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Grand Rounds: Update on Early Introduction of Allergenic Foods

01-21-2022

By Brian Schroer, MD , Director, Allergy and Immunology, Akron Children's Hospital, Akron, OH

Allergy and Immunology


Objectives (Educational Content) :

1. Explain the role eczema plays in the development of food allergies. 2. Implement specific instructions for introduction of allergenic foods in low and high-risk children in clinic. 3. Evaluate the benefits of early food introduction and describe the risk of unnecessary avoidance to parents.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

New information on introduction of allergenic foods in children.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:

01-20-2023

Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.

Disclosure:

Dr. Schroer has returned the disclosure form indicating the following relevant financial or other relationship with the following commercial interest: Ready Set Food! Consultant, Scientific Advisory Board. The relevant financial relationship listed for this individual has been mitigated.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Bibliography:

1- Schneider L,  et al. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013;131(2):295-9.e1-27.

2. Chang A, Robison R, Cai M, Singh AM. Natural History of Food-Triggered Atopic Dermatitis and Development of Immediate Reactions in Children. J Allergy Clin Immunol Pract. 2016;4(2):229-36.e1

3. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract. 2013;1(1):22-8

4. Lim NR, Lohman ME, Lio PA. The Role of Elimination Diets in Atopic Dermatitis-A Comprehensive Review. Pediatr Dermatol. 2017;34(5):516-27. 

5. Eigenmann PA, Beyer K, Lack G, Muraro A, Ong PY, Sicherer SH, et al. Are avoidance diets still warranted in children with atopic dermatitis? Pediatr Allergy Immunol. 2020;31(1):19-26

6. Keet C, Pistiner M, Plesa M, Szelag D, Shreffler W, Wood R, et al. Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy. Journal of Allergy and Clinical Immunology. 2021:In Press.

7. Kelleher MM, Dunn-Galvin A, Gray C, Murray DM, Kiely M, Kenny L, et al. Skin barrier impairment at birth predicts food allergy at 2 years of age. J Allergy Clin Immunol. 2016;137(4):1111-6.e8.

8. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-13.

9. Brough H, et al. Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Allergy, Volume: 75, Issue: 9, Pages: 2185-2205.

10. Fleischer D, et al. A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology J Allergy Clin Immunol Prac. 2021;9(1):22-43. 

11. Schroer B, Groetch M, Mack D, Venter C. Practical challenges and considerations for early introduction of potential food allergens for prevention of food allergy. J Allergy Clin Immunol Prac. 2021;9:44-56.

12. Perkins. Enquiring About Tolerance (EAT). NEJM 2016

13. Burgess JA. Age at introduction to complementary solid food and food allergy and sensitization: a systematic review and meta-analysis. Clin Exp Allergy. 2019

14.https://www.niaid.nih.gov/diseases-conditions/guidelines-clinicians-and-patients-food-allergy

15. Bellach. HEAP. JACI 2017

16. Burgess JA. Age at introduction to complementary solid food and food allergy and sensitization: a systematic review and meta-analysis. Clin Exp Allergy. 2019.

17. Soriano, et al. Earlier ingestion of peanut after changes to infant feeding guidelines: the Early Nuts study. JACI. 2019..

18. Tapke et al. A retrospective cohort study of pediatrician implementation of the 2017 United States early peanut introduction guidelines. Annals Allergy 2021.

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