FOOD ALLERGY RISK REDUCTION (FARR) PROGRAM

Earlier this year, the Learning Early about Peanut Allergy (LEAP) study showed that by giving peanut products early to infants who are at higher risk of peanut allergy (ie, those who already had egg allergy and/or eczema) there was a dramatic reduction in the rate of peanut allergy compared to avoiding peanut. 

Now, based on a recent recommendation regarding how to best introduce the results of the LEAP study into clinical practice, we have introduced our own Food Allergy Risk Reduction program, or FARR, at the Center for Allergy & Immunology.

Peanut allergy affects between 1 to 3% of children in westernized countries. There appears to be a sudden increase in the number of cases of peanut allergy within the past 15 years, tripling in some countries, including the United States. The LEAP study provided Level 1 evidence that the practice of early peanut introduction in selected high-risk infants and toddlers (those with risk factors for peanut allergy who also have a small positive prick test to peanut on skin testing) is safe and effective.  While hard data only exists for peanut, it is not difficult to apply the data to tree nuts, soy, or wheat; and it could apply to milk and egg as well.

WHAT IS FARR?

In the FARR program, appropriately selected infants under one year of age who have not had a reaction to the food of concern are skin tested to that food. Infants whose skin test is negative or mildly positive are then challenged with the food over a two hour period. If there is no reaction, the parents are instructed to administer the specified quantity of food at least three times a week.

WHO SHOULD CONSIDER FARR?

The LEAP study only enrolled infants who had severe eczema or egg allergy in regards to their risk of peanut allergy. Such children are those most likely to benefit from FARR. We know, however, that many children with food allergy do not meet those criteria. 

In an effort to identify who might be a candidate for FARR, we have utilized a Food Allergy Risk Reduction Scoring System developed by Dr. Richard Wasserman and colleagues.

This scoring system is based on an extrapolation from limited data about the risk factors for the development of food allergy. This system reflects our best estimate of the importance of known risk factors but has not been validated by prospective studies. This scoring system is intended to serve as a guide but decisions about FARR should be made in consultation with your allergist.

RISK FACTOR POINTS:

Eczema prior to age 3 months -10 points
Severe eczema beginning after 3 months - 7 points
Any eczema - 5 points
History of food allergy - 7 points
Any wheezing illness - 3 points
Sibling or parent with food allergy - 3 points
Family history of atopy but not food allergy - 2 points

SCORE - FARR RECOMMENDATION

≥6 Strongly suggest
4-5 Suggest
2-3 Neutral
<2 Not generally recommended

Other factors to consider include a weakly positive blood food allergy test, parental concerns about food allergy and food allergic siblings or other family members in the home.

FARR is not necessary for an infant already eating the food of concern without any adverse reactions. FARR would rarely be appropriate for a child with no personal or family history of allergy. Children with a strongly positive blood food allergy test are not good candidates for FARR.

Interested in learning if FARR is appropriate for your patient or family?

If you are interested in learning more about FARR and if your child is eligible for the program, please contact our office at 816-531-0930 or request an appointment online.