Groundbreaking results of the first randomized clinical trial to prevent food allergy in a large group of high-risk infants were presented today at the annual scientific meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) in Houston. Published in the prestigious New England Journal of Medicine, researchers led by Gideon Lack, M.D., of Kings College London, found that sustained consumption of a peanut-containing snack by babies at high risk for developing peanut allergy prevented them from developing peanut allergy. Peanut consumption achieved an 86 percent reduction in peanut allergy at age 5 among children who had negative skin prick tests to peanut at study entry, and a 70 percent reduction in peanut allergy among those who were sensitized to peanut (positive skin prick test) at the beginning of the study.
The Learning Early About Peanut Allergy (LEAP) study was funded by Food Allergy Research & Education (FARE) and the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. It was designed and conducted by the Immune Tolerance Network, a collaborative network of clinical researchers sponsored by NIAID. Read more about these critically important findings in our press release, and stay tuned to our blog for additional research updates from the AAAAI meeting.
Hmmmm. Does regular exposure through breast milk count?
Quote from: GoingNuts on February 23, 2015, 07:16:21 PM
Hmmmm. Does regular exposure through breast milk count?
I would say no. I think sometimes the protein goes through the milk, but not always.
I don't know how else DS would have gotten sensitized to peanut. He reacted upon first exposure. And he wasn't even eating it.
I'm not going to do my usual "Tweeted by" thing b/c everybody is talking about this ...
-----------------------------------
"Preventing Peanut Allergy through Early Consumption — Ready for Prime Time?"
Rebecca S. Gruchalla, M.D., Ph.D., and Hugh A. Sampson, M.D.
February 23, 2015
http://www.nejm.org/doi/full/10.1056/NEJMe1500186#.VOueOkbpw4E.twitter (http://www.nejm.org/doi/full/10.1056/NEJMe1500186#.VOueOkbpw4E.twitter)
QuoteMore than 500 infants at high risk for peanut allergy were randomly assigned to receive peanut products (consumption group) or to avoid them (avoidance group). Approximately 10% of children, in whom a wheal measuring more than 4 mm developed after they received a peanut-specific skin-prick test, were excluded from the study because of concerns that they would have severe reactions. At 5 years of age, the children were given a peanut challenge to determine the prevalence of peanut allergy. The results are striking — overall, the prevalence of peanut allergy in the peanut-avoidance group was 17.2% as compared with 3.2% in the consumption group.
-----------------------------------
http://www.leapstudy.co.uk/about-leap (http://www.leapstudy.co.uk/about-leap)
-----------------------------------
"Early Introduction of Peanut Protects Against Allergy, LEAP Study Finds"
http://allergicliving.com/2015/02/23/early-introduction-of-peanut-protects-against-allergy-leap-study-finds/ (http://allergicliving.com/2015/02/23/early-introduction-of-peanut-protects-against-allergy-leap-study-finds/)
QuoteFeeding peanut to young infants with heightened allergy risk reduces the odds that a peanut allergy will develop by a remarkable 70 to 80 percent, according to findings in the landmark LEAP study, which were revealed at the AAAAI conference in Houston on Feb. 23.
-----------------------------------
Landmark study presented at AAAAI Annual Meeting paves way for food allergy prevention
LEAP study hints at new food allergy guidelines
http://www.aaaai.org/about-the-aaaai/newsroom/news-releases/leap-study-food-allergy.aspx (http://www.aaaai.org/about-the-aaaai/newsroom/news-releases/leap-study-food-allergy.aspx)
Quote"We believe the results from this trial are so compelling, and the problem of the increasing prevalence of peanut allergy so alarming that new guidelines should be forthcoming very soon," Hugh A. Sampson, MD, FAAAAI, noted in an accompanying editorial. Sampson is a past-president of AAAAI and current Director of the Jaffe Food Allergy Institute with the Icahn School of Medicine at Mount Sinai.
DS definitely reacted to breast milk. And I was consuming peanuts on a regular basis. When DD wanted PBJ fir lunch, it was just so easy to make two and have one myself for lunch.
I'd say DS was reacting to PB in my breast milk as well - and he had an obvious reaction the first time he tried to eat PB. He didn't even eat it; he just grabbed a sandwich, put it up to his mouth and before he could take a bite he had massive clown lips. He was about 17 months old at that time.
http://www.bbc.co.uk/news/health-31550816 (http://www.bbc.co.uk/news/health-31550816)
Dr Lack was my sons first allergy doctor .
