Implementation of the new NIAID Peanut Allergy Guidelines: Outcomes and Experience

RATIONALE: The “Learning Early About Peanut” (LEAP) study changed clinical allergy practice by demonstrating that early consumption of peanut-containing food by infants who are at high-risk for developing peanut allergy greatly reduces the subsequent development of clinical allergy. In January 2017, the NIAID published the Addendum Guidelines for the Diagnosis and Management of Food Allergy in the United States, which provides specific, risk-stratified recommendations for the introduction of peanut into infants’ diets. However, little literature has been published regarding implementation of these guidelines in everyday clinical practice.

METHODS: Oral food challenges (OFCs) to peanut offered to patients based on criteria defined by the NIAID guidelines (age under 12 months, history of severe eczema and/or history of egg allergy) were retrospectively analyzed via chart review to determine challenge outcome (pass or fail). Predictive variables of outcome including skin prick test wheal size, food-specific IgE, other comorbid atopic conditions, and general demographic characteristics were also obtained.

RESULTS: Twenty patients and 22 OFCs were identified. Four out of 22 OFCs failed, including one patient that developed anaphylaxis requiring IM epinephrine. Two patients who failed their initial challenge passed subsequent challenges. Three patients passed their OFC but had not introduced peanut into the diet at follow-up.

CONCLUSIONS: Even among a small cohort of patients, the complexities of adhering to the new guidelines are evident. While the guidelines certainly provide improved clarity and standardization, active collaboration and gained experience in everyday clinical settings will be critical in helping practicing allergists navigate these complex clinical situations.