Applying LEAP Recommendations In Clinical Practice: Not As Straightforward As It Seems

Background: Following the revolutionary results from the LEAP (Learning Early about Peanut Allergy) study advising the early introduction of peanuts to children at high risk of this allergy, clinicians and allergists have been trying to implement this safely into clinical practice, with the ultimate goal of reversing the trend of rising peanut allergy within the population. However, despite good intentions and well-thought through methods, this does not always go to plan.

Method: We discuss a 13-month old girl with severe eczema who has a negative skin prick test, IgE and component blood tests to peanut, and is suitably advised to perform an oral peanut challenge at home. Unfortunately, Mum subsequently reports symptoms of widespread urticaria and watery eyes on ingestion of a small amount of peanut butter. Despite the likelihood that this is an allergic reaction to peanut, because of the discrepancy between her tests and her home challenge, parents request to proceed with an hospital-based oral food challenge.

Conclusion: Applying evidenced-based knowledge within clinical practice may not be as straightforward as clinicians would envisage. In order to work together and made a significant reduction in prevalence of peanut allergy particularly in the UK, clearer national guidelines or recommendations need to be developed to guide clinicians towards the safe introduction of peanuts in children with high risk of developing this allergy.