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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: March 4, 2015
Expiration Date: March 4, 2016

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards. Program ID: 1405237Q2

Last week 772 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 237 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to inform clinical practice," one article was selected by the DynaMed Editorial Team.

Consumption of Peanut Products During Infancy May Reduce the Incidence of Peanut Allergy Compared to Peanut Avoidance in High Risk Children

Reference: LEAP Trial (N Engl J Med 2015 Feb 26;372(9):803) (level 2 [mid-level] evidence)

Peanut allergies in children are on the rise world-wide, with an increase in self-reported childhood peanut allergies in the United States from 0.4% in 1997 to 1.4% in 2008 (World Allergy Organ J 2013 Dec 4;6(1):21, J Allergy Clin Immunol 2010 Jun;125(6):1322). In 2000, the American Academy of Pediatrics recommended excluding peanuts from the diets of pregnant and nursing mothers of infants at high risk for developing allergies and excluding peanuts from the child’s diet until 3 years of age (Pediatrics 2000 Aug;106(2 Pt 1):346). This recommendation was removed in 2008, however, with the increasing prevalence of peanut allergies and new studies finding elimination of food allergens from diet did not prevent the development of food allergies (Pediatrics 2008 Jan;121(1):183, N Engl J Med 2003 Mar 13;348(11):977, Pediatrics 2006 Feb;117(2):401), but the questions surrounding timing of food introduction for the prevention of food allergies remain. A recent randomized trial of 640 infants aged 4-11 months at high risk for developing allergies compared peanut consumption vs. peanut avoidance until age 60 months. High risk infants were defined as those with severe eczema, egg allergy, or both.

Prior to randomization, all infants were tested for peanut allergy by skin-prick test and stratified into groups based wheal size. Infants with no measurable wheal (negative) or a 1-4 mm wheal diameter (positive) were randomized, while infants with a wheal diameter > 4 mm were excluded for safety reasons. All infants randomized to peanut consumption were given a baseline unblinded food challenge. Seven infants with a positive food challenge were instructed to avoid peanut products, but were included in peanut consumption group in the intention-to-treat analysis. All other infants with a negative baseline food challenge received at least 6 g of peanut protein (Bamba snack or smooth peanut butter) divided across at least 3 meals each week. Peanut allergy was assessed at 60 months by oral food challenge.

The intention-to-treat analysis included 98% of randomized infants and results are shown in the table below. The table also shows the analysis by baseline stratification of skin-prick test results. There were no significant differences in hospitalization rates or adverse events between groups.

Rate of Peanut Allergy at 60 Months
  Peanut consumption group Peanut avoidance group p value NNT
All infants (n=640) 3.2% 17.2% p <0.01 NNT 8
Infants with positive skin prick test (n=542) 1.9% 13.7% p <0.01 NNT 9
Infants with negative skin prick test (n=98) 10.6% 35.2% p = 0.04 NNT 9

This trial suggests that early peanut consumption may decrease the development of peanut allergies in high risk children and moreover the length of this study provides particularly compelling evidence that the reduced risk of allergy is not a transient effect. These results highlight the importance of basing clinical recommendations on evidence from clinical trials whenever possible, since clinical outcomes have often proven to be counter-intuitive. Further studies are required to determine if early peanut exposure would prevent the development of peanut allergies in low-risk children showing early peanut sensitization on skin-prick test or if these results could be generalized to other common food allergens.

For more information, see the Food allergy topic in DynaMed.

DynaMed Introduces New and Improved Mobile App

DynaMed users can now access valuable, evidence-based content anywhere with the new DynaMed mobile app. The new app has been redesigned to make it easier and faster for physicians to find answers to clinical questions. The app features an improved user experience, seamless authentication and easy access to the latest clinical content. It provides offline access, and the ability to denote favorites, email topics and write and save notes about particular topics. Users download the complete DynaMed content set and periodically receive notifications to update the content.

The DynaMed app is a complimentary part of personal and institutional DynaMed subscriptions. The app has also been designed for easy, one-time authentication via email, making the process as convenient as possible.

The app can be downloaded from the iTunes Store or Google Play. For more information, please visit the DynaMed Mobile Access page.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: Gastroenterology, Nephrology, Oncology (especially Breast cancer, Head and neck cancer, Pancreatic cancer), Ophthalmology, and, Pediatric Neurology.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

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Become a DynaMed Resident Focus Reviewer
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