Update on Early Introduction of Peanut to Prevent Allergy Development: Challenges with Implementation

  • Irene Mikhail
  • Ben T. Prince
  • David R. StukusEmail author
Food Allergy (E Kim, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Food Allergy


Purpose of Review

This review summarizes the evidence leading towards the development of new guidelines that recommend early introduction of peanut to prevent the development of peanut allergy. It also reviews the current understanding of challenges faced with implementation of these recommendations on a widespread basis.

Recent Findings

Prior recommendations to avoid feeding allergenic foods to infants have been updated and reversed. This paradigm shift in advice has created an opportunity on a population level to try and halt the recent increase in prevalence of peanut allergy. However, challenges with implementation of these new guidelines exist in many areas.


While evidence supports the early introduction of peanut to prevent allergy development, the application and challenges faced with these recommendations are not fully understood. Persistent efforts from pediatricians and allergists, as well as acceptance from parents, will be necessary in order to make a significant impact on the prevalence of peanut allergy.


Peanut allergy Early introduction Prevention Food allergy Infant feeding Quality improvement 



enquiring about tolerance


immunoglobulin E


learning early about peanut


National Institute of Allergy and Infectious Disease


oral food challenge


Plan Do Study Act


quality improvement


skin prick test


United Kingdom


United States


Compliance with Ethical Standards

Conflict of Interest

Dr. Stukus was a member of the expert panel and coauthor of the 2017 NIAID Addendum guidelines for early introduction of peanut to prevent allergy. This was unpaid and his role does not serve as a conflict of interest. Drs. Mikhail and Prince declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Irene Mikhail
    • 1
  • Ben T. Prince
    • 1
  • David R. Stukus
    • 1
    Email author
  1. 1.Nationwide Children’s Hospital, Division of Allergy and ImmunologyThe Ohio State University College of MedicineColumbusUSA

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