#50 Timing of Dietary Peanut Introduction and Development of Peanut Allergy among High-Risk Infants: Review of Infants followed at an Academic Pediatric Allergy Center
Mihaela Paina, Section of Allergy and Clinical Immunology; Matthew Levesque, Children’s Hospital Research Institute of Manitoba; Elinor Simons, Section of Allergy and Clinical Immunology
In August 2015, the World Allergy Organization Consensus Communication recommended Allergy assessment before peanut introduction for infants at high risk of peanut allergy, to facilitate their early introduction to peanut. We evaluated if infants referred to Allergy had peanut introduced earlier since the Consensus was published.
We retrospectively evaluated medical records of a cohort of infants born in 2013-2017, followed until 2016-2017 and referred to Pediatric Allergy before age 12 months for any reason. Among infants at high risk for peanut allergy because of egg allergy and/or severe eczema, we compared age of peanut introduction and development of peanut allergy before and after August 2015. Data were analyzed by chi-square and Kruskal-Wallis tests.
Of the 530 infants evaluated, 98 were high-risk, 89 had available information regarding peanut introduction and 68 had introduced peanut, 32 (47%) before and 36 (53%) after Allergy assessment. Infants introduced to peanut before and after Allergy assessment had less eczema (50% versus 75%, p=0.033) and similar egg allergy (72% versus 58%, p=0.24), peanut sensitization (31% versus 47%, p=0.18) and peanut allergy (31% versus 33%, p=0.85) prevalence. Their median ages of peanut introduction were 10.3 and 13.5 months, respectively (p<0.0001); 84% and 39%, respectively (p=0.0001) had peanut introduced before age 12 months. Among infants introduced to peanut after Allergy assessment, the median age of introduction decreased from 19.8 months before to 13.0 months after the Consensus (p=0.058). Development of peanut sensitization (p=0.43) and allergy (p=0.98) were similar irrespective of the timing of peanut introduction relative to Allergy assessment or to Consensus publication.
Since the Consensus, age of peanut introduction has decreased among high-risk infants introduced to peanut after Allergy assessment. The development of peanut allergy in infancy has not changed; the incidence of persistent peanut allergy in this population remains to be determined.