Guideline 1 recommends that the highest risk infants — those with severe eczema and/or egg allergy (see definitions below) — be introduced to peanut as early as 4-6 months of age, following successful feeding of other solid food(s) to ensure the infant is developmentally ready. Allergy testing is strongly advised prior to peanut introduction for this group. The preferred test is the SPT, but the guideline also allows for blood testing for peanut-specific IgE (sIgE), which is more widely available (see figure, right-click to enlarge). Allergy tests for multiple foods are not recommended because of their poor positive predictive value.
Guideline 2 suggests that infants with mild to moderate eczema, a group also at increased risk of peanut allergy, should be introduced to peanut “around 6 months of age, in accordance with family preferences and cultural practices, to reduce the risk of peanut allergy.” These infants may have peanut introduced at home following successful ingestion of other solid food(s) without an in-office evaluation, although an evaluation can be considered.
Guideline 3 addresses infants without eczema or food allergy who are not at increased risk, suggesting that peanut be introduced “freely” into the diet together with other solid foods and in accordance with family preferences and cultural practices.
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