Risk for Peanut-Triggered FPIES Low With Early Introduction

TOPLINE:

In a Dutch study, food protein–induced enterocolitis syndrome (FPIES) occurred in only 0.3% of atopic infants at risk for immunoglobulin E (IgE)–mediated peanut allergy who were introduced to peanuts between 4 and 11 months of age. The majority of infants developed peanut tolerance by 3 years of age.

METHODOLOGY:

• Researchers analyzed 892 infants from six pediatric allergy centers across the Netherlands between February 2018 and January 2021 to observe incidents of negative peanut challenge.
• The infants were aged between 4 and 12 months, were born to atopic parents, and had eczema and/or immediate reactions to food other than peanuts, and/or had a first-degree family member with systemic reactions to peanuts and tree nuts.
• Overall, 706 infants (median age, 26 weeks; 60% boys) had no prior exposure to peanuts, whereas 186 infants (median age, 37 weeks; 57% boys) had immediate reactions to peanuts at first introduction at home.
• Skin prick tests were performed to determine peanut-specific IgE levels during the third year of life. Oral food challenges were performed to introduce peanuts, with regular follow-up evaluations post-challenge.

TAKEAWAY:

• Overall, two (0.3%) participants among those without prior exposure to peanuts and six (3.2%) with reactions to peanuts at home developed peanut-triggered FPIES.
• Seven of these eight (88%) participants had previous ingestions of peanuts without reactions before the FPIES phenotype became apparent.
• Six of these eight (75%) infants showed spontaneous resolution of peanut -triggered FPIES, with peanuts successfully introduced in their diet between 2 and 3 years of age.

IN PRACTICE:

“When introducing peanuts in the first year of life, physicians should be aware of FPIES reactions, but it should not be a reason to avoid early introduction of peanut,” the authors of the study wrote.

SOURCE:

Dirk H. J. Verhoeven, MD, with the Reinier de Graaf Hospital, Delft, the Netherlands, was the corresponding author of the study, which was published online on March 13 in Pediatric Allergy and Immunology.

LIMITATIONS:

The selected cohort had an increased risk for IgE-mediated peanut allergies. Additionally, infants with FPIES may have been missed due to the development of spontaneous tolerance between a reaction at home and food challenges.

DISCLOSURES:

The research was supported by an unrestricted grant from the Reinier de Graaf Hospital Scientific Board. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.