The new guidelines for the introduction of peanut in both the healthy infants and those at high risk for allergy will become an addendum to NIAID’s 2010 Guidelines for the Diagnosis and Management of Food Allergies. Following is a summary of the draft guidance for high-risk children:
- ‘High risk’ is defined as a baby who has severe eczema and/or egg allergy.
- The expert panel recommends that, to reduce the risk for peanut allergy, a palatable peanut food should be introduced to high-risk babies as early as 4 to 6 months.
- Before peanut introduction, the panel recommends medical evaluation that includes a blood test. If a child’s peanut-specific IgE is less than 0.35 kUA/L, the risk is considered low, and the panel recommends the introduction of peanut, with a first dose of 2 grams of peanut protein. If the parent or physician has concerns, the dose can be given at the doctor’s office or clinic.
- When peanut-specific IgE is greater than 0.35 kUA/L, the panel recommends the child be referred to a specialist for further assessment, and possibly skin-prick testing. If the hive or “wheal” size on skin testing is under 2 millimeters, there is a low likelihood of allergic reaction, and a first dose of 2 grams of peanut protein can be introduced. If the parent or physician has concerns, the dose can be given at the doctor’s office or clinic.
- If the wheal size to peanut skin testing is 3 to 7 mm, the panel suggests either a medically supervised feeding or an oral food challenge. This should be undertaken in either a specialist’s office or specialized facility. If there is no reaction to the feeding or challenge, the panel recommends introducing peanut into the child’s diet. If there is an allergic reaction, peanut is should be strictly avoided and the family should receive counseling regarding food allergy management.
- If the wheal size to peanut skin testing is above 8 mm, the likelihood of the baby already having peanut allergy is high. Peanut should be strictly avoided and the family should receive counseling regarding food allergy management.
- For those children who are successfully having peanut introduced into their diet, the panel provides physicians with instructions on quantity to regularly consume.
Public comments on the draft guidelines are now being accepted on the NIAID website until April 18, 2016.