Tools for Practice Outils pour la pratique

#197 Early Peanuts for Little Peanuts: The not-so-paltry benefits

Does early peanut introduction in infancy influence the development of peanut allergy?

Early peanut introduction reduces the risk of developing peanut allergy in high-risk infants from 17% to 3% at five yearsNormal risk infants may also benefit. Since 9% of high-risk infants were excluded due to a positive baseline skin prick test (SPT), it may be reasonable to investigate those at highest risk prior to exposure. 

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

  • Randomized Controlled Trials: 
    • 640 high-risk infants (severe eczema, egg allergy, or both) aged 4-11 months, randomized to consumption (6 g peanuts/week) or avoidance.1 At five years 
      • Positive oral food challenge to peanuts: 3.2% consumption versus 17.2% avoidance, Number Needed to Treat=8.  
      • Harms: Consumption group underwent baseline food challenge7/319 infants reacted(six required antihistamine, one oral steroids). At five years, one child in avoidance group required epinephrine following oral food challenge. 
      • Limitations: No placebo, infants excluded if SPT >4 mm (9of infants). 
    • Normal-risk, breastfed infants (n=1,303) aged three months randomized to early introduction of six allergens (example 2 g peanuts/week) or avoidance of allergenic foods before six months.2 
      • At 1-3 years of age, no significant difference in positive oral food challenge: 
        •  Peanuts: 1.2% early versus 2.5% avoidance. 
      • LimitationsComplex protocol led to significant difference in adherence (43% early versus 93% avoidance); excluded infants with peanut sensitization (SPT >0 mm). 
  • Observational study: 
    • Newborns (n=2,124) followed to examine food introduction timing and sensitization.3 Peanut avoidance during first year increased risk for: 
      • Peanut sensitization (SPT >2 mm)Odds Ratio 1.76 (1.07-3.01). 
      • LimitationsPotential recall biasconfirmatory oral food challenges not done.
  • Early exposure hypothesis came from the 10x lower risk of peanut allergy among Israeli compared to UK children. Israeli children had greater intake of peanuts during infancy (7.1 g/month versus 0 g/month).4 
  • Large cohort study (10,907 participants) suggested a lower risk of peanut allergy in offspring of non-allergenic mothers who had increased peanut consumption during pregnancy, ≥5 times per weeks versus <1 per month, Odds Ratio 0.31 (0.13-0.75).5 
  • Guidelines recommend not restricting maternal diet or delaying food allergen introduction in high-risk infants.6,7 

Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • Danielle Perry RN
  • Christina Korownyk MD CCFP

1. Du Toit G, Roberts G, Sayre PH, et al. N Engl J Med. 2015; 372(9):803-13.

2. Perkin MR, Logan K, Tseng A, et al. N Engl J Med. 2016; 374(18):1733-43.

3. Tran MM, Lefebvre DL, Dai D, et al. Pediatr Allergy Immunol. 2017; 28(5):471-7.

4. Du Toit G, Zadik-Mnuhin G, Amir T, et al. J Allergy Clin Immunol. 2008; 122(5):984-91.

5. Frazier AL, Camargo CJ, Malspeis S, et al. JAMA Pediatr. 2014; 168(2):156-62.

6. Fleischer D, Sicherer S, Greenhawt M, et al. Pediatr Dermatol. 2016; 33(1):103-6.

7. Chan E, Cummings C. Paediatr Child Health. 2013; 18(10):545-54.

Authors do not have any conflicts of interest to declare.