The prevalence of peanut allergy among children in the United States has risen dramatically in recent years. Recent studies have proposed a link between atopic dermatitis (often just called eczema by non-physicians) and peanut allergy. It is theorized that exposure to peanut allergens through skin increases the risk of developing peanut allergy, while eating peanuts at an early age decreases the risk of developing peanut allergy. As a result of theses studies, notably the Learning Early About Peanut study, the National Institute of Allergy and Infectious Diseases updated its guidelines on peanut allergy prevention with the following recommendations.
- Children with severe atopic dermatitis. In children with severe atopic dermatitis, egg allergy or both it is advised that infant-safe forms of peanut be introduced at age 4 to 6 months. This should be preceded by an allergy evaluation.
- Children with mild to moderate atopic dermatitis. For children with mild to moderate atopic dermatitis, it is recommended that peanut protein be introduced at around 6 months of age. Typically, no allergy evaluation is required prior to peanut introduction.
- Children with no atopic dermatitis. In children with no history of atopic dermatitis or food allergies, peanut protein should be introduced in accordance with the family’s preferences.
The observation that cutaneous sensitization increases the risk of food allergy implies that early treatment of atopic dermatitis and repair of the skin barrier could reduce the risk of developing food allergies. Early emollient use (though not containing peanut oil) should be introduced in children at high risk of atopic dermatitis, such as those with a family history, allergies, or asthma. Similarly, aggressive treatment of atopic dermatitis at an early age may prevent the development of food allergies through cutaneous sensitization.
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