From the Guidelines
The family should be encouraged to introduce highly allergenic foods, including peanuts, shellfish, and eggs, into their 6-month-old's diet. Current evidence shows that early introduction of allergenic foods, rather than delayed introduction, actually reduces the risk of developing food allergies. For peanuts specifically, introduction between 4-11 months is recommended, particularly for infants at higher risk of allergies, as stated in the guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) 1. The first exposure to these foods should occur at home when the infant is healthy, starting with small amounts mixed with previously tolerated foods. Parents should observe for any allergic reactions such as hives, vomiting, or respiratory distress.
The dry, scaly patches on the infant's extremities suggest atopic dermatitis (eczema), which is associated with increased risk of food allergies, making early introduction of allergenic foods even more important, as noted in the guidelines for the prevention of peanut allergy in the United States 1. The family history of food allergy in a cousin is not a contraindication to introducing these foods, as genetic risk is primarily associated with immediate family members (parents and siblings). Continuing vitamin D supplementation remains appropriate for the breastfed infant, and the petroleum jelly for dry skin is an appropriate treatment for the likely eczema.
It is also important to consider the most recent guidelines and recommendations, such as those from the Journal of Allergy and Clinical Immunology in 2019, which emphasize the importance of introducing allergenic foods, including peanuts, in the first year of life to infants who are developmentally ready, around 6 months of age, but not before 4 months of age, particularly to those at high risk of allergy 1. Additionally, international guidelines, such as those compared in the Journal of Allergy and Clinical Immunology in 2021, support the introduction of allergenic foods, including peanuts, in the first year of life to reduce the risk of food allergies 1.
From the Research
Introduction to Allergies and Prevention
- The patient's family is concerned about introducing highly allergenic foods such as peanuts, shellfish, and eggs due to a family history of severe allergic reactions 2.
- There is limited evidence on the primary prevention of allergic diseases, including the introduction of highly allergenic foods 2.
Vitamin D Supplementation and Allergies
- A systematic review of randomized and non-randomized studies found that vitamin D supplementation may not decrease the risk of developing allergic diseases such as atopic dermatitis, allergic rhinitis, asthma, and food allergies 2.
- However, another study found that vitamin D supplementation can improve allergic symptoms in patients with allergic rhinitis and vitamin D deficiency 3.
Treatment of Allergic Reactions
- First-generation antihistamines can have adverse effects on the central nervous system, while newer antihistamines are potentially safer and cause less sedation with similar efficacy 4, 5.
- Second-generation H1 antihistamines are recommended for the treatment of allergic conditions such as allergic rhinitis and urticaria due to their safety and efficacy 5.
Other Considerations
- There is no relevant evidence on the introduction of highly allergenic foods in the provided studies.
- A study on the mechanism of oxidation of reduced nicotinamide dinucleotide phosphate by submitochondrial particles from beef heart is not relevant to the patient's condition 6.