Early Introduction to Peanut and Eggs

By: Ravneet Donegan, MD, Allergy & Immunology, 04/19/2022

Major allergy and immunology societies continue to encourage early dietary introduction to commonly allergenic foods such as cow's milk, eggs, wheat, soy, sesame, peanuts, tree-nuts, fish, and shellfish with a special focus on PEANUT and COOKED EGG.

In 2021, the North American Allergy Societies, which includes the American Academy of Allergy, Asthma, and Immunology (AAAAI), American College of Allergy, Asthma, and Immunology (ACAAI), and Canadian Society of Allergy and Clinical Immunology (CSACI) released a consensus statement to “Provide Guidance On Food Allergy Prevention Through Nutrition" based on recently published data that has "the strong potential of strategies to prevent the development of food allergy.”

Major Take-Home Points from this Consensus Statement Include the Following:

  1. Consider infants with severe eczema at highest risk for developing food allergy. However, even children without a history of eczema or family history of allergic disorders can develop food allergies. Therefore, early introduction to commonly allergenic foods should generally be encouraged in all infants.

  2. Regularly* feed PEANUT and COOKED EGG starting at 4-6 months. Introduction can occur at home using age-appropriate forms of these foods as soon as 4-6 months of age, if the child is developmentally ready.
    • *Eating something “Regularly” for allergenic foods is typically about 2-3x/week or more.

  3. Do not deliberately delay the introduction of other common food allergens, which include cow's milk, wheat, soy, sesame, tree-nuts, fish, and shellfish.

  4. Feed a diverse diet. Observational evidence suggests that feeding infants a broad variety of food after they have been introduced to solids around 4-6 months of age, including potentially allergenic foods, may help prevent food allergy from developing.

  5. Hypoallergenic formulas are not recommended for preventing food allergy. There is no conclusive data that demonstrates a protective benefit in the prevention of food allergy from hypoallergenic formulas.

  6. Maternal exclusion diets are not There is no evidence that mothers should avoid common food allergens during pregnancy or while breastfeeding as a means to prevent food allergy.

References:

- Fleischer DM, Chan ES, Venter C, et al. A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. J Allergy Clin Immunol Pract. 2021;9(1):22-43.e4. doi:10.1016/j.jaip.2020.11.002