Prevention Guidelines & Supporting Research

Learn about the latest food allergy prevention guidelines and the research on which the guidelines are based. As new findings become available they will be added here, so check back regularly for summaries of the latest research on food allergy prevention.

Jay Lieberman

“Pediatric clinicians need to know that early allergen introduction is an easy and safe way to decrease rates of peanut food allergy, and possibly other food allergies too.”

Jay Lieberman, MD
MD Professor of Pediatrics, The University of Tennessee Health Science Center and Le Bonheur Children’s Hospital

Current Guidelines from Leading Health Organizations Support Early Allergen Introduction

NIAID Guideline Summary

  • Most infants should receive infant-safe peanut-containing foods when develpmentally ready for solids foods, as early as 4 to 6 months of age.
  • Peanut should not be the first solid food introduced.
  • Infants with severe eczema or egg allergy are considered high risk for peanut allergy and should receive infant-safe peanut foods starting between 4 and 6 months 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. While not officially part of the NIAID guidelines, recent consensus guidance suggest testing is not required. (7)

USDA/HHS Guideline Summary

  • Potentially allergenic foods should be introduced when other complementary foods are introduced to an infant’s diet. These include peanut, egg, cow’s milk products, tree nuts, wheat, crustacean shellfish, fish, and soy.
  • Introducing peanut-containing foods in the first year of life reduces the risk that an infant will develop a food allergy to peanuts.
  • For infants at high risk of peanut allergy, introduce peanut-containing foods at 4 to 6 months of age and follow the existing Addendum Guidelines for the Prevention of Peanut Allergy in the United States.

Other Organizations that Support or Endorse Early Allergen Introduction:

FDA Guidance

“The FDA acknowledges the qualified health claim linking early peanut introduction and reduced risk of developing peanut allergy.”

“Introducing foods containing ground peanuts between 4 and 10 months of age and continuing consumption may reduce the risk of developing peanut allergy by 5 years of age.”

AAP Guidance

“There is now evidence that early introduction of peanuts may prevent peanut allergy.”

“The new recommendations for the prevention of peanut allergy are based largely on the LEAP (Learning Early About Peanut Allergy) trial and are endorsed by the AAP.”

“It is hoped that the screening process for the infants at highest risk (specific IgE measurement, skin-prick test, and oral food-challenge test) will not be a deterrent or generate ‘screening creep’ for infants not in the high-risk category.”

AAAAI / ACAAI / CSACI Guidance

“To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months.”

“Other allergens should be introduced around this time as well. Upon introducing complementary foods, infants should be fed a diverse diet, because this may help foster prevention of food allergy.”

“This expert consensus guidance recommends that screening before introduction is not required, but may be preferred by some families.”

Christopher Warren

“The data from the landmark LEAP and EAT Studies upon which the current NIAID peanut allergy prevention guidelines are based show that introducing safe peanut foods during the first year of life is very effective at reducing peanut allergy risk in infants with and without eczema, of all ethnicities, and irrespective of whether or not they are sensitized to peanut.”

Christopher Warren, PhD
Assistant Professor of Preventive Medicine and Director of Population Health Research at the Northwestern University Feinberg School of Medicine’s Center for Food Allergy and Asthma Research.

Research Supporting Early Introduction for Food Allergy Prevention

The LEAP Study

Published in 2015, the landmark Learning Early About Peanut Allergy (LEAP) study showed an 81% relative reduction in the prevalence of peanut allergy when an infant-safe form of peanut was introduced early (between 4-11 months of age) and fed regularly until 5 years of age. Importantly, this study only included infants considered at high risk for food allergy due to severe eczema, egg allergy, or both. This study was funded, in part, by FARE.1

The EAT Study

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 prevalence of those food allergies.6

Is the protective effect of early peanut introduction durable?

Yes! The Persistence of Oral Tolerance to Peanut study, also called LEAP-On (partially funded by FARE), followed children who had participated in LEAP to evaluate what would happen if children who ate peanut foods from an early age avoided peanut for a full year. Researchers found that children who ate peanut foods from infancy to age 5 years and then avoided peanuts from ages 5 to 6 years were still 74% less likely to develop peanut allergy than children who had consistently avoided peanut foods from infancy to age 6 years. LEAP-On showed that the peanut tolerance promoted by early introduction to peanut foods could be long-lasting.6