Increased Rates of Peanut and Tree Nut Aspiration as a Possible Consequence of Allergy Prevention by Early Introduction.

Abstract Background Paediatric airway foreign bodies (FB) are a surgical emergency, and peanuts and tree nuts (PN/TNs) can pose a significant aspiration risk in young children. In 2015, the Learning Early About Peanut allergy (LEAP) trial established that early introduction of peanuts in high risk infants reduced the risk of developing a peanut allergy. Infant feeding guidelines were subsequently modified to actively encourage the introduction of allergenic foods for all infants. The impact of this shift in feeding advice on the incidence of PN/TN inhalation has not been previously studied. Objective To determine the incidence of PN/TN inhalation presentations to a quaternary paediatric hospital between 2008-2018. Methods A retrospective cohort study of children who were diagnosed with an airway FB by rigid bronchoscopy. Results There were 200 cases of FB inhalation (35% PN/TN, 34% other foods and 31% inorganic material). There was a rise in the total incidence of FB inhalation over the study period (IRR1.09, p Conclusion Since the publication of LEAP, there has been a rise in PN/TN and other hard solid food inhalation at our institution. This study highlights the urgent need to engage the public to promote safe introduction of hard foods in young children.