New Guidelines for Early Peanut Introduction to Prevent a Peanut Allergy

Freedom Allergy, New Infant Peanut Guidelines, Pediatric Allergist, Peachtree City, Marietta, Georgia

 

On Thursday, January 5, 2017, the National Institute of Allergy and Infections Diseases released formal and detailed guidelines about the early introduction of peanuts to infants in order to proactively prevent the development of a peanut allergy.  This announcement is a complete reversal from past advice of peanut avoidance for high risk infants until 3 years old.  The American Academy of Pediatrics endorses these guidelines and encourages parents to begin feeding their infants peanuts early.

The new guidelines is a result of the Learning Early About Peanut Allergy (LEAP) study that was published in 2015 in the New England Journal of Medicine.  The study divided over 600 high-risk children between the ages of 4 and 11 months old into two groups, and followed them until age 5.  The participants had to have severe eczema, an egg allergy, or both, with a negative or positive peanut skin prick test less than 4 mm in diameter.  The first group avoided peanuts.  The second group consumed peanut-containing snacks at least three times a week.  Of the children who avoided peanut, 17% developed the allergy by age 5.  Of the children who consumed peanut, only 3% developed a peanut allergy.  The result was definitive and confirms that early introduction of peanut to an infant is highly effective in preventing a peanut allergy from developing.

The new released guidelines are categorized into three groups:

  • High Risk:  infants with severe eczema, egg allergy, or both
  • Guidance:  introduce peanut as early as 4-6 months
  • How/Where:  allergy testing with an allergist is strongly advised, with peanut introduction under physician supervision (see chart below)

 

  • Moderate Risk:  infants with mild to moderate eczema
  • Guidance:  introduce peanut around 6 months
  • How/Where:  peanut introduction can be at home, although testing and physician-supervised feeding may be conducted at the request of the parent

 

  • Low Risk:  no eczema, no food allergies, and no family history of allergies
  • Guidance:  introduce peanut at any time
  • How/Where:  peanut introduction at home

The NIH guidelines also advise parents to feed their infant peanuts for the first time only when he/she is healthy, and to ensure observation of the infant for at least two hours after peanut consumption to watch for signs of a reaction.  Signs of an allergic reaction may include:  hives, vomiting, coughing, wheezing, swelling (face, lip, or tongue), change in skin color, or lethargy.  In addition, recipe options are provided for the safe feeding of peanuts to infants, such as mixing peanut butter with warm water to thin it out, mixing peanut powder into baby food, or using Bamba peanut puff snacks.  It is also recommended to feed peanut-containing food at least three times a week.

Parents who have an high-risk infant (having either eczema, an egg allergy, or both) should contact an allergist before introducing peanut at home.  A parent who is concerned or nervous about introducing peanut to their infant may also contact an allergist for supervised feeding in the office.  A skin prick test or blood test may be conducted to assess the risk of peanut introduction to the child (see chart below).  Based on the results, an in-office introduction may be performed at the office under the supervision of the doctor, or it may be advised that the infant is allergic and should not be fed peanut.

 

SPT = skin prick test OFC = oral food challenge

SPT = skin prick test
OFC = oral food challenge

http://www.annallergy.org/article/S1081-1206(16)31164-4/fulltext#appsec5

Addendum Guideline 1, Figure 1.

 

 

 

References:

Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel

http://www.annallergy.org/article/S1081-1206(16)31164-4/fulltext#appsec5

Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy (LEAP study)

http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=article

LEAP website

http://www.leapstudy.com/leap-study-results#.WHHBBLGZNWc

New guidelines detail use of ‘infant-safe’ peanut to prevent allergy

http://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

 

Blood Tests – False Positive?