So what would make a baby be identified as high-risk? If there was any family history of allergies of any kind? Wouldn't that be every baby in the US?
It says their high-risk definition was babies who themselves had eczema or egg allergy. That would be none of my kids. So under that protocol my DD wouldn't be selected to try to prevent it.
It will be interesting to see what actual guidelines come out of this. I know they got dramatic results, but can they really generalize this for use at this point?
Well, my economist friend posted about this on FB. I commented, and she replied the obvious, but still good news, "Nothing works for everyone. But exposure works for more." So, as a guideline the research was good, but there are alway outliers.
What I hate is how the media runs with this stuff, as if it is a one size fits all "cure."
My comment in her thread was about breastfeeding, and my child being sensitized then.
Lol.
@iknowtiffany: A new study shows 99% of people will read #LEAP headlines and nothing further. #AAAAI15
Why do I bother to read the exclusion criteria when I know it will just make me frustrated?
Tweeted by @AllergyKidsDoc
Quote#LEAP results exciting but you should NOT do at home - every single participant screened with both skin test AND oral challenge #AAAAI15
--------------------------
Tweeted by @iknowtiffany
QuoteSide effects of #LEAP include: blaming moms for allergies & a sudden increase in mother-in-laws giving babies peanut butter.
A group of kids who could eat peanut were fed peanut and continue to eat peanut. While I understand the excitement over the results from treatment versus control on a publication standpoint the transfer to real life validity isn't overwhelming when one considers the first wave of peanut allergic kids did not under the conventional thought of the early to mid 2000s from allergy to avoid if high risk.
Meaning if ignorance of high risk avoidance existed then how did such a significant population of sensitized individuals come into being? And what about the other 7 of the top 8?
Why do I bother. How quickly allergists forget the blame we shouldered for NOT waiting to introduce.
I'd like to hear what some of the allergist parents say about this. There's no way Ruchi Gupta or Michael Pistiner caused their kids' sensitization to peanut. Same for our allergist who believes it's there at birth.
Mine wasn't breast fed, so no exposure there and he reacted the first time he tried a little bit of PB at 8 months.
I've seen a friend of a friend post "But isn't peanut butter a choking hazard?" Seriously, people will think they should do this on their own.
Listening to the researchers involved on the Diane Rehm Show. Wow. So helpful. Will post a link whrn available.
Quote from: devnull on February 24, 2015, 01:23:14 PM
A group of kids who could eat peanut were fed peanut and continue to eat peanut. While I understand the excitement over the results from treatment versus control on a publication standpoint the transfer to real life validity isn't overwhelming when one considers the first wave of peanut allergic kids did not under the conventional thought of the early to mid 2000s from allergy to avoid if high risk.
Meaning if ignorance of high risk avoidance existed then how did such a significant population of sensitized individuals come into being? And what about the other 7 of the top 8?
Why do I bother. How quickly allergists forget the blame we shouldered for NOT waiting to introduce.
100% Agreed. With my two kids I ate PB, ice cream, etc. all through their pregnancies AND when nursing. Even when my first had eczema, projectile vomiting, not sleeping, etc., dr told me that eliminating potential allergens from my diet would not affect allergy development.
Looking back, I could have maybe made our lives somewhat easier had I eliminated allergens anyway, even though we didn't yet know what she was allergic to. I tried eliminating milk just on my own, but DD was so allergic to other things that it didn't make any difference.
I just Don't.Need.This.Added.Guilt from this new research study. :pout:
These were my thoughts on this topic yesterday:
Re: Living with Food Allergies, 2013 and on (http://foodallergysupport.olicentral.com/index.php/topic,6726.msg174343.html#msg174343)
Unless they are including some context on the excluded population this has zero application to our lives as is. On the other hand I very much want to hear more along the lines of SLIT for MFA starting in infancy for individuals with biomarkers as Hugo Von Bever has been extolling for a few years. But he is concerned with the overall allergic march not just peanut OIT, whatever form of OIT that takes.
The folks on Diane Rehm said moms should not feel guilt. It's not what we ate. Or didn't eat. One of them talked about the study about peanut dust in the house, not what was consumed or not consumed during pregnancy and lactation that was likely to be a larger factor.
