Addendum guidelines for the prevention of peanut allergy in the United States. J Allergy CliniImmunol. 2017 Jan;139(1):29-44.]
The NIAID-sponsored guidelines include the following three addendum recommendations: