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 In a survey of pediatricians, family doctors and allergy
specialists, the majority of pediatricians and family doctors
recommended introducing allergenic foods between 6 months and 1 year
of age. Most allergists correctly said milk, egg and puréed peanuts
or peanut powder should be introduced between the ages of 4 and 6
months.
Emerging evidence that early peanut ingestion can help prevent
peanut allergy in high-risk children has resulted in changing
guidelines, said lead study author Dr. Elissa Abrams, a pediatric
allergist at the University of Manitoba in Winnipeg.
"We felt it was important to identify what knowledge gaps existed,
if any, among both primary care physicians and allergists with
respect to guidelines about allergy prevention in infancy," Abrams
said in an email.
The researchers sent a survey to members of the Canadian Pediatric
Society, the Canadian Society of Allergy and Clinical Immunology and
a wide sample of Canadian family physicians. The survey asked about
the doctor's approach to managing infants at high risk for food
allergies.
Eighty allergists, 170 pediatricians and 206 family practice
physicians responded.
"Some primary care physicians are still recommending delaying
introduction of allergenic solids, which was an interesting finding
as the guidelines support earlier introduction of these foods to
prevent food allergy, especially in children with a family history
of allergies," Abrams said.
Infants with known egg allergy or severe eczema are also considered
to be at high risk of other food allergies, the study team writes in
The Journal of Allergy and Clinical Immunology: In Practice. After
being evaluated by a physician, these kids should be introduced to
peanut between 4 and 6 months of age.
In the survey, allergists were almost 10 times more likely than
pediatricians and family practitioners to recommend allergy testing
before introducing peanuts to infants with severe eczema. Only 17
percent of allergists, 8 percent of pediatricians and 10 percent of
family practitioners routinely recommended peanut allergy testing in
infants with egg allergies, however.
Almost all allergists considered infants with severe eczema or egg
allergy as being high risk. Most family practitioners and
pediatricians defined high risk as having siblings or parents with
peanut allergy.
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"American Academy of Pediatrics and the Canadian Pediatric Society
guidelines have defined an infant at risk of food allergy as having
one or more immediate family members with an allergic condition such
as food allergy, allergic rhinitis (hayfever), asthma, or eczema,"
Abrams said.
The National Institute of Allergy and Infectious Diseases addendum
guideline on peanut allergy prevention more recently defined an
infant at risk of peanut allergy specifically as having either
severe eczema and/or egg allergy. It's likely that risk is a
gradient, and perhaps some infants - such as those with severe
eczema - are at higher risk than others, Abrams noted.
The researchers also found that allergists tended to recommend at
least three feedings of peanuts each week, while the other
practitioners didn't offer any advice on how often peanuts should be
fed after they're introduced.
"I think this was a much-needed study to give an idea of how the
guidelines are being implemented clinically," said Dr. Rita Kachru,
an allergist at the David Geffen School of Medicine at the
University of California, Los Angeles who wasn't involved in the
study.
The results underline the need for better dissemination of data to
all groups, she said.
"The recommendations in the U.S. are that infants at the highest
risk for development of food allergy (severe eczema and/or egg
allergy) be introduced to peanut as early as 4-6 months after
allergy testing either by serology (specific IgE) or skin testing,"
Kachru said in an email.
"If the testing is negative, introduction of food is implemented; if
the testing is done by pediatrician/FP and is positive, the
recommendation is a referral to an allergist for possible further
testing/oral challenge."
SOURCE: https://bit.ly/2BKGRhU The Journal of Allergy and Clinical
Immunology: In Practice, online August 13, 2018.
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