Caregiver Peanut Feeding Practices Following Oral Food Challenges to Peanut in Infants
Monday, March 5, 2018
South Hall A2 (Convention Center)
Sharon L. Hwang, MD, Trong V. Le, MD
RATIONALE: Recent NIAID guidelines promote early peanut introduction to prevent allergy in at-risk infants. We aim to assess the safety of oral food challenges (OFC) and subsequent caregiver-infant peanut feeding practices.

METHODS: A retrospective chart review was conducted of infants ≤12 months of age who completed a peanut OFC from 2016-2017. For passed challenges, caregivers were instructed to continue feedings with at least 2g of peanut protein, at least three times a week. Follow-up surveys regarding caregiver-infant peanut feeding practices were assessed. Study was IRB exempt approved.

RESULTS: Twenty-one patients were identified. Median age was 10 months (range 5-12 months). 86% had eczema and 9% had a peanut-allergic sibling. 71% had positive skin testing to peanut and 82% to egg white with mean wheal sizes of 3.2mm (95% CI [2.2, 4.2]) and 6.9mm (95% CI [3.6-10.3]), respectively. Of 6 failed OFCs, 3 required IM epinephrine and 1 required fluid resuscitation. The caregivers of all 15 infants who passed their OFC continued offering peanut at home. 57% consumed ≥2g and 29% consumed <2g of peanut protein three times a week; 14% consumed 2g every two weeks. The average period of infant home peanut consumption was 5 months (range 0.5-12.5 months) with no adverse symptoms reported.

CONCLUSIONS: Higher than expected rates of failed OFC with varying severity were noted. While infants continued home peanut consumption without reaction, variable peanut feeding practices among caregivers were observed. Long-term follow-up is required to evaluate clinical outcomes.