Peanut Allergy Prevention: Guidelines from the NIAID
Am Fam Physician. 2017 Jul 15;96(2):130.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Food containing peanuts should be introduced into the diet of infants four to six months of age who have severe eczema and/or egg allergy.
• Peanut-specific immunoglobulin E should be measured or a skin prick test performed before introducing peanuts in high-risk groups.
• If an infant has mild to moderate eczema, foods with peanuts can be given at approximately six months of age.
From the AFP Editors
Allergy to peanuts presents early and remains throughout life for most patients. It is the leading cause of death in the United States associated with anaphylaxis caused by food.
Because of a lack of evidence, the first guideline on food allergies published in 2010 by the National Institute of Allergy and Infectious Diseases (NIAID) did not provide recommendations on preventing peanut allergy. However, data have emerged indicating that peanut allergy can be prevented by introducing foods containing peanuts early to infants. For this reason, the NIAID has provided addendum guidelines, which include recommendations based on this new evidence.
Food containing peanuts should be introduced into the diet of infants four to six months of age who have severe eczema, egg allergy, or both. Before doing so, peanut-specific immunoglobulin E (IgE) should be measured or a skin prick test performed. When diagnosing an allergy via peanut-specific IgE, it should be noted that there is a strong negative predictive value for a level less than .035 kUA per L, making this test beneficial over skin prick testing in certain situations (e.g., family medicine and pediatric offices) to avoid unneeded subspecialist referral or to shorten the delay in introducing peanuts into the patient's diet. In infants whose IgE level is less than .035 kUA per L, the risk of experiencing a reaction is low; therefore, peanuts can be introduced at home or an office setting, depending on the preferences of the patient's parents or health care professional. Patients with
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This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
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