Updated Food Allergy Guidelines to Include Prevention of Peanut Allergy

Peanut allergy is the leading cause of death related to food-induced anaphylaxis in the United States and its incidence is increasing.The NIAID’s 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States did not provide recommendations for the prevention of food allergy, because data were lacking . After that the LEAP trial and other studies have shown that early introduction of peanut can prevent food allergy in high-risk children, and the NIAID updated the guidelines to include prevention of peanut allergy.

The Update provides 3 separate guidelines for infants at various risk levels for the development of peanut allergy and is intended for use by a wide variety of health care providers. Topics addressed include the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and the timing and approaches for introduction of peanut-containing foods in the health care provider's office or at home. Salient Features of Update are :

• Infants with severe eczema or egg allergy should undergo peanut specific IgE (sIgE) measurement, skin prick testing (SPT), or both prior to introduction of peanut at ages 4 to 6 months. Unless other foods are problematic, food panels should be avoided.


• If the sIgE is <0.35 kU _a /L or the SPT wheal diameter is 0–2 mm, the child may try peanut at home after trying a few other solid foods.


• If the sIgE is ≥0.35 kU _a /L, the child should be evaluated by a specialist for possible SPT.


• If the SPT wheal diameter is 3–7 mm, peanut should be administered by a supervised feeding or graded challenge.


• If the SPT wheal diameter is ≥8mm, the child is likely allergic and should strictly avoid peanut and be managed by a specialist.


• Infants with mild-to-moderate eczema should start peanut-containing foods around age 6 months and may do so at home.


• Infants with no eczema or food allergy may start age-appropriate peanut-containing foods when desired.


• If peanut is introduced, the child should regularly consume 6 to 7 g of peanut protein weekly over 3 or more feedings (1 tablespoon of peanut butter has 4 grams of peanut protein).

The “Guidelines for the diagnosis and management of food allergy in the United States” were published in December 2010 by an Expert Panel and a Coordinating Committee convened by the National Institute of Allergy and Infectious Diseases (NIAID). These guidelines did not offer strategies for the prevention of food allergy and particularly peanut allergy because of a lack of definitive studies at the time.Therefore they have been included now to make it more comprehensive.