Early Peanut Introduction for Allergy Prevention: Evidence and Practical Implementation in Pediatric Practice

Peanut allergy is one of the most common and potentially life-threatening food allergies in children. It frequently persists into adulthood and imposes significant burdens on affected families, including dietary vigilance, social restrictions, and the constant risk of anaphylaxis. For many years, clinical guidelines recommended delaying the introduction of allergenic foods during infancy, based on the assumption that limiting early exposure would reduce the risk of sensitization and subsequent development of allergy. However, accumulating epidemiological observations and rigorous clinical trial data have fundamentally reversed this paradigm, demonstrating that early oral exposure to peanut protein during a critical window in infancy promotes immune tolerance rather than sensitization. This narrative review synthesizes the key evidence underpinning this paradigm shift, beginning with the epidemiological observations that prompted investigation and centering on the landmark Learning Early About Peanut Allergy randomized controlled trial, which demonstrated a substantial relative risk reduction in peanut allergy among high-risk infants who consumed peanut regularly during early infancy through early childhood. The review also examines long-term follow-up data through adolescence confirming the durability of this protective effect, supporting evidence from the Enquiring About Tolerance trial and pooled analyses, and the biological rationale for early oral tolerance induction. Finally, it provides practical, risk-stratified guidance aligned with current recommendations from the National Institute of Allergy and Infectious Diseases, the American Academy of Pediatrics, and other major medical organizations, addressing clinical implementation strategies, safety considerations, and barriers to adoption in routine pediatric care.