I am not concerned by who was excluded. No study is perfect, but this looked at a much larger population than most and has some nice longevity to it. The fact that it got SO much attention from other allergists at AAAAI tells me that other people who understand scientific method aren't discounting this. That's huge to me.
So my kid's profile matches the ones included in the study. He has atopic family history.
As far as other guilt, I have none. I applied current best practices for avoiding allergies 17 years ago. I was more informed than most parents on that front. It's just that current thinking was apparently wrong. Not my fault. Frankly, my only guilty feelings are associated with readily giving him Propulsid at 6 weeks becUse I was worried about hige projectile vomiting and his being accepted into daycare at 6 weeks.
And they do include context in the interview. I found their discussion nuanced and helpful.
Also, it's not like this is big news. Other recent studies have come to a similar conclusion
Here's the link:
The Diane Rehm Show
Wednesday, Feb 25 2015 • 10 a.m. (ET)
New Research On Preventing Peanut Allergies
A new study suggests doctors have been giving the wrong advice about peanuts for years.
For reasons not entirely clear, the number of people allergic to peanuts has risen dramatically in recent years. Peanut allergies usually appear in childhood. The condition is sometimes fatal, and there is no cure. For children with risk factors for allergies, pediatricians have long advised complete avoidance of peanuts. But a new study by British doctors — just published in The New England Journal of Medicine — suggests that advice was wrong. The study shows that exposing infants to peanuts could sharply cut the incidence of allergies to the legume. Many pediatricians are optimistic but not ready to issue new guidelines. We discuss the latest research.
Guests
Dr. Sally Joo Bailey assistant professor of pediatrics at Georgetown University School of Medicine.
Dr. Gideon Lack professor, King's College London, and co-investigator of the peanut allergy study published in the New England Journal of Medicine.
Dr. Hemant Sharma acting chief of the Division of Allergy and Immunology, and director of the Food Allergy Program, Children's National Health System.
http://t.co/PA7x5X0Eni (http://t.co/PA7x5X0Eni)
Scientific method doesn't mean much it's too vague. Study design, population, exclusion, internal and external validity, conclusion, biases, conflicts of interest there are a lot of components beyond what I briefly mention so context becomes key. I would have to read the paper itself to see a lot of that no news outlet would come close.
In that respect I would actually find the Australia trial on sustained unresponsiveness more novel even though it was double placebo.
Had to move off my phone.
QuoteSo my kid's profile matches the ones included in the study. He has atopic family history.
Not unless he could already tolerate one peanut regularly and would not have had a wheal of over 4mm. That was the exclusion I read. How many children they identified 'at risk' but had to exclude to get their target population is something I would want to know. I'd like to see those numbers even though it has no bearing on the results themselves (which I do not argue in the least) because they clearly identified who was excluded.
Certainly we know immunotherapy works. Who it works for in terms of sustained lack of response (I have a hard time with the word "unresponsiveness" after discontinuation of very rigid scheduling or dosing under care of the limited amount of allergists qualified to do so with sufficient administrative support for compliance. So if that was the price of admission, the ability to tolerate one peanut and not have a wheal over 4mm then there is absolutely no way to generalize that to the excluded population.
I believe that is what was in Links' quote on the exclusion criteria and of course if that was wrong, or I read it incorrectly that would be a game changer.
Quote from: Mezzo on February 24, 2015, 08:19:48 PM
I've seen a friend of a friend post "But isn't peanut butter a choking hazard?" Seriously, people will think they should do this on their own.
Exactly - I thought the whole reason for the delay wasn't due to allergies, it was due to choking on something very sticky and small hard round objects. I wonder how many babies are going to end up in the ER due to choking because of this. And then possibly misdiagnosed because I'm sure choking and throat swelling looks pretty similar in an infant...
In the interview they talked about using peanut flour
17 years ago the reason for the delay was in fact to try to avoid allergies. There was a whole set of guidelines about when to introduce egg (white, yellow) as well as strawberries.
Choking was really a separate issue.
Just FYI ...
the full article
http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=articleTop (http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=articleTop)
&
QuoteDatasets for both the intention-to-treat and per-protocol analyses are available through TrialShare, a public website managed by the Immune Tolerance Network (www.itntrialshare.org/LEAP.url (http://www.itntrialshare.org/LEAP.url)).
