A 6-month-old boy is brought to the clinic for a routine well-child check. The patient was exclusively breastfed for the first 4 months of life. Over the past 2 months, his family has gradually introduced complementary foods, including cereals and several infant fruit and vegetable products, into his diet. The family is concerned about introducing highly allergenic foods such as peanuts, shellfish, and eggs because the patient's cousin was hospitalized after developing a severe allergic reaction to eggs. The patient is developing normally and growing at the 50th percentile for weight. His medications include a vitamin D supplement and petroleum jelly for dry skin. Heart, lung, and abdominal examinations are normal. There are small, dry, scaly patches of skin over the extensor surfaces of the extremities. Which of the following is the best approach to the introduction of highly allergenic foods in this patient?

Question

A 6-month-old boy is brought to the clinic for a routine well-child check.  The patient was exclusively breastfed for the first 4 months of life.  Over the past 2 months, his family has gradually introduced complementary foods, including cereals and several infant fruit and vegetable products, into his diet.  The family is concerned about introducing highly allergenic foods such as peanuts, shellfish, and eggs because the patient's cousin was hospitalized after developing a severe allergic reaction to eggs.  The patient is developing normally and growing at the 50th percentile for weight.  His medications include a vitamin D supplement and petroleum jelly for dry skin.  Heart, lung, and abdominal examinations are normal.  There are small, dry, scaly patches of skin over the extensor surfaces of the extremities.  Which of the following is the best approach to the introduction of highly allergenic foods in this patient?

Quizplus · Accepted Answer

11ec25c8_d626_1713_bc81_5bb01bbd0aa1_MD0003_00 Early introduction of highly allergenic foods after age 4-6 months may prevent food allergies. The most common highly allergenic foods in the United States are cow's milk, eggs, soy, wheat, peanuts, tree nuts, and seafood. Food allergies are more common in patients who have atopic disease (eg, eczema) or a family history of atopy. These patients can be categorized as low versus high risk for developing food allergies. Low-risk infants are generally healthy and may have mild eczema that responds to or does not require topical corticosteroids, as in this child. A patient who has a family member with food allergies but no personal history of an allergic reaction to food is also considered low risk. If the child can tolerate typical first foods (eg, cereals, fruits, vegetables), early introduction of highly allergenic foods is safe and recommended. Small amounts of the food (eg, peanut butter) should be offered at home, where the infant can be observed closely for an adverse event. An antihistamine should be available and administered if an allergic reaction (eg, rash, swelling, wheezing) occurs. In contrast, high-risk infants have severe, refractory eczema and/or a known/suspected IgE-mediated food allergy. Allergy testing (eg, IgE levels, skin testing) is recommended prior to the introduction of highly allergenic foods in high-risk infants. Depending on the results, a food challenge may be performed in the office (ie, mild to moderate skin reaction) or complete avoidance may be advised (ie, large wheal on skin test) until testing is repeated the following year (Choices C and D). (Choice B) Delayed introduction of highly allergenic foods is not recommended due to the increased risk of food allergies. (Choice E) Exclusive breastfeeding is encouraged for the first 6 months of life. However, complementary foods are required to satisfy the infant's nutritional requirements after age 6 months. Educational objective: An infant without severe, refractory eczema or an IgE-mediated food allergy is considered low risk for developing food allergies, and early introduction of highly allergenic foods after age 4-6 months is recommended. References: How to prevent food allergy during infancy: what has changed since 2013? (http://www.ncbi.nlm.nih.gov/pubmed/29601355) Timing of introduction, sensitization, and allergy to highly allergenic foods at age 3 years in a general-population Canadian cohort. (http://www.ncbi.nlm.nih.gov/pubmed/31678300) Identifying infants at high risk of peanut allergy: the Learning Early About Peanut Allergy (LEAP) screening study. (http://www.ncbi.nlm.nih.gov/pubmed/23174658)

A 6-Month-Old Boy Is Brought to the Clinic for a Routine