2018 Section 5 - Rhinology and Allergic Disorders

Figure 2. Algorithm for the evaluation of children with severe eczema and/or egg allergy before peanut introduction.

cluding as supplementation) had a 19.3-fold lower odds of developing milk allergy compared with infants exposed between 105 and 194 days of life). 23 A recent meta-analysis noted that there was no protective ben- efit against the development of food allergy from the use of partially or extensively hydrolyzed cow’s milk formula in children at risk for the development of food allergy. 24 CONCLUSION Feeding guidance regarding when to introduce pea- nut into the diet of an infant has changed. New re- search that shows that early introduction of peanut- containing product at 4–6 months of life (after a few other foods have been introduced into the infant’s diet) is associated with a significantly reduced risk of such infants who develop peanut allergy. This practice is safe and feasible. Adherence to these clinical practice recommendations is an amazing opportunity to help potentially reduce the number of cases of peanut al- lergy per year. However, this can only be accom- plished with the cooperation of parents and health care providers, who adhere to these recommendations. For the time being, the NIAID-sponsored guidelines 18 do not address the benefits of early introduction of other foods, although growing evidence exists that supports a benefit for early egg introduction. REFERENCES 1. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 128:e9–e17, 2011.

2. Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge- proven IgE-mediated food allergy using population-based sam- pling and predetermined challenge criteria in infants. J Allergy Clin Immunol 127:668–676.e1–e2, 2011. 3. Sicherer SH, Munoz-Furlong A, Godbold JH, and Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 125:1322– 1326, 2010. 4. Venter C, Maslin K, Patil V, et al. The prevalence, natural history and time trends of peanut allergy over the first 10 years of life in two cohorts born in the same geographical location 12 years apart. Pediatr Allergy Immunol 27:804–811, 2016. 5. Peters RL, Allen KJ, Dharmage SC, et al. Skin prick test re- sponses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. J Allergy Clin Immunol 132:874–880, 2013. 6. Wood RA. Food allergen immunotherapy: Current status and prospects for the future. J Allergy Clin Immunol 137:973–982, 2016. 7. Jackson KD, Howie LD, and Akinbami LJ. Trends in allergic conditions among children: United States, 1997–2011. NCHS Data Brief, no 121. Hyattsville, MD: National Center for Health Statistics, 2013. 8. American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 106(pt. 1):346 – 349, 2000. 9. Greer FR, Sicherer SH, and Burks AW. Effects of early nutri- tional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 121:183–191, 2008. 10. Luccioli S, Zhang Y, Verrill L, et al. Infant feeding practices and reported food allergies at 6 years of age. Pediatrics 134(suppl. 1):S21–S28, 2014. 11. McKean M, Caughey AB, Leong RE, et al. The timing of infant food introduction in families with a history of atopy. Clin Pediatr (Phila) 54:745–751, 2015.

March–April 2017, Vol. 38, No. 2

154