------------------------
I keep thinking of (I think it was CM's) whack-a-mole analogy. If you prevent peanut allergy, do those atopic tendencies pop up in another form (different FA, asthma, etc)?
"What makes current peanut allergy prevention study so much better than past studies?"
http://foodallergysleuth.blogspot.com/2015/02/what-makes-current-peanut-allergy.html?spref=tw (http://foodallergysleuth.blogspot.com/2015/02/what-makes-current-peanut-allergy.html?spref=tw)
QuoteEvery now and again, a study comes along that changes things, and I truly believe that the Learning Early about Peanut Allergy (LEAP) study by Du Toit, et al.1 will usher in an era of solid evidence-based guidance in terms of infant dietary recommendations and a much needed "benchmark" for designing future studies addressing allergy prevention.
Two Editorials. The first one had me seeing 10 different shades of red:
http://www.newsday.com/opinion/columnists/lane-filler/don-t-get-nutty-over-peanuts-lane-filler-1.9973081 (http://www.newsday.com/opinion/columnists/lane-filler/don-t-get-nutty-over-peanuts-lane-filler-1.9973081)
I much prefer the second, from Snacking Safely:
http://snacksafely.com/2015/02/of-babies-peanuts-and-allergy-moms/ (http://snacksafely.com/2015/02/of-babies-peanuts-and-allergy-moms/)
Link to the DISCLOSURES form for the study:
http://www.nejm.org/doi/suppl/10.1056/NEJMoa1414850/suppl_file/nejmoa1414850_disclosures.pdf (http://www.nejm.org/doi/suppl/10.1056/NEJMoa1414850/suppl_file/nejmoa1414850_disclosures.pdf)
To more fully zero out my concerns about funding bias I would have preferred not so many of the co-authors operate on National Peanut Board money so I could dial down the skepticism, but to be fair this was solid work with plain design. It also helps answer the question why only peanut. Kicking the tires never reveals anything settling.
Or, non-specified 'support' as it was written. Non-financial support should have been disclosed as non-financial. Generic 'support' wasn't part of the definitions.
I keep thinking back to the scene in Good Will Hunting where Robin Williams just keeps repeating to Will,
"It's not your fault."
The questions start getting uncomfortable when you match up ajas' recent post to NPB's internal concerns about promoting a marketing makeover for their industry due to peanut allergic children then this makes a splash with NPB money. Thankfully, disclosures make for better transparency. You can't buy better marketing turnaround than that. Mentally I'm playing with the vast majority of kids in the untreated group that just didn't sensitize despite a lack of OIT regimen. Also, what does this mean for allergens and anaphylaxis aside from peanut? I mean I get why peanut, NPB funds peanut allergy studies that would promote more peanut eating like dairy culture manufacturers fund the Australia probiotic OIT study.
I'm still left with what's moving forward in allergy and immunology? Anaphylaxis? Mechanisms? The segment that is always excluded -- are we still on a steady forced march towards marginalisation? It's like reading tea leaves where I need to start looking more towards Stanford with Dr. Nadeau out of self-preservation.
But that's why context is key: for what this identifies it shows positive results. With any such study it's the media translation that mangles it.
Quote from: GoingNuts on February 27, 2015, 07:06:41 AM
Two Editorials. The first one had me seeing 10 different shades of red:
http://www.newsday.com/opinion/columnists/lane-filler/don-t-get-nutty-over-peanuts-lane-filler-1.9973081 (http://www.newsday.com/opinion/columnists/lane-filler/don-t-get-nutty-over-peanuts-lane-filler-1.9973081)
I much prefer the second, from Snacking Safely:
http://snacksafely.com/2015/02/of-babies-peanuts-and-allergy-moms/ (http://snacksafely.com/2015/02/of-babies-peanuts-and-allergy-moms/)
Hmm. The first one I blew off as a blowhard. Lane Miller probably has all sorts of problems with everything.
The second guy, while I appreciate his pep talk I'm not having an emotional roller coaster on this. We never avoided to begin with. I mean thanks, I'm cool though. There's also this other guy I live with that does just as much managing as I do. :thumbsup:
I dig this and thank them for taking the time to speak up. While I'm not blaming myself in the least what the two doctors are doing here is combatting overgeneralization.
http://community.kidswithfoodallergies.org/blog/new-peanut-allergy-study-does-not-say-parents-are-to-blame-1?nc=1 (http://community.kidswithfoodallergies.org/blog/new-peanut-allergy-study-does-not-say-parents-are-to-blame-1?nc=1)
Tweetworthy.
