Oral food challenges in infants frequently de-label peanut allergy.

Abstract

The food allergy epidemic has seen a rise both in public awareness as well as parental fear and hesitancy about early allergen introduction. Parents often seek advice and testing for multiple allergens prior to introduction, or when isolated facial skin reactions have occurred. Allergy testing in this setting has the potential to over diagnose peanut allergy. Since 2008 the Australasian Society of Clinical Immunology and Allergy has recommended early and sustained introduction of peanut from 4-12 months of age with insufficient evidence to support a population-based screening approach (using skin prick or serum specific IgE testing). The LEAP study performed screening skin prick testing (SPT) to peanut in at-risk infants, defined as those with egg allergy, severe eczema or both, and employed a cutoff SPT of >4mm as likely predictive of peanut allergy. Such infants (almost 10% of the recruited cohort) were excluded from the intervention arm of the trial. We examined data from 12 years of peanut oral food challenge (OFC) in children 12 months and under at Epworth Allergy Specialists with the aim of assessing the relationship between initial clinical presentation, SPT size and peanut tolerance in our cohort.