Practical Guidance & Tools For Your Clinic

Use the guidance below, along with the downloadable office aids and guides, to help you and your colleagues easily incorporate early allergen introduction into your practice.

All pediatric clinicians should be aware of current guidelines for the prevention of food allergy such as the early introduction of safe peanut foods into the weaning diet.”

George du Toit, MB, BCh
Professor in Pediatric Allergy, Evelina Children’s Hospital London and King’s College London, Investigator on the LEAP Studies

Adopt the Three E’s of Early Peanut Introduction

1. ENCOURAGE

Encourage all parents to introduce infant-safe peanut-containing foods when their baby is developmentally ready, as early as 4 to 6 months of age.

  • At-home introduction of infant-safe peanut-containing foods has been shown to be effective and safe for most infants and should not interfere with continued breastfeeding.
  • Early and often are the keys to success. Evidence from large, randomized, controlled trials suggests that providing peanut-containing foods 2 to 3 times per week is optimal for risk reduction.
  • Empathize with families already managing peanut allergy at home. Strategize how they can regularly provide peanut-containing foods to their infant while protecting the allergic household member(s) from exposure to peanut.

2. EVALUATE

Evaluate the small subset of infants (<5%) who have severe atopic dermatitis or an egg allergy and are considered at high risk for developing a peanut allergy.

  • These high-risk infants benefit most from the introduction of infant-safe peanut-containing foods starting as early as 4 months.
  • Consider ordering peanut-specific serum IgE testing prior to the introduction of peanut-containing foods for these infants.
  • Promptly refer infants with positive peanut-specific IgE results to an allergy specialist for additional evaluation and recommendations.

3. EDUCATE

Educate parents about readiness cues to start introducing solids and how to introduce peanut-containing foods safely and effectively.

  • Introduce infant-safe forms of peanut after 2 or 3 other complementary foods have been safely introduced.
  • Two teaspoons of smooth peanut butter mixed with water, breast milk, or formula is a good place to start. This is equivalent to about 2 g of peanut protein.
  • Discuss the early introduction of other top allergen foods as part of a diverse and healthy diet and as recommended in the 2020-2025 Dietary Guidelines for Americans. These foods include egg, tree nut, sesame, soy (tofu), cow’s milk products (yogurt), shellfish, finned fish, and wheat.
  • Share information on how to identify a food allergy reaction in an infant.

“You can help prevent food allergy disease just by spending a few extra minutes in your complementary feeding discussions with parents.”

Stephanie Leeds, MD 
Assistant Professor, Pediatric Allergy and Immunology, Yale University

Using Well-Baby Visits to Promote Early Introduction of Allergenic Solids

  • Assess baby for signs of severe atopic dermatitis
  • Counsel parents on signs of developmental readiness for the introduction of solid foods
  • Explain the benefits of introducing infant-safe forms of peanut early
  • Assess baby for signs of developmental readiness for introduction of solid foods
  • For babies who are not yet developmentally ready, review signs of readiness with parents
  • Assess baby for signs of severe atopic dermatitis
  • Unless baby has severe atopic dermatitis, remind parents about the benefits of early introduction of peanut-containing foods, and review recommended infant-safe peanut food preparations
  • If baby has severe atopic dermatitis, either refer to an allergist or order peanut-specific serum IgE testing and make recommendations based on results
  • If complementary foods have been introduced, ask about progress with the introduction of peanut and other allergenic solid foods
  • Remind parents that feeding of allergenic solids should be an ongoing process

Download FREE Tools to Use in Your Clinic

Three E’s of Early Peanut Introduction

Use this simple checklist as an in-office guide as you discuss early peanut introduction with parents.

Preventing Food Allergies in Infants: Putting the NIAID Guidelines Into Practice

Download this simple, comprehensive guide for you and your staff to better understand early allergen introduction and to read expert recommendations for implementing the guidelines in your practice.