An expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) has released clinical guidelines regarding the early introduction of peanut-containing foods into the diets of infants to prevent the development of peanut allergies.

The addendum guidelines supplement the 2010 guidelines released by the NIAID, and include 3 separate recommendations for infants at various risk levels for peanut allergies.

“Living with peanut allergies requires constant vigilance,” stated Anthony S. Fauci, MD, director of the NIAID. “We expect that widespread implementation of these guidelines by healthcare providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”

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In the first addendum guideline, the panel recommends that infants with severe eczema, egg allergy, or both be introduced to age-appropriate peanut-containing food at ages 4 to 6 months to reduce the risk of allergy. An evaluation with peanut-specific IgE measurement, skin prick tests, or both should be considered to determine whether peanuts should be introduced and to determine the proper method of introduction.

The second guideline suggests that infants with mild-to-moderate eczema should be introduced to peanut-containing food around 6 months of age. The panel notes that solid foods should be introduced before introducing peanut-containing foods, but infants in this category can have dietary peanut introduced at home without an in-office evaluation. However, some clinicians may prefer an in-office supervised feeding or evaluation.

In the third guideline, the panel recommends that infants without a food energy or eczema should have peanut-containing foods introduced in the diet together with solid foods in accordance with family preferences and cultural practices.

The addendum guidelines were developed after data from the Learning Early About Peanut Allergy (LEAP) found that regular peanut consumption in infancy and continued until 5 years of age resulted in an 81% reduction in the development of peanut allergies among infants who were at high risk of developing the allergy. The LEAP study was a randomized, clinical trial that included more than 600 infants.

“The LEAP study clearly showed that introduction of peanut early in life significantly lowered the risk of developing peanut allergy by age 5,” stated Daniel Rotrosen, MD, director of NIAID’s Division of Allergy, Immunology, and Transplantation. “The magnitude of the benefit and the scientific strength of the study raised the need to operationalize these findings by developing clinical recommendations focused on peanut allergy prevention.


  1. Togias A, Cooper SF, Acebal ML, et al. 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. J Allergy Clin Immunol. 2017;139:29-44. doi:10.1016/j.jaci.2016.10.010
  2. National Institutes of Health. NIH-sponsored expert panel issues clinical guidelines to prevent peanut allergy [press release]. Published January 5, 2017. Accessed January 9, 2017.