Food introduction in younger siblings of children with food allergy - Twitter summary from #CSACI15 meeting

Twitter summary made possible by:
@dranneellis
@allergydoc4kidz
@igecpd
@erika_ladouceur
@drloriconnors
@drdougmackmd

Dr Philippe Begin from Montreal (via Stanford) on food introduction in younger siblings of children with food allergy. Dr Philipe Bégin from Hôpital Ste. Justine discussing thorny issue of introduction of foods to siblings who have food allergy.

Discussing @maryjmchenry study in AACI about food introduction in siblings: 77% of parents had significant anxiety.

High level of anxiety of introducing foods to younger sibling of food allergic child. McHenry and Watson published on introduction in families with food-allergic children, lots of anxiety and avoidance. @maryjmchenry surveyed 644 Canadian families with food allergy - 90% delayed intro of peanut to younger siblings. 90% of Canadian families with a peanut allergic child avoided early introduction of peanut in younger siblings. More than half of these families had received specific advice to avoid or delay specific foods.

There is 7% risk of sibling having peanut allergy - this is nominally increased! Dr Bégin: O'Hourihane's study in BMJ noted 7% rate of peanut allergy in younger siblings of Peanut allergic kids. Siblings have just under 7% chance of PN allergy, OR in SAGE cohort of about 6 over general population.O'Hourihane's 1996 study showed that the rate of peanut allergy in a sibling of a peanut allergic child was 6.9% .

Risk of elevated sibling rate may be because of avoidances! As per LEAP study - don't wait - give it.

Probably best NOT to test for siblings, unless significant parental reluctance to attempt introduction despite counseling. Establishing pre-test probability critical before considering any testing for food allergy.

FRATRIES study

Dr Bégin started a prospective trial of PN introduction without instructions in siblings of peanut allergic kids called 'FRATRIES'. After the peanut challenge then then did 'double blind' allergy testing: 7 tests with fresh peanut butter and pea butter. The tests were read by different allergists so as to not create bias in their reading of them. Dr Bégin: 161 kids enrolled so far. Completion in Nov 2015. 8 reactions to peanut: 5 got Epi with 2 getting 2 or more shots. 1 hosp.

FRATRIES study rate of reaction in sibling higher in older sibs. Dr Bégin: The older the child enrolled, the greater the likelihood of reaction in this study of Peanut anaphylaxis