The recent publication of the LEAP study in the New England Journal of Medicine(click here for more) has led to recent guidance on the early introduction of peanut into the diet of high risk infants. Here is the recommendation offered by a collaboration of the American Academy of Pediatrics, American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, and multiple international medical societies:

Based on data generated in the LEAP trial and existing guidelines, the following interim guidance is suggested to assist the clinical decision-making of healthcare providers:

• There is now scientific evidence (Level 1 evidence from a randomized controlled trial) that healthcare providers should recommend introducing peanut-containing products into the diet of “high-risk” infants early on in life (between 4 – 11 months of age) in countries where peanut allergy is prevalent, since delaying the introduction of peanut may be associated with an increased risk of developing peanut allergy.

• Infants with early-onset atopic disease, such as severe eczema, or egg allergy in the first 4-6 months of life may benefit from evaluation by an allergist or physician trained in management of allergic diseases in this age group to diagnose any food allergy and assist in implementing these suggestions regarding the appropriateness of early peanut introduction.

Rationale for evaluating and applying this policy to a high-risk population

The LEAP study demonstrates that early peanut introduction can be successfully carried-out in high-risk population (such as the population defined in the LEAP trial). However, without intervention by healthcare providers, there is the potential that such high-risk infants will remain at risk for delayed introduction of solids and allergenic foods into their diet, because of the widespread belief that such foods may exacerbate eczema.