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Rates of New Peanut Allergy and Discontinuation Following Introduction in High-Risk Infants.

BACKGROUND: Peanut introduction guidelines recommend that infants with severe eczema and/or egg allergy consume 6 grams peanut protein weekly to prevent peanut allergy. Rates of new peanut allergy after introduction and adherence remain under study.

OBJECTIVE: To determine compliance with peanut introduction guidelines, rates of new peanut allergy, and reasons for discontinuation of peanut consumption in a cohort of high-risk infants.

METHODS: A prospective cohort of 4-11 month-old high-risk infants (defined as moderate-severe eczema or non-peanut food allergy or a first degree relative with peanut allergy) with no prior peanut exposure who were determined to not be peanut allergic were recommended to introduce 6 grams of peanut protein weekly. Participants were followed to 30 months with two in person visits and monthly questionnaires.

RESULTS: Two-hundred and seventy seven infants were followed. At last follow-up, 245 (88%) were consuming some peanut protein with median weekly consumption of 3 grams (IQR: 1-5 grams). New peanut allergy developed in 6 (2%) with 2 of those cases consistent with food protein induced enterocolitis syndrome. Fear of reaction in another household member was the most common reason for peanut discontinuation. Reactions to peanut after introduction in the index infant occurred in <2% of peanut allergic siblings and in 20% of peanut allergic parents.

CONCLUSION: We found low rates of new peanut allergy and generally low rates of peanut discontinuation after introduction in our high-risk cohort. However, families of high-risk infants require significant support with introduction, especially those with another peanut allergic member.

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