Navigating Challenges in the Implementation of Early Peanut Introduction Guidelines

Navigating Challenges in the Implementation of Early Peanut Introduction Guidelines Posted By:
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In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) released guidelines advocating for the early introduction of peanuts to infants as a preventive measure against peanut allergies. The recommendations were based on the 2015 Learning Early About Peanut Allergy (LEAP) study which demonstrated that early introduction of peanut products to high-risk infants as early as 4 to 6 months substantially reduced their risk of developing peanut allergy later in life. Although many allergists were already implementing early introduction recommendations before the official 2017 guidelines were published, there remain several major barriers to implementing the recommendations, from both a provider and caregiver perspective.  

The NIAID Addendum Guidelines for the Prevention of Peanut Allergy discussed introduction and/or possible testing strategies for infants at high risk of developing peanut allergy. Below is a table summarizing the Addendum Guidelines: 

Table: Summary of NIAID Addendum Guidelines for the Prevention of Peanut Allergy

A recent 2023 study by Samady and colleagues found that only about 13% of parents said they are aware of the new guidelines, and only about 58% of primary care providers are discussing them with parents or caregivers. Those who do discuss early introduction with their provider are more likely to introduce peanuts earlier, but nearly 75% are still waiting until their child is at least 6 months of age.   

Unfortunately, numerous barriers and challenges to implementing the guidelines remain. One such barrier is outdated practice recommendations. Other barriers include inconsistent recommendations and lack of awareness of who is considered high-risk. Many providers may struggle to identify an infant with severe vs moderate forms of atopic dermatitis/eczema, and therefore consider any infant with eczema to be high-risk. Time constraints at well-visit appointments is a challenge for many parents and doctors, and there is also the fear of reaction, with many parents delaying introduction because of this. Reassuring parents, or even offering supervised feedings in the office setting, can help relieve some of this anxiety and increase successful introduction. Further, the addendum guidelines also contain appendices to help provide parents with at-home introduction for low-risk infants.  

An additional challenge is when primary care providers who order serum-specific IgE testing are unfamiliar with the interpretation of these results. In addition, many primary care providers will order full serum IgE food panels, which is not clinically indicated and can lead to unnecessary avoidance of other foods. When in doubt, it’s best to refer to an allergist for further guidance. Double-blind, placebo-controlled oral food challenges remain the gold standard for diagnosis of food allergy, and oral food challenges are safely done in the allergy office under supervision for appropriate patients or in those where the diagnosis is in question. 


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Filed under: NPs & PAs , Allergy/Immunology

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