Timing of Dietary Peanut Introduction and Incidence of Peanut Allergy among High-Risk Infants: Review of Infants followed at an Academic Pediatric Allergy Center
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Mihaela Paina, MD MS FRCPC, Matthew Levesque, BSc, Elinor Simons, MD PhD MS FAAAAI FAAP

RATIONALE: In August 2015, the WAO Allergy Consensus Communication recommended Allergy assessment before peanut introduction for infants at high risk of peanut allergy, to facilitate early introduction to peanut. We evaluated if infants referred to Allergy had peanut introduced earlier since the Consensus was published.

METHODS: We screened all infants born in 2013-2017, followed until 2016-2017 and referred to Pediatric Allergy before age 12 months. Among infants at high risk for peanut allergy because of egg allergy and/or severe atopic dermatitis, we compared age of peanut introduction and incidence of peanut allergy before and after August 2015. Data were analyzed by chi-square and Kruskal-Wallis tests.

RESULTS: Of 530 infants, 98 were high-risk, 89 had available information regarding peanut introduction and 68 had introduced peanut, 32 (47%) before and 36 (53%) after Allergy assessment. Infants introduced before assessment had more egg allergy (p=0.24) and less eczema (p=0.033). For infants introduced to peanut before and after Allergy assessment, median ages of introduction were 10.3 and 13.5 months, respectively (p<0.0001); 84% and 39% (p=0.0001) had peanut introduced before age 12 months. Among infants introduced to peanut after Allergy assessment, the median age of introduction decreased from 19.8 months before to 13.0 months after the Consensus (p=0.058). Peanut sensitization (p=0.43) and allergy (p=0.98) were similar irrespective of introduction timing.

CONCLUSIONS: Since the Consensus, peanut introduction has occurred earlier among high-risk infants introduced to peanut after Allergy assessment. Incidence of peanut allergy during infancy has not changed post Consensus; the incidence of persistent peanut allergy remains to be determined.