From Medscspe:
New Peanut Allergy Recommendation Debated
Kate Johnson
February 24, 2015
HOUSTON — Within hours of the release of the Learning Early About Peanut (LEAP) study results, experts were debating the logistics and magnitude of the changes recommended for the management of infants considered to be at high risk for peanut allergy.
Parents should not simply hear a "consume peanut" message, said James Baker, MD, chief executive officer of Food Allergy Research & Education. "We hope that parents understand this isn't something you do without consulting a physician and making absolutely sure the child is not allergic first," he said during a news conference here at the American Academy of Allergy, Asthma & Immunology 2015.
The finding that consumption, not avoidance, reduces the risk of developing peanut allergy by the age of 5 led the LEAP investigators to call for new guidelines to be drafted.
"Timing here is key; there's a narrow window of opportunity to intervene early," said LEAP investigator Gideon Lack, MB BCh, from King's College London and Guy's and St. Thomas' National Health Service Foundation Trust, United Kingdom.
All at-risk infants should receive skin-prick testing for peanut, the LEAP team suggests. Those with a negative test should proceed to normal peanut consumption. Those with a positive test should undergo an oral food challenge and, depending on the results, proceed to normal peanut consumption with careful supervision or avoidance.
When asked about the logistics of such an approach, Dr Lack acknowledged it will be a challenge.
"To actually put this into practice is really going to take a coordinated strategy between all the stakeholders, health professionals, and departments of health in different countries," Dr Lack told Medscape Medical News.
However, he said, the about-face on infant peanut consumption will likely be well received in the medical community.
"One of the things about coming out of medical school is that you realize the learning curve has just started. We have to re-educate ourselves all the time, and that's key. As we acquire more evidence, things change," he explained.
"We believe there's an urgent need for clinicians to be skilled in identifying the at-risk population," said LEAP investigator George Du Toit, MB BCh, from King's College London and Guy's and St. Thomas' NHS Foundation Trust.
Managing Risk
"This means a basic knowledge about atopic eczema, egg allergy, and milk allergy, which are all risk factors for peanut allergy, and then of course skin-prick testing, which in the LEAP study we found to be invaluable for dissecting risk categories," Dr Du Toit explained. "Worldwide, not all patients — in fact a real minority of allergic patients — have access to even those basic diagnostic skills."
On top of that, although infants in the LEAP cohort had only mild to moderate allergic reactions, and no hospitalizations or epinephrine were required, "clinicians need to be able to deal with young infants who have an allergic reaction," he said.
"If any high-risk challenges were to take place, they should only occur in experienced hands and in the appropriate setting with resuscitation skills and facilities," Dr Du Toit explained.
New guidelines are urgently needed to reflect these findings, said Daniel Rotrosen, MD, from the National Institute of Allergy and Infectious Diseases. However, "even with a landmark study like this, and obvious improvement, it's difficult to move to implementation," he explained.
Pediatricians, dermatologists, and family practitioners will be urged to work toward updating the guidelines. "I don't think it should become a turf issue," said Dr Lack. "What matters is expertise. It could be a pediatrician, a family doctor, or a dermatologist who assesses the child and does a skin-prick test. The important thing is training in these procedures, and recognition."
Matthew Greenhawt, MD, from the University of Michigan in Ann Arbor, said he has concerns about the sudden change suggested by LEAP investigators and other experts.
Leaping to Conclusions
Should policy be changed on the basis of one study, "even one study with truly remarkable results?" Dr Greenhawt asked.
"I'd love to see this replicated in the United States, and I'd love to know whether you need to do this for 5 years or 3 years or 12 months," he told Medscape Medical News.
This study was small, Dr Greenhawt pointed out. "You would never change cholesterol recommendations based on one study of 500 patients, and the suggestion being made is that we need to act on this now," he explained.
"I certainly understand the logic and I think we are on the right track, but are we putting the cart before the horse? If you're going to make a recommendation like that, there should be an infrastructure in place to handle the volume of patients that we're going to see," Dr Greenhawt warned.
