National Institute of Allergy and Infectious Diseases | health information 

NIAID

Addendum Guidelines for the Prevention of 

Peanut Allergy in the United States

Summary for Clinicians

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Institute of Allergy and Infectious Diseases

In 2015, findings from the landmark Learning Early About Peanut Allergy (LEAP) study—the first 

randomized trial to study early allergen introduction as a preventive strategy—showed that early 

introduction of peanut-containing foods to infants at high risk of developing peanut allergy was safe 

and led to an 81 percent relative reduction in the subsequent development of peanut allergy.

Based on the size of the observed effect and the statistical significance of this result, the National 

Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), 

established a coordinating committee and convened an expert panel to develop clinical guidelines to 

address the prevention of peanut allergy. These guidelines are an Addendum to the 2010 Guidelines 

for the Diagnosis and Management of Food Allergy in the United States.

Three separate guidelines for infants at various risk levels for development of peanut allergy are 

included in the Addendum and are intended for use by a wide variety of healthcare providers.

Summary of Addendum Guidelines

Addendum 

Guideline Infant Criteria Recommendations Earliest Age of Peanut Introduction

1 Severe eczema, egg 

allergy, or both

Strongly consider evaluation with peanutspecific IgE and/or skin prick test and, 

if necessary, an oral food challenge. 

Based on test results, introduce peanutcontaining foods.

4 to 6 months

2 Mild to moderate eczema Introduce peanut-containing foods. Around 6 months

3 No eczema or any food 

allergy

Introduce peanut-containing foods. Age-appropriate and in accordance with 

family preferences and cultural practices

Guideline 1

The expert panel recommends that infants with severe eczema, egg allergy, or both have introduction 

of age-appropriate peanut-containing food as early as 4 to 6 months of age to reduce the risk of 

peanut allergy. Other solid foods should be introduced before peanut-containing foods to show that 

the infant is developmentally ready. The expert panel recommends that evaluation with peanutspecific immunoglobulin E (peanut sIgE), skin prick testing (SPT), or both be strongly considered 

before introduction of peanut to determine if peanut should be introduced, and if so, the preferred 

method of introduction. To minimize a delay in peanut introduction for children who may test 

negative, testing for peanut sIgE may be the preferred initial approach in certain healthcare settings, 
2

NIAID

such as family medicine, pediatrics, or dermatology practices, in which skin prick testing is not 

routine. Alternatively, referral for assessment by a specialist may be an option if desired by the 

healthcare provider and when available in a timely manner.

Recommended Approaches for Evaluation of Children With Severe Eczema and/or Egg Allergy Before 

Peanut Introduction

*To minimize a delay in peanut introduction for children who may test negative, testing for peanut sIgE may be the preferred initial

approach in certain healthcare settings. Food allergen panel testing or the addition of sIgE testing for foods other than peanut is

not recommended due to poor positive predictive value.

Guideline 2

The expert panel suggests that infants with mild to moderate eczema should have introduction of ageappropriate peanut-containing food around 6 months of age, in accordance with family preferences 

and cultural practices, to reduce the risk of peanut allergy. Other solid foods should be introduced 

before peanut-containing foods to show that the infant is developmentally ready. The expert panel 

recommends that infants in this category may have dietary peanut introduced at home without an 

in-office evaluation. However, the expert panel recognizes that some caregivers and healthcare 

providers may desire an in-office supervised feeding, evaluation, or both.

Guideline 3

The expert panel suggests that infants without eczema or any food allergy have age-appropriate 

peanut-containing foods freely introduced in the diet, together with other solid foods, and in 

accordance with family preferences and cultural practices.

January 2017

www.niaid.nih.gov