1. Beal, Judy A. DNSc, RN, FAAN

Article Content

At the Fall 2021 Annual Scientific Meeting of the American College of Allergy, Asthma, and Immunology, Warren et al. (2021) reported pediatric primary care providers were not following the 2017 National Institute of Allergy and Infectious Diseases (NIAID) guidelines for the early introduction of peanut-containing foods to prevent peanut allergy (Togias et al., 2017). An expert panel was convened by NIAID to review evidence that showed that introducing peanut-containing food products during early infancy can prevent development of a life-threatening allergy to peanut products (Togias et al.). Their work was based on a 2015 clinical trial that found regularly consuming peanut products between infancy through 5 years of age can reduce development of an allergy in infants at high-risk (with severe eczema and/or egg allergy) by 81% (Du Toit et al., 2015). The Addendum Guidelines for the Prevention of Peanut Allergy in the United States provides three recommendations for pediatric providers: 1) high-risk infants (those with severe eczema and/or egg allergy) should be introduced to peanut-containing foods at 4 to 6 months and caregivers should consult with their provider before introducing any of these foods as a skin-prick test or oral challenge may be indicated to determine significant existing allergy; 2) infants with mild or moderate eczema should be introduced to peanut-containing foods at 6 months; and 3) infants without eczema, or any food allergy should be introduced to these food products whenever solid foods are offered (Togias et al.).


In the follow-up on adherence to the 2017 NIAID guidelines, Warren et al. (2021) conducted a multidisciplinary survey study of parents and caregivers of children ages 7 months to 42 months. Responses were obtained from 3,062 U.S.-based households and were deemed to be socially and demographically representative. Eleven percent of study infants had a diagnosis of eczema and of that 11%, 26% had severe disease markers. Overall, 58% of respondents reported their primary care provider had discussed introduction of peanut products at 11 months versus 69% of those caregivers with children with eczema. Only 44% reported introducing peanut products by 11 months and of those caregivers, only 13% were aware of the NIAID guidelines. The authors concluded that these prevention of peanut allergy guidelines are rarely followed, and parents and caregivers are not well informed.


The NIAID guidelines recommend introducing peanut products for high-risk infants at 4 to 6 months and for those with mild-to-moderate risk at 6 months (Togias et al., 2017). Pediatric nurses are critical to the education of parents and caregivers about these lifesaving guidelines. The American Academy of Pediatrics (Sicherer, 2017) has specific and detailed advice for each of the three guidelines. Related resources have been published for pediatric providers as well as for parents and caregivers (NIAID, 2017).




Du Toit G., Roberts G., Sayre P. H., Bahnson H. T., Radulovic S., Santos A. F., Brough H. A., Phippard D., Basting M., Feeney M., Turcanu V., Sever M. L., Lorenzo M. G., Plaut M., Lack G.for the LEAP Study Team. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England Journal of Medicine, 372(9), 803-813.[Context Link]


National Institute of Allergy and Infectious Diseases. (2017). NIH-Sponsored expert panel issues clinical guidelines to prevent peanut allergy. Accessed December 21, 2021. [Context Link]


Sicherer S. H. (2017). New guidelines detail use of 'infant-safe' peanut to prevent allergy. AAP News, 38(2), 1-4.[Context Link]


Togias A., Cooper S. F., Acebal M. L., Assa'ad A., Baker J. R. Jr., Beck L. A., Block J., Byrd-Bredbenner C., Chan E. S., Eichenfield L. F., Fleischer D. M., Fuchs G. J. 3rd, Furuta G. T., Greenhawt M. J., Gupta R. S., Habich M., Jones S. M., Keaton K., Muraro A., ..., Boyce J. A. (2017). Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. The Journal of Allergy and Clinical Immunology, 139(1), 29-44.[Context Link]


Warren C., Nimmagadda S., Samady W., Venter C., Galic I., Hultquist H., Vincent E., Gupta R. (2021). Current US parent/caregiver knowledge, attitudes, and behaviors regarding dietary introduction of peanut protein during infancy. Annals of Allergy, Asthma, and Immunology, 127(5), S19-S56.[Context Link]