Implications of the "Consensus Communication on Early Peanut Introduction in the Prevention of Peanut Allergy in High-Risk Infants" for Allergists, Primary Care Physicians, Patients, and Society.

In a landmark collaborative action, 10 international medical professional organizations, 2 among them not being allergistimmunologist based (the American Academy of Pediatrics and the Society for Pediatric Dermatology), created a “Consensus communication” suggesting that the approaches taken in the Learning Early About Peanut (LEAP) trial should be actualized for clinical care “in more diverse settings throughout the world.” The Consensus communication is receiving widespread publication and media coverage. The purpose of this editorial is to bring attention to this Clinical communication for the readership, and to underscore a number of implications that were not discussed in the guidance. Briefly, the LEAP trial enrolled 640 infants between 4 and up to 11 months of age (average age almost 8 months) having severe eczema, egg allergy, or both. The study enrollment procedures included skin testing to peanut. Infants with skin tests greater than 4 mm were excluded with the assumption that they were likely already allergic. Infants enrolled and randomized to ingest peanut did so initially under physician supervision, with a graded feeding for those with positive tests (overall, 7 of 319 reacted at the baseline feeding). The results after supervised feeding at 5 years of age showed that the rate of peanut allergy was 17% in those who were avoiding peanut compared with 3% in those