by Jesse M. Hackell, M.D., FAAP
An AAP-endorsed clinical practice guideline on the diagnosis and
treatment of cerumen impaction focuses on primary prevention, the decision to intervene, and
referral and coordination of care.
The updated guideline was released by the American Academy of Otolaryngology – Head and Neck
Surgery Foundation. It is published in
Otolaryngology — Head and Neck Surgery and is available
Clinical Practice Guideline (Update): Earwax (
Cerumen Impaction) is a revision of a 2008 guideline
and includes evaluation of new evidence reviews,
newly formulated action statements with an algorithm for implementation and enhanced tools for
patient education. The authoring group represented otolaryngology, audiology, pediatrics, internal
medicine, nursing and consumer health care advocacy, and the updated guideline has been endorsed
by multiple professional societies.
by Scott H. Sicherer, M.D., FAAP
With a potentially huge public
health impact, new AAP-endorsed
guidelines outline a new approach
that promises to reduce the risk of peanut allergy.
Estimated to affect 1%-2% of children, peanut allergy often is severe and lifelong. The new guidelines
recommend early introduction of peanut protein for
infants who are at increased risk of developing the allergy. They caution, however, that peanuts and peanut
butter are choking hazards, and advise on forms that
are safe for infants such as peanut butter smoothed
into pureed fruits or vegetables.
Addendum Guidelines for the Prevention of Peanut
Allergy in the United States: Report of the National In-
stitute of Allergy and Infectious Diseases-Sponsored Ex-
pert Panel is available at http://dx.doi.org/10.1016/j.
jaci.2016.10.010 and is co-published in the Jour-
nal of Allergy and Clinical Immunology and other
The guidelines are based primarily on the results of
the landmark Learning Early About Peanut (LEAP)
trial (Du Toit G, et al. N Engl J Med. 2015;372:803-
813). The study randomized 640 infants from 4-11
months of age with severe eczema and/or egg allergy
to ingest or avoid peanut until 60 months of age. The
study excluded infants with large positive skin prick
tests (SPTs) to peanut, assuming they already were
allergic, and stratified the enrolled infants as having
no peanut SPT wheal or having one that was 1-4
millimeters in diameter.
The results showed that in the negative SPT group,
the prevalence of peanut allergy at age 5 was 13.7%
in the avoidance group vs. 1.9% in the consump-
www.aapnews.org Volume 38 • Number 2 • February 2017
Study: Only 23% of youths
from the AAP Department of Research
Among U.S. children meeting clinical criteria for hypertension, few are given a diagnosis of hypertension and even fewer are being
treated with medication. These findings are detailed in a recently published study involving
the AAP Pediatric Research in Office Settings
(PROS) network (Kaelber DC, et al. Pediatrics.
Prior research has shown that hypertension is
underdiagnosed among children, and untreated
hypertension can have negative effects on child
development and health over time. The current
study used a large national sample of electronic
health records (EHRs) from more than 1.2 million children in 196 pediatric primary care practices to determine how frequently hypertension
is diagnosed and treated.
Data came from analyses of EHRs from
398,079 children ages 3-18 years who had three or
more primary care visits between 1999 and 2014
where both blood pressure and height were mea-
See Peanut allergy, page 4
In this issue
Common legal questions answered
Committee on Medical Liability and Risk Management member
answers questions about practicing across state lines, tail
insurance. Page 18
Updated policy on confidential care
Pregnant adolescents have the right to confidential care when
seeking abortion services, according to an updated AAP policy.
Excessive or impacted earwax can block smaller
ear canals, making removal necessary for evaluation of the tympanic membrane in cases of fever;
other treatment indications include ear pain or
pressure, and hearing loss.
See Impacted cerumen, page 10
See Hypertension, page 17
New guidelines detail use of ‘infant-safe’
peanut to prevent allergy
Updated guideline advises on treating
children with impacted cerumen
Only 6% of children diagnosed with hypertension were prescribed antihypertensive
medication within 12 months of diagnosis,
the study also found.