Timing of introduction of allergenic solids for infants at high risk

Question 1

Most common allergens in children?

Answer 1

• Cow’s milk
• Egg
• Peanut
• Tree nuts
• Fish
• Shellfish
• Wheat
• Soy

Question 2

Definition of infant at high risk for food allergy?

Answer 2

Personal history of atopy, including eczema, or having a first-degree relative with atopy (e.g. eczema, food allergy, allergic rhinitis, or asthma)

Question 3

What was the LEAP study? Overall relative risk reduction?

Answer 3

• Learning Early About Peanut
• First randomized controlled trial to provide evidence that early peanut introduction could help prevent peanut allergy in high-risk infants
• Results showed an overall relative risk reduction in peanut allergy of up to 80% with early peanut introduction

Question 4

There is emerging evidence from randomized trials which have included infants younger than ______, that earlier allergenic solid introduction may prevent _____ and ____ allergy in infants at high risk.

Answer 4

• 6 months

- Peanut and egg

Question 5

Food allergy affects an estimated ___ to ___% of the population, with evidence of ______ prevalence over time.

Answer 5

• 2-10%

- Increasing

Question 6

Since 2013, evidence from randomized trials has increasingly supported _______ to prevent food allergy, specifically to _____ and _____.

Answer 6

• the early introduction (before 6 months) of allergenic foods
• peanut and egg

Question 7

Regardless of timing for introducing complementary foods, _____ should be protected, promoted and supported up to the age of ________, because of its unique _______ and ______ benenefits.

Answer 7

• breastfeeding
• 2 years and beyond
• developmental and immunological

Question 8

Recommendation re: introduction of common allergenic foods infants at high-risk for food allergy? For no or low risk infants?

Answer 8

• High-risk: based on developmental readiness, consider introducing common allergenic solids at around 6 months, but not before 4 months of age
• No or low-risk: Introducing complementary foods at about 6 months is recommended

Question 9

How to introduce allergenic foods?

Answer 9

• Introduce allergenic foods one at a time, to gauge reaction, without unnecessary delay between each new food
• If infant appears to be tolerating a common allergenic food, advise to offer a few times a week to maintain tolerance

Question 10

What to do if an adverse reaction is observed?

Answer 10

Advise parents to consult with PCP about next steps

Question 11

How to prevent choking?

Answer 11

The texture or size of any complementary food should be age-appropriate

• For young infants, smooth peanut butter can be diluted with water or mixed with a previously tolerated pureed fruit or vegetable or with breastmilk
• For older infants, can be spread lightly on piece of thin toast crust, or could offer a peanut puff product