Implementation of Guidelines for Early Peanut Introduction at a Pediatric Academic Center
Sunday, March 4, 2018: 3:00 PM
S320CD (Convention Center)
David R. Stukus, MD FAAAAI, ,
RATIONALE: In early 2017, new guidelines recommended introducing peanut to infants before 12 months of age, with provision for allergy evaluation for high-risk infants prior to feeding. Feasibility of guideline implementation remains unknown.

METHODS: The electronic medical record was reviewed for patients </=12 months old with eczema and/or egg allergy who had a peanut skin test (SPT) performed between January 1 and July 31, 2017 during outpatient allergy evaluation at an academic pediatric referral center.

RESULTS: Among 123 infants meeting criteria, 57.7% were male, 50.4% were Caucasian, and mean age was 6+/-0.19 months (range 4-12). Ninety-six percent had moderate-to-severe eczema and 43.1% had >/=1 food allergy, most commonly egg (34.1%). Seventy percent (N=86) of SPT were 0-2 mm, 21.1% were 3-7 mm, and 8.9% were >/=8 mm. At home introduction was recommended for 66.7% (N=82) of infants, all of which had 0-2 mm SPT. No infants with SPT>/=8 mm were offered challenges. Twenty percent (N=24) were advised to have in-office challenge and 3 occurred at time of initial evaluation. Among deferred challenges, only 57.4% (12/21) returned (mean 4.16+/-1.9 weeks later). There were 11 reactions, 81.8% occurring in the 3-7 mm group. Only one patient had anaphylaxis (SPT=5 mm); other reactions were mild and treated with antihistamines.

CONCLUSIONS: Negative SPT are expected for most infants prior to peanut introduction. For higher risk infants, there may be benefit to conducting challenges at the time of evaluation to prevent loss to follow-up. When guidelines are followed, supervised peanut introduction is safe, with low risk for anaphylaxis.