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Increased Rates of Peanut and Tree Nut Aspiration as a Possible Consequence of Allergy Prevention by Early

James Leung1, John Ainsworth2, Rachel Peters3

  • 1Paediatric Otolaryngology Head and Neck Surgery Unit, The Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.

The Journal of Allergy and Clinical Immunology. in Practice
|April 16, 2021
PubMed

Insights

Following the Learning Early About Peanut allergy (LEAP) trial, pediatric airway foreign body (FB) ingestions, particularly of peanuts and tree nuts (PN/TNs), significantly increased. This highlights the need for safe food introduction guidelines for infants.

Area of Science:

  • Pediatric Pulmonology
  • Allergy and Immunology
  • Pediatric Surgery

Background:

  • Pediatric airway foreign bodies (FBs) present a surgical emergency, with peanuts and tree nuts (PN/TNs) posing a significant aspiration risk.
  • The 2015 Learning Early About Peanut allergy (LEAP) trial recommended early introduction of allergenic foods to infants, altering feeding guidelines.
  • The impact of these revised guidelines on PN/TN inhalation incidence was previously unstudied.

Purpose of the Study:

  • To determine the incidence of peanut and tree nut (PN/TN) inhalation presentations at a quaternary pediatric hospital.
  • To analyze trends in airway foreign body (FB) inhalation between 2008 and 2018.

Main Methods:

  • A retrospective cohort study was conducted.
  • Children diagnosed with airway FBs via rigid bronchoscopy were included.
  • Data spanned from 2008 to 2018.

Main Results:

  • A total of 200 airway FB cases were identified: 35% PN/TN, 34% other foods, 31% inorganic material.
  • Overall FB inhalation incidence rose significantly (IRR, 1.09; P < .001), driven by PN/TN (IRR, 1.16; P < .002) and other food (IRR, 1.12; P = .01) aspirations.
  • Post-LEAP (2015-2018) compared to pre-LEAP (2008-2014) periods showed a threefold increase in PN/TN inhalation and a twofold increase in other food inhalation.

Conclusions:

  • The LEAP study's publication correlates with increased PN/TN and other hard solid food aspirations.
  • Urgent public engagement is needed to promote safe introduction of hard foods to young children.
  • Revised feeding guidelines may inadvertently increase the risk of pediatric airway foreign body ingestion.
Abstract

Keywords:
AirwayAspirationForeign bodyInhalationLEAPNutPeanutPediatricsTree nut

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