FAQs for Clinicians2023-06-23T15:25:05+00:00

Food Allergy Prevention FAQs for Clinicians

Here are answers to some of the common questions clinicians ask us we about food allergy prevention.

“Clinicians need to know that at least 95% of infants can and should be introduced to peanuts as early as age 4 to 6 months—no food allergy testing needed. It is only very small percentage of higher-risk infants diagnosed with severe eczema or an egg allergy where sIgE testing should be considered.”

Ruchi Gupta, MD, MPH
Director, Center for Food Allergy & Asthma Research (CFAAR); Professor of Pediatrics, Northwestern University Feinberg School of Medicine & Lurie Children’s Hospital

Food Allergy Prevention FAQs for Clinicians

Do other countries follow the same guidelines as the United States?2023-06-01T17:39:46+00:00

While there is some variation between countries regarding specific recommendations about how to implement early introduction for food allergy prevention, an international consensus has been reached in some key areas. First, national guidelines around the world—including those from Europe, Asia, Australia, Canada, and the United States—agree that it is important to introduce certain commonly allergenic solids (e.g., peanut, egg) into the infant diet during the first year of life. Most countries have identified the 4- to 6-month period as a key window of opportunity for food allergy prevention. Furthermore, no major national or international allergy organization recommends delaying introduction of allergenic solids until after 1 year of age, and most countries highlight the particular importance of early introduction among infants at highest risk. 

 However, there are also some key differences. In contrast with the U.S., many countries do not recommend peanut-specific IgE testing in high-risk infants, citing the safety of food allergen introduction, the exceedingly low risk of serious food allergy reactions with first exposure in babies younger than 1 year, and logistical barriers to testing, which could prevent uptake of early introduction as a key public health intervention. 

What is the research behind early food allergen introduction?2023-06-01T17:39:52+00:00

Published in 2015, the landmark Learning Early About Peanut Allergy (LEAP) study showed an 81% reduction in the prevalence of peanut allergy when an infant-safe form of peanut was introduced early and fed regularly to infants between 4-11 months of age. Importantly, this study only included infants considered “high risk” for food allergy due to severe eczema, egg allergy, or both. 

Published in 2016, the Enquiring About Tolerance (EAT) study randomized breastfed babies with all categories of food allergy risk to either early or standard introduction of allergenic foods. This study demonstrated that introduction and continued feeding of peanut and cooked egg during the first year of life significantly reduced the incidence of allergy to these foods.  

Several other studies on early introduction have been conducted and are ongoing, and evidence is accumulating that early introduction of other allergenic foods besides peanut may help to prevent food allergy. 

How do current recommendations differ from previous guidelines for introducing common allergenic solids?2023-06-01T17:39:58+00:00

As recently as the early 2000s, it was widely accepted that babies at risk for food allergies should avoid common allergenic solids until 1 year of age or older. However, advice to delay the introduction of peanut and other allergenic foods was not based on evidence from rigorous scientific studies.  

Data from rigorous randomized controlled trials now clearly show that delaying introduction of commonly allergenic foods will not prevent food allergies and may even increase the risk for food allergy development. 

Do recommendations for early introduction differ depending on baby’s risk factors for peanut allergy?2023-06-01T17:40:05+00:00

According to guidelines, introduction of peanut foods should be considered for all babies, regardless of risk for food allergy.  

For lower-risk babies without severe eczema or egg allergy, parents should introduce infant-safe peanut foods according to family preferences and cultural practices. Baby should be developmentally ready for solid foods, which typically occurs between 4 and 6 months of age, and peanut should not be the first solid food introduced. 

In high-risk babies with severe atopic dermatitis or egg allergy, peanut-containing foods should be introduced between 4 and 6 months of age to reduce the risk of developing peanut allergy. Pediatric providers can consider screening high-risk infants for peanut-specific serum IgE levels prior to recommending peanut food introduction. 

What do experts recommend to help prevent food allergy?2024-01-24T15:36:30+00:00

In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) published updated guidance recommending early introduction of peanut to prevent peanut allergy. The guidance recommends early introduction for all infants, with particular emphasis on those with severe atopic dermatitis or egg allergy. These infants are considered at high risk for peanut allergy and should begin to receive infant-safe peanut foods between 4 and 6 months of age. Prior to introduction of peanut-containing foods, NIAID recommends consideration of peanut-specific serum IgE testing for these high-risk infants. The NIAID guidelines on early introduction of peanut foods are aligned with those from the American Academy of Pediatrics (AAP) published in 2019 and the Dietary Guidelines for Americans 2020-2025 published in 2020 by the United States Department of Agriculture (USDA) 

A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition was published in 2021 and provides guidance from three major North American allergy societies (AAAAI, ACAAI, CS. In addition to supporting early introduction of infant-safe peanut foods, this consensus document also recommends early introduction of well-cooked egg to prevent egg allergy. 

AAAAI, ACAAI, CSACI). These societies agree on the following: 

  • There is no data indicating that introducing other allergenic foods around 6 months of age is harmful.  
  • Parents should not delay introduction of these foods once other complementary foods have been started. 
  • Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended.  
  • Exclusive breast-feeding is universally recommended for all mother and there is no specific association between exclusive breast-feeding and the primary prevention of any specific food allergy. 

The North American consensus guidance also recommend that both peanut and egg be introduced around 6 months of age, but not before 4 months, to prevent peanut and/or egg allergy. This guidance goes beyond recommendations provided in the Addendum guidelines for the prevention of peanut allergy in the United States. 

What is early allergen introduction?2023-06-16T02:15:08+00:00

Early allergen introduction is the process of introducing common allergenic foods to developmentally ready infants as early as 4 to 6 months of age. Current guidelines recommend early introduction of infant-safe forms of peanut to prevent peanut allergy. Find a summary of all the relevant guidelines here.

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