NIAID’s updated peanut allergy guideline offers key recommendations for dermatologists

lawrence-eichenfield-head-shot.jpgBy Lawrence Eichenfield, MD

The Academy was one of 26 organizations involved in the development of the National Institute of Allergy and Infectious Diseases’ Addendum Guidelines for the Prevention of Peanut Allergy in the United States. I served as one of the Academy’s representatives on the NIAID guideline coordinating committee.

Based on recent research indicating that the early introduction of peanut-containing foods may prevent the development of peanut allergy, these guidelines provide recommendations for infants at various risk levels.

This is significant for dermatologists because patients with atopic dermatitis are among those with an increased risk for food allergy, and dermatologists should know that infants with severe eczema or egg allergy in the first year of life are the group at highest risk for developing peanut allergy and the group being targeted for early evaluation and feeding to prevent allergy development.

Among the key messages for dermatologists:

  • This update to the 2010 NIAID food allergy guidelines addresses the prevention of peanut allergy and is based on the findings of the LEAP (Learning Early About Peanut Allergy) clinical trial, which suggests that early introduction of peanut-containing foods could reduce the risk of peanut allergy in high-risk infants.
  • This update is significant to dermatologists because atopic dermatitis patients have an increased risk for peanut allergy.
  • The updated guideline provides three recommendations for infants at various risk levels:
    • Severe eczema and/or egg allergy: Consider food allergy testing, and based on test results, introduce peanut-containing foods at four to six months.
    • Mild to moderate eczema: Introduce peanut-containing foods around six months.
    • No eczema or food allergy: Introduce peanut-containing foods at the appropriate age in accordance with family and cultural preferences.
  • The guideline does not recommend allergy testing for foods other than peanut, as this could lead to misinterpretation or over diagnosis of food allergy and unnecessary dietary restrictions.
  • Peanuts themselves pose a risk of aspiration under 5 years of age. The guidelines recommend using smooth peanut butter mixed with milk or pureed fruit, Bamba, an Israeli snack food, peanut soup, or finely ground peanuts mixed into other foods such as yogurt .

Review the Academy’s key messages to learn more about the guidelines, and visit the NIAID website for more information.

Lawrence F. Eichenfield, M.D., is Professor of Dermatology and Pediatrics Chief, and Pediatric and Adolescent Dermatology Vice Chair at the Department of Dermatology University of California, San Diego School of Medicine and Rady Children’s Hospital, San Diego .