New scorecard helps detect peanut allergy

Paediatricians may have a new tool in a scorecard that could ably detect peanut allergy in infants with atopic dermatitis (AD).

The scorecard reflects recent addendum guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) in the US for peanut allergy prevention, which include, among others, the definition of risk categories, appropriate use of testing (specific IgE measurement, skin prick tests, and oral food challenges), and approaches and timing of introduction of peanut-containing foods in the clinic and at home.

“When the NIAID guidelines first came out, it asked paediatricians to serve as frontline practitioners in implementing the recommendations by identifying children at risk for peanut allergy and guiding families on what to do next,” said Professor Waheeda Samady from the Northwestern University Feinberg School of Medicine in Chicago, Illinois, US. “The impetus for the guidance was to further support paediatricians in this role.”

Leading cause of death

Peanut allergy is a leading cause of anaphylaxis and death and imposes substantial psychosocial and economic burdens on patients and their families. [Allergy 2010;65:933-945]

Infants with AD or eczema are six times more likely to have an egg allergy and 11 times more likely to have peanut allergy by 12 months compared with infants without AD. [Clin Exp Allergy 2015;45:255-264] This calls for increased awareness among paediatricians, particularly if AD is severe, with early onset, among their patients.

Paediatricians are adept at identifying and treating mild-to-moderate AD. However, Samady noted that little emphasis has been placed on categorizing AD based on severity and its correlation with peanut allergy risk.

AD severity and peanut allergy

Two in-house paediatric dermatologists assessed 58 images from 13 children and categorized them as having no sign of AD to severe signs (from 0–4). After a first pass on categorization, they agreed on 84 percent of images. [PAS 2023, poster 380]

Of 189 paediatricians who utilized the scorecard, fewer than half reported that they “sometimes,” “very often,” or “always” used the scorecard for AD assessment. A little fewer than three quarters said their ability to diagnose and categorize AD improved.

Takeaways

“Severity staging of AD is not something that the general paediatrician necessarily performs on a day-to-day basis,” commented Dr Kawaljit Brar from the Division of Allergy and Immunology at Hassenfeld Children’s Hospital in New York, US. “Children who are at high risk are often referred to specialists, who perform allergy screenings and determine whether food introduction at home is safe, or whether office feedings supervised by an allergist are necessary.”

“The findings represent a wonderful initiative to educate paediatricians for them to better understand which patients require screening for peanut allergy and which patients do not and can just get introduced to peanuts at home,” Brar added.