Early peanut introduction can prevent allergy but parents need clearer guidance

Feeding babies peanut-containing foods as early as possible can help prevent peanut allergy, but a new study published in JAMA Network Open found that parents need more support to get it right. Interviews with parents revealed widespread confusion about the purpose, risks, and timing of early peanut introduction guidelines.

"While some parents we talked to understood correctly that starting their baby on peanut foods trains the immune system in order to prevent the development of peanut allergy, other parents mistakenly believed that the purpose is to test if their baby is allergic – a misconception that fueled fears of severe allergic reaction, leading to hesitation and delays in peanut introduction," said lead author Waheeda Samady, MD, a hospital-based pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

"For prevention of peanut allergy, timing and consistency are of the essence," she said. "We encourage peanut introduction as soon as the baby starts eating solids, before or around 6 months of age. It's also important to continue peanut exposure twice a week through the first year and into toddler years. Feeding babies peanut foods just once or twice is not enough."

Early peanut introduction guidelines were issued in 2017 following groundbreaking research showing over 80% reduction in peanut allergy development. Peanut allergy affects approximately 2% of U.S. children and is the least likely food allergy to be outgrown, making prevention through early introduction an important public health strategy.

Dr. Samady and colleagues analyzed 49 interviews with Chicago parents of infants aged 8-13 months from diverse backgrounds. Participants were recruited from primary care academic clinics, federally qualified health centers and private clinics.

Researchers also found that parents mostly did not understand that eczema places their baby at high risk for developing food allergy, making early peanut introduction even more critical.

If a baby has eczema, peanut introduction should start early, around 4 months of age, if possible, to maximize peanut allergy prevention coupled with good skincare. Pediatricians need to reinforce this message, given that most parents we interviewed were not aware that eczema increases the baby's chances of developing food allergies."

Waheeda Samady, MD, Lead Author

In the study, parents reported that pediatricians were their primary source of information about early peanut introduction.

"Pediatricians are key to successful guideline implementation, but they need better resources for families to provide comprehensive information during busy well-child visits," Dr. Samady noted. "Overall, we found that parents are accepting of early peanut introduction, but they need clearer guidance and more support."

Dr. Samady emphasized that improved messaging and resources for families should clarify that early peanut introduction prevents peanut allergy through regular dietary exposure, address the connection between eczema and food allergy risk, provide specific guidance on timing and frequency, and reassure parents about the low risk of severe allergic reactions in infants.

"Parents need to be reassured that if their baby is allergic to peanut, they may see hives, some swelling, or vomiting, but allergic reactions in infancy are usually mild," she explained. "We should empower parents with information and action plans so this does not stop them from participating in early peanut introduction."

This research was funded by the National Institute of Allergy and Infectious Diseases (NIAID K23AI159517).