Should Younger Siblings of Peanut Allergic Children Be Screened for Peanut Allergy?

The role of screening younger siblings of peanut allergic children with allergy testing before peanut introduction is controversial. Although certain guidelines note some value in screening this population, it is not a direct indication in the recent National Institute of Allergy and Infectious Diseases guideline. Some studies suggest that siblings of peanut allergic children are at increased risk of peanut allergy, whereas others note that delayed ingestion or mislabeling of allergy in these children may be the main factors accounting for this increased risk. The low risk of severe reaction with first ingestion and risks of pre-emptive testing must be balanced against data suggesting that families are reluctant to introduce peanut in siblings without testing. The goal of this article is to critically appraise the debated issues in this topic, providing a practical approach to this common clinical dilemma.