Freedom Allergy, Allergy Doctor, Atlanta, Georgia

False Positive Food Allergies

While many medical offices use blood tests to evaluate allergies, board certified allergists rely on skin prick testing, which offers a more appropriate reflection of true allergies. Blood tests frequently show “false positive” results, and provide evidence of an allergy that is not accurate. Many times, families come to our office with blood results from another doctor’s office showing a food allergy, when they have never actually had an allergic reaction to that food. If you have a question of blood results, it would be best to discuss the findings with an allergist, to make sure you move forward with the best plan for your allergies. After all, why eliminate a food from your diet, when you are not actually allergic to that food?

Read more, from the American College of Allergy, Asthma and ImmunologyContinue reading

Allergist Versus Ear, Nose, and Throat Doctor

Allergy Doctor, Peachtree City, Atlanta, Georgia

Freedom Allergy, Ruchir Agrawal, Peachtree City, Fayetteville, Georgia

Why Choose an Allergist for your Allergy and Asthma?

Allergies and asthma are both chronic conditions, and warrant visiting a specialist for the best management. However, with so many specialists out there, how do you know which one to choose?  Read the FAQ below.

My allergies bother my ears, nose and throat – doesn’t this mean I should see an ear, nose and throat doctor?

Many times, patients go directly to an ear, nose and throat (ENT) doctor for their allergy symptoms. After all, don’t allergies bother your ears, nose and throat?

Ear, Nose and Throat doctors are surgeons who specialize mainly in structural problems that can be corrected with surgery. But many of these problems, such as difficulty breathing through the nose, or having a raspy voice or having trouble hearing, are actually due to allergies.  Allergies, eczema, and asthma are all chronic conditions that fall under the same umbrella of allergy medicine, and more than 50% of sinus problems are caused by allergies.  The other 50% are often caused by a combination of both allergy and non-allergy related problems. Continue reading

Conditions & Procedures

Allergy & Asthma Doctor, Peachtree City, Marietta , Georgia

Conditions We Treat

  • Adverse Drug Reactions
  • Angioedema
  • Asthma
  • Allergic Rhinitis
  • Allergies (Seasonal, Food, Environmental)
  • Anaphylaxis
  • Aspirin Allergy and Desensitization
  • Chronic Cough
  • Cough from Allergies
  • Dry Eyes from Allergic Rhinitis
  • Dry Throat and Runny Nose
  • Eczema
  • Eosinophilic Esophagitis
  • Eosinophilic Disorders
  • Food Allergy
  • Food Intolerance (Comprehensive Diagnosis and Management)
  • Environmental Allergies
  • Functional Medicine
  • Headaches, Fatigue and Cold Symptoms
  • Hives/Urticaria
  • Immunodeficiency
  • Integrative Medicine
  • Recurrent Infections
  • Sinus and Nasal Infections
  • Sinusitis (Acute)
  • Sinusitis (Chronic)
  • Skin Rashes
  • Sneezing (Frequent and Prolonged)
  • Stuffy Nose
  • Vocal Cord Dysfunction
  • Wheezing

Procedures We Offer

Oral Immunotherapy

Oral Immunotherapy – Atlanta, Peachtree City, Georgia

What is Oral Immunotherapy?

Oral immunotherapy (OIT) is a method of desensitizing your body to an allergen. A person suffering from a food allergy can develop a tolerance to the food by ingesting small doses over set time intervals. The concentration of food gradually increases throughout the therapy until you can eat the food without having an allergic reaction. This treatment should only be performed by an experienced board certified allergist, in the safety of a medical setting. Dr. Agrawal at Freedom Allergy is only one of a few board certified physicians in the Southern Region to perform this innovative allergy treatment.

Which Foods can Freedom Allergy Treat with Oral Immunotherapy?

  • Peanut
  • Tree Nuts (almond, pecan, walnut, hazelnut, cashew, pistachio, brazil nut, macadamia nut)
  • Milk
  • Egg
  • Contact us to inquire about other foods

What Ages Can Undergo Oral Immunotherapy?

We treat patients as young as 2 years old through adult.

Who Should Not Undergo Oral Immunotherapy?

Contraindications to OIT include unstable asthma and eosinophilic esophagitis.

