Stanislaw J. Gabryszewski, MD, PhD

Peanut Allergy Decline Shows Success of Early Introduction Guidelines, With Stanislaw J. Gabryszewski, MD, PhD

 study reflects a rare public health success story—one that appears to have translated from trial findings to real-world impact.

For Stanislaw J. Gabryszewski, MD, PhD, an attending physician at the Children’s Hospital of Philadelphia and a trial investigator of the analysis, the data represent the outcome experts had hoped to see a decade after the release of the first early introduction guidelines. Gabryszewski and colleagues conducted a study to understand whether the 2015 and 2017 guideline updates actually translated into meaningful changes in food allergy prevalence

“Reassuringly, we did see declines in the rates of both peanut and overall food allergy prevalence,” he told 

The 2015 Learning Early About Peanut Allergy

 study first demonstrated that introducing peanut early, between 4 to 6 months of age, dramatically reduced the risk of developing an allergy later in life. That research led to the first expert consensus guidelines on early peanut introduction, followed by broader 2017 recommendations that included children at low and moderate risk. Gabryszewski said the latter update may have contributed to the more pronounced declines observed in the years that followed.

“[The addendum guidelines] made the advice more broadly applicable to all children, and it also provides some additional time for uptake of early introduction guidelines,” Gabryszewski said. “So, I think it's not entirely surprising that we saw an even further reduction in peanut allergy prevalence after these addendum guidelines.”

While the prevalence of peanut allergy fell significantly, dropping 27% and 43% after the 2015 and 2017 guidelines, respectively, the study found egg allergy had become the most frequently diagnosed food allergy. Previously, peanuts had been the number 1 most common food allergen.

“Egg allergy prevalence was pretty similar between the pre- and post-guidelines periods,” he explained. What drove down the peanut ranking was just that the prevalence of peanut allergy itself went down so much that it became number 2.”

Despite the reassuring data, he emphasized that food allergy remains a substantial concern. Implementing these guidelines in everyday practice continues to present challenges. Checkup appointments can be busy, covering milestones, nutrition, and immunizations, and Gabryszewski emphasized the importance of standardizing early food introduction conversations.

The analysis covered data through 2020, but Gabryszewski noted that newer guidelines released in 2021 by major allergy organizations go a step further—encouraging early introduction of peanut, egg, and other foods as part of a diverse diet. He said future research will help determine whether these updated recommendations drive food allergy rates down even more.

“Overall, our study provides encouraging news for many people, including families, pediatricians, allergists, and public health experts, and it suggests that introducing peanut and other foods in developmentally ready infants is likely taking hold,” Gabryszewski said. “It supports a concrete, real-world strategy that can help us work together to prevent food allergy.”

Relevant disclosures include include Horizon Therapeutics plc.

In a separate piece, HCPLive spoke with two other experts— Ruchi Gupta, MD, MPH, from Northwestern University, and Vivian P. Hernandez-Trujillo, MD, from Nicklaus Children’s Hospital—on their reactions to the 

trends following the 2015 and 2017 food introduction guidelines.

Derman C. Early Peanut Introduction Guidelines Linked to Drop in Food Allergy Rates. HCPLive. October 20, 2025. https://www.hcplive.com/view/early-peanut-introduction-guidelines-linked-drop-food-allergy-rates. Accessed October 30, 2025.

Gabryszewski SJ, Dudley J, Faerber JA, et al. Guidelines for Early Food Introduction and Patterns of Food Allergy. Pediatrics. Published online October 20, 2025. doi:10.1542/peds.2024-070516

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Gabryszewski said new data confirm early introduction guidelines are working, showing real-world declines in peanut allergy. 

Peanut Allergy Rates Plummet 10 Years After AAP Early Introduction Guidelines

sharp decline in peanut and food allergy prevalence

, but experts say the real work is just beginning.

A decade after the American Academy of Pediatrics (AAP) endorsed early peanut introduction, new real-world data suggest those recommendations are paying off.

A study led by David Hill, MD, PhD, and colleagues at the Children’s Hospital of Philadelphia analyzed data from more than 85,000 children across nearly 50 pediatric practices and found a 27% drop in 

 following the 2015 early introduction guidelines (

 <.0001), along with a 43% decrease after the 2017 addendum (

 