Dr Baker recently served as senior vice president and global vaccine head at Merck Corporation. Dr Lack reports holding stock and stock options in DBV Technologies. Dr Du Toit and Dr Rotrosen have disclosed no relevant financial relationships. Dr Greenhawt has reported that he is a member of the Educational Advisory Council for the National Peanut Board and has served as a consultant for Deerfield Industries.
American Academy of Allergy, Asthma & Immunology (AAAAI) 2015. Presented February 23, 2015.
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Cite this article: New Peanut Allergy Recommendation Debated. Medscape. Feb 24, 2015.
The doctor who says you'd never change the way cholesterol is handled for everyone based on one small study - that makes a lot of sense. Are they sure they're ready to do something new to this many BABIES? Shouldn't someone replicate this?
Good point Mezzo.
QuotePediatricians, dermatologists, and family practitioners will be urged to work toward updating the guidelines. "I don't think it should become a turf issue," said Dr Lack. "What matters is expertise. It could be a pediatrician, a family doctor, or a dermatologist who assesses the child and does a skin-prick test. The important thing is training in these procedures, and recognition."
"This means a basic knowledge about atopic eczema, egg allergy, and milk allergy, which are all risk factors for peanut allergy, and then of course skin-prick testing, which in the LEAP study we found to be invaluable for dissecting risk categories," Dr Du Toit explained. "Worldwide, not all patients — in fact a real minority of allergic patients — have access to even those basic diagnostic skills."
On top of that, although infants in the LEAP cohort had only mild to moderate allergic reactions, and no hospitalizations or epinephrine were required, "clinicians need to be able to deal with young infants who have an allergic reaction," he said.
"If any high-risk challenges were to take place, they should only occur in experienced hands and in the appropriate setting with resuscitation skills and facilities," Dr Du Toit explained.
I believe he needs to read the recent paper on pediatricians' near complete lack of understanding allergens and anaphylaxis treatment. Also, recipe for clustermessup in the making. I disagree with the idea that it is a turf issues so much as a subject matter expertise related to a select few within the discipline itself.
Quote... the suggestion being made is that we need to act on this now
If you're going to make a recommendation like that, there should be an infrastructure in place to handle the volume of patients that we're going to see," Dr Greenhawt warned.
Yes, making economics and geography independent variables that threaten to stratify patient care levels not to mention regimen compliance.
This sort of begs the question though: Are many out there avoiding like the untreated cohort? When we speak of the theoretical window for the theoretical lowest risk for anaphylaxis but higher risk for sensitizing individuals are they really out there in large numbers? Keep in mind the vast majority in the strict avoidance group (no treatment) did not sensitize regardless, as a small number in the treatment group did.
Assuming in a non clinical setting it's neither regimen nor strict avoidance we could hypothesize a lower number than the untreated group for sensitization. The risk of neither treating or avoiding may yield a number not far away from treatment.
Also, I'd like to see a 5 year follow up of no regimen then test for sustained unresponsiveness. Did it hold? Or do longitudinal data of the treatment cohort trend similarly to standard OIT data once the regimen treatment has ended.
unrelated but saw this in post: Intranasal Flu Vaccine Appears Safe for Egg-Allergic Kids. need to find that.
http://www.nejm.org/doi/suppl/10.1056/NEJMoa1414850/suppl_file/nejmoa1414850_disclosures.pdf (http://www.nejm.org/doi/suppl/10.1056/NEJMoa1414850/suppl_file/nejmoa1414850_disclosures.pdf)
in case anyone wanted to read.
https://foodallergy.partners.org/public/LEAP_response.pdf (https://foodallergy.partners.org/public/LEAP_response.pdf)
http://blog.foodallergy.org/2015/03/11/correcting-misconceptions-about-the-leap-study/comment-page-1/#comment-29629 (http://blog.foodallergy.org/2015/03/11/correcting-misconceptions-about-the-leap-study/comment-page-1/#comment-29629)
They may both be wrong. I had a long post on my phone but lost it. I'll catch up later.
Tweeted by @AllergyEducator
"Consensus Communication Early Peanut Introduction"
http://www.worldallergy.org/consensus-communication-early-peanut-introduction (http://www.worldallergy.org/consensus-communication-early-peanut-introduction)
QuoteInterim Guidance Regarding Early Peanut Introduction