1. Morin, Karen H. PhD, RN, ANEF, FAAN

Article Content

How often have you been asked not to open a package of peanuts when traveling by air because a passenger has been identified as having a peanut allergy? How often have you counselled parents of infants about the need for extreme caution when introducing peanuts, milk, or eggs when use of complementary foods is appropriate? Typically, healthcare providers instruct parents to delay introduction of peanuts, a food allergen, until the infant is at least 1 year old. However, recent evidence from a one-site randomized control trial indicates that healthcare professionals may need to change the advice they offer to parents of children who are at high risk for peanut allergy (Du Toit et al., 2015).


Why is this topic important? Approximately 15 million Americans, of which 8% are children, have food allergies; thus, food allergies are a major public health issue (Greenhawt, 2015). The incidence of peanut allergy has doubled from 1.4% to 3% over the past 10 years in developed countries (Du Toit et al., 2015; Fleischer et al., 2015) and also is being reported in Asia and Africa. Peanut allergy, developing early in life, is the "leading cause of anaphylaxis and death due to food allergy" (Du Toit et al., p. 804), and has a significant impact on the quality of life of the affected child and his or her parents (Greenhawt).


What did the investigators do? The study included 640 infants between 4 and 11 months of age with severe eczema, egg allergy, or both, who were randomly assigned to cohorts based on intervention, that is, consumption or avoidance of peanuts, and sensitivity to peanuts, determined by the presence or absence of a wheal produced in response to a skin-prick (DuToit et al., 2015). Outcome in both cohorts was the proportion of infants who had peanut allergy at 5 years of age. Adherence rates were excellent at 92%: infants ingested a median of 7.7 ng of protein per week for the first 2 years. Parents gave infants 1 teaspoon of peanut butter combined with milk, or as peanut soup. Prevalence of peanut allergy in the avoidance group was 13.7%, and 1.9% in the consumption group. Investigators concluded that early introduction of peanuts decreased development of peanut allergy in this high-risk group.


What are the consensus recommendations?Interim guidelines (Fleischer et al., 2015) recommend 1) "introducing peanut-containing products into the diets of 'high-risk' infants early" (p. 802), particularly in countries where peanut allergy is common; and 2) evaluation of an allergist in the first 4 to 6 months of life may be beneficial for infants who have early-onset atopic disease. These recommendations do have limitations. They do not address alternative doses [strength of dosage issues], the length of time required to have tolerance results, and the consequences of stopping ingestion prematurely or administering peanut products irregularly.


What does this mean for nurses? Being aware of the most current information means that nurses can provide appropriate guidance when asked. Nurses also can help parents craft meaningful and relevant questions when interacting with their child's healthcare provider.




Du Toit G., Roberts G., Sayre P. H., Bahnson H. T., Radulovic S., Santos A. F., ..., Lack G. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England Journal of Medicine, 372(9), 803-813. doi:10.1056/NEJMoa1414850 [Context Link]


Fleischer D. M., Sicherer S., Greenhawt M., Campbell D., Chan E., Muraro A., ..., Rosenwasser L. (2015). Consensus statement on early peanut introduction and the prevention of peanut allergy in high-risk infants. Pediatrics, 136(2), 258-261. doi:10.1016/j.jaci.2015.06.001 [Context Link]


Greenhawt M. (2015). The learning early about peanut allergy study: The benefits of early peanut introduction, and a new horizon in fighting the food allergy epidemic. Pediatric Clinics of North America, 62(2), 1509-1521. doi:10.1016/j.pcl.2015.07.010 [Context Link]