Food Allergy

Food Allergy – Atlanta, Peachtree City, Georgia

What is a Food Allergy?

A food allergy occurs when your body’s immune system overreacts to a protein in a certain food. In severe allergies, these reactions can be life threatening. The majority (90 percent) of food allergies are caused by eight foods: cow’s milk, eggs, fish, peanuts, shellfish, soy, tree nuts, and wheat.

Video Courtesy of American Academy of Allergy Asthma & Immunology

Click Here to read more about Food Allergies from the American Academy of Allergy Asthma & Immunology.

 

Food Allergy Versus Food Intolerance

Reacting to a food does not necessarily mean you are allergic to that food – you may just be intolerant to it. Food intolerance can cause similar symptoms to a food allergy, but food intolerance does not cause a full immune system response in your body. Food allergies cause an immune system response, and affect multiple organs. Generally, food intolerance causes less severe reactions, and may only cause digestive problems. People develop food intolerance for many different reasons, including lacking an enzyme necessary to digest the food, or having a sensitivity to additives in a food.

Article: Food Allergy Versus Food Intolerance

Read More….

 

Ways to Diagnose a Food Allergy

  1. Skin Testing

During allergy skin testing, your skin is exposed to several allergens (food and/or environmental) and assessed for an allergic response. Your allergist will use a small plastic device to prick the skin and apply the allergens. If your skin becomes red, raised and itchy after 15-20 minutes, this may indicate an allergy.

Read More…

  1. Allergy Blood Testing

Allergy blood tests are used if a patient can’t stop a medication that interferes with skin testing, if the patient has a skin condition like dermatitis, psoriasis or eczema, or if it would better suit the patient to have just one “poke” versus several (ie, a baby or young child). Blood testing is also used if the patient has poorly controlled asthma, or if the allergy is so severe that the testing could cause a systemic or anaphylactic reaction. Allergy blood tests are also used to check how well a patient’s allergy treatment is working.

Types of allergy blood tests include Enzyme-Linked Immunosorbent Assay (ELISA) and Radioallergosorbent Test (RAST). ELISA is used more commonly than RAST, and measures the amount of antibodies in your blood specific to certain allergens.

Complement testing can be used to measure the amount of a specific antibody or a specific antigen in the blood. The test helps determine which foods may be causing inflammation in the body and triggering an immune response.

Read More…

  1. Oral Food Challenge

Double-blinded, placebo-controlled oral food challenge is considered the “gold standard” for food allergy diagnosis. This test is often used after skin prick testing and allergy blood testing fail to provide definitive results. In an oral food challenge, the patient is given very small amounts of a food that is suspicious for an allergy. Over a certain length of time, the amount of food is increased until any sign of an allergic reaction occurs. This test is always done under strict supervision of an allergist. The oral food challenge procedure can be costly and time consuming, however, so it is often not performed.

Read More…

 

Delayed Food Allergy

Food allergy symptoms typically occur right after ingesting the responsible food, or at least within two hours. However, in a delayed response, the symptoms may take six or more hours to appear. These delayed responses can surface in different ways – such as a skin reaction from a food allergy, or a gastrointestinal reaction after ingesting milk or soy.

 

Patch Testing

Patch Testing is a way to test for the allergens responsible for delayed allergic reactions. Instead of poking the skin with a plastic device to administer an allergen (as in allergy skin testing), patch testing occurs by placing a patch on a patient’s back that contains a small amount of the allergen. The patch stays on for two days, since a delayed allergic response will not occur quickly enough for skin prick testing. The patch site will be observed for redness, blisters, and swelling.

 

Sensitivity Testing

Sensitivity Testing is a blood test used to check for food sensitivities (different from food allergies). Food sensitivity is different from food allergy and food intolerance, and essentially describes an inconsistent and unpredictable reaction to certain foods. A person with food sensitivity may eat the food one time with no reaction, but experience symptoms (stomach cramps, nausea, acid reflux) at other times.