Real-World Data Confirm Early Peanut Feeding Benefit for High-Risk Infants

SAN ANTONIO -- Real-world data presented here supported the early introduction of peanuts to infants at high risk for developing peanut allergies, yet also highlighted caregiver challenges in following the guideline-recommended protocol.

In a study of 309 high-risk infants considered for early peanut introduction, 12% were allergic at baseline, while 65% had no issues with early peanut feeding over a median follow-up of 24 months and 2% developed a peanut allergy during that time, according to Abhilasha Banerjee, MD, of Johns Hopkins University in Baltimore.

Furthermore, just one of the 17 babies with an initial positive skin test became allergic to peanuts, she reported during a poster presentation at the American Academy of Allergy, Asthma & Immunology annual meeting.

A closer look at the 61 patients in the study who discontinued the early feeding protocol revealed that the main reason caregivers gave for discontinuing was fear of reaction in a peanut-allergic family member (36%), mostly a young sibling. Another 21% said they discontinued because their child refused the food and 15% said the protocol was "too much work," reported Corinne Keet, MD, PhD, of the University of North Carolina at Chapel Hill.

Keet said that while parents did not appear to be concerned about following the early-feeding protocol at study enrollment, the fact that roughly one in five did not continue the practice was a concern.

"Many people considered peanut feedings to be easy or very easy, but there was a sizable minority that considered [the peanut-feeding protocol] to be difficult or very difficult," Keet said. "This is possibly because of the extra work for a family member."

The data showed the challenges families face when following the early-feeding guidelines, said Keet. For example, the median amount of peanut protein consumed per week came in at 3 g versus the 6 g recommended by National Institute of Allergy and Infectious Diseases (NIAID) guidelines.

In the landmark LEAP study, published in 2015, introducing peanut into the diets of high-risk infants with negative skin-prick tests before age 11 months was associated with an 86% reduction in peanut sensitivity at 5 years of age, with a 70% reduction for those with a positive skin test at baseline. Based on the LEAP findings, NIAID changed its practice guidelines in 2017 and recommended peanut introduction for high-risk infants between ages 4-6 months, with skin-prick testing advised prior to peanut feeding.

Banerjee told MedPage Today that a better understanding of the real-world challenges to following the NIAID guidelines may lead to interventions to support families and, ultimately, reduce the prevalence of peanut allergies. "We need to address these challenges so that this very effective prevention strategy is followed," she said.

Keet reported that up to 20% of peanut-allergic parents in the current study reported having allergic reactions while feeding peanut to their high-risk babies; reactions were reported in 2% of peanut-allergic siblings.

When asked about precautions for when a family member had a peanut allergy, caregivers said they kept the sibling away from the feeding, used separate utensils for the peanut feedings, and/or performed enhanced cleaning after peanut feeding, Keet noted.

Their study enrolled 309 infants with no prior peanut exposure who were considered high risk for developing a peanut allergy: based on having moderate-to-severe eczema, a documented non-peanut food allergy, or a close family member with a peanut allergy.

After peanut skin-prick testing, the 269 infants without peanut allergy (mean age 7 months, three-fourths white, a majority boys) were recommended for peanut introduction, at 2 g of peanut protein three times a week. Monthly electronic questionnaires were administered to caregivers, with follow-up visits conducted at 18 and 30 months.

Of those who started the NIAID-recommended protocol, six patients developed a new peanut allergy, 200 were consistent with feeding, 34 discontinued temporarily, and 29 had stopped at last follow-up.