Shifting Paradigms in Food Allergy Prevention: A Guide for Pediatricians
For years, conventional wisdom advised delaying the introduction of allergenic foods to infants, fueled by concerns about triggering allergies. However, current recommendations have dramatically shifted, emphasizing early and consistent introduction as a key preventative measure. Dr. David Stukus, MD, Professor of Clinical Pediatrics and Director of the Food Allergy Treatment Center at Nationwide Children’s Hospital and The Ohio State University College of Medicine, highlights this evolution and provides practical guidance for clinicians.
The turning point arrived with the 2015 publication of the Learning early About Peanut (LEAP) trial. This landmark, prospective, randomized clinical trial demonstrated an impressive 81% reduction in peanut allergies among infants regularly exposed to peanut early in life, compared to those who avoided it. This pivotal study spurred further research, and subsequent clinical trials and meta-analyses have consistently confirmed that early introduction of allergenic foods, and maintaining them in the diet, is both safe and effective in preventing food allergies.
Despite this robust evidence, parental anxieties and outdated facts persist. Dr. Stukus stresses the importance of proactive reassurance and humility when counseling families. Acknowledging the historical shift in recommendations is crucial. He advocates integrating discussions about food allergy prevention into routine well-child visits – at newborn, 2-, 4-, 6-, and 9-month checkups – supported by consistent messaging and readily available handouts.
He emphasizes that severe allergic reactions to a first-time exposure are rare, and families should be equipped with practical advice on how to safely introduce thes foods.
A common parental request is for allergy testing before introducing potential allergens. Dr. Stukus strongly discourages this practice without a clear clinical indication. He explains that ige tests are designed to detect specific IgE antibodies, not to diagnose allergies, and are prone to false positives. Broad panel tests can lead to overdiagnosis and misdiagnosis, causing unnecessary anxiety and restriction. While acknowledging parental insistence, clinicians should engage in focused discussions about specific concerns and, if testing is pursued, clearly explain how the results will be interpreted and utilized, potentially offering in-office food introduction for added safety.
Crucially, a single introduction isn’t sufficient.”It’s really intentionally keeping it in the diet consistently,” Dr. Stukus explains. While precise dosing isn’t necessary, encouraging regular inclusion of allergenic foods as part of the infant’s routine is vital, with the topic revisited at future well-child visits.
To ensure these preventative measures reach all families, Dr. stukus suggests implementing systematic approaches within pediatric practices. Utilizing checklists or standardized handouts can help guarantee that food allergy prevention is consistently addressed. He emphasizes that integrating this guidance into the standard visit blueprint, like any other essential aspect of pediatric care, requires deliberate effort. Prioritizing this guidance, especially for underserved or high-risk populations, can substantially reduce the future burden of food allergies.
Disclosure: Dr. stukus reports no relevant disclosures.
Reference: Stukus D. Feeding the Future: How to Prevent Food Allergies. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025.Denver, Colorado.
