Does early introduction of peanuts to an infant's diet reduce the risk for peanut allergy?

Abstract

Q: Does early introduction of peanuts to an infant's diet reduce the risk for peanut allergy? Evidence-based answer: Probably not, unless the child has severe eczema or egg allergy. In a general pediatric population, introducing peanuts early (at age 3 to 6 months) doesn't appear to alter rates of subsequent peanut allergy compared with introduction after age 6 months (strength of recommendation [SOR]: B, randomized clinical trial [RCT] using multiple potential food allergens). In children with severe eczema, egg allergy, or both, however, the risk for a peanut allergy is 12% to 24% lower when peanut-containing foods are introduced at age 4 to 11 months than after age 1 year. Early introduction of peanuts is associated with about 1 additional mild virus-associated syndrome (upper respiratory infection [URI], exanthem, conjunctivitis, or gastroenteritis) per patient (SOR: B, RCT). Introducing peanuts before age 1 year is recommended for atopic children without evidence of pre-existing peanut allergy; an earlier start, at age 4 to 6 months, is advised for infants with severe eczema or egg allergy (SOR: C, expert opinion).