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Successful Introduction of Peanut in Sensitized Infants With Reported Reactions at Home
Dirk H J Verhoeven1, Olga Benjamin-van Aalst2, Ted Klok3
1Department of Pediatrics, Reinier de Graaf Hospital, Delft, the Netherlands; Section of Allergology and Clinical Immunology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
The Journal of Allergy and Clinical Immunology. in Practice
|September 5, 2024
Summary
Most infants with reported home reactions to peanut after early introduction can safely consume peanut. Oral food challenges in infants under 12 months prevent misdiagnosis and promote tolerance.
Area of Science:
- Allergy and Immunology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Early peanut introduction is effective in preventing peanut allergy.
- Optimal diagnostic strategies for infants with suspected reactions post-introduction are unclear.
Purpose of the Study:
- To evaluate the optimal diagnostic pathway for infants experiencing reactions to peanut at home after early introduction.
- To assess the safety and efficacy of oral food challenges (OFCs) in this population.
Main Methods:
- The PeanutNL cohort study enrolled high-risk infants for early peanut introduction.
- A subgroup of 186 infants with home reactions underwent skin prick tests and OFCs at a median age of 8 months.
- Infants with negative OFCs had peanut reintroduced at home.
Main Results:
- 69% of infants showed sensitization on skin prick tests; 80% had >4 mm wheals.
- 120 out of 163 infants (73.6%) with mild-to-moderate home reactions had negative OFCs.
- After negative OFCs, 96% of infants safely consumed peanut long-term, with 81% eating 3.0g portions.
Conclusions:
- 65% of infants with reported home reactions to peanut exhibit negative OFCs.
- Safe reintroduction and continued consumption of peanut are possible for most infants with negative OFCs.
- Challenging infants under 12 months prevents peanut allergy misdiagnosis and facilitates tolerance induction.
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