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In the United States, peanut allergy is the leading cause of death due to severe, food-related allergic reactions. The allergy usually develops in child- hood and lasts through adulthood. In January 2017, an expert panel sponsored by the United States National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health (NIH), issued clinical guidelines for early introduction of peanut-con- taining foods to infants to prevent the development of peanut allergy. The Addendum Guidelines for the Pre- vention of Peanut Allergy in the United States are a supplement to The 2010 Guidelines for the Diagnosis and Man- agement of Food Allergy in the United States and were simultaneously pub- lished in six journals. Three guidelines based on infants' risk The addendum, for use by health- care providers, pediatricians and family practice physicians, provides three guidelines for infants at vari- ous levels of risk for developing peanut allergy. All infants should start other solid foods before being introduced to peanut-containing foods. Addendum Guideline 1 is for infants at high risk of developing peanut allergy because they already have severe eczema, egg allergy or both. It recommends infants have peanut-containing foods as early as four to six months of age. However, parents and caregivers should first consult their infant's healthcare provider, who may perform tests to help decide if and how peanuts should be safely introduced. Guide- line 2 suggests infants with mild or moderate eczema should have peanut-containing foods around 6 months of age. Guideline 3 suggests infants without eczema or any food allergy have peanut-containing foods freely introduced. Rather than feeding infants whole peanuts, which are a choking haz- ard, peanut-containing foods or peanut powder should be put into familiar foods or peanut butter might be spread on bread or crack- ers. Once infants have eaten peanut- containing foods safely, regular exposure is key to allergy prevention. The guidelines recommend that infants—and particularly those at the greatest risk of allergies—eat about two grams of peanut protein (the amount in two teaspoons of peanut butter) three times per week. Significant departure from prior practice Pediatricians often advised parents to delay introducing peanuts and other common causes of food aller- gies into children's diets. However, that view began changing in 2010 when a panel of food allergy experts concluded there was insufficient evi- dence to show such delays protected children, explained Francis Collins, MD, PhD, Director of the National Institutes of Health. 1 In 2015, a randomized clinical trial of more than 600 infants (The L E A P s t u d y 2 ) s h o w e d r e g u l a r peanut consumption starting in infancy and continuing until 5 years of age led to an 81 percent reduction in development of peanut allergy for children at high risk because they already had severe eczema, egg allergy or both. A follow-up study showed those children remained allergy-free after avoiding peanuts for a year. 3 Consequently in 2015, NIAID established a coordinating commit- tee, representing 26 professional organizations, advocacy groups and NIH issues new guidelines for prevention of peanut allergy in children 28 JUNE2017 Inhalation BACKPAGE continued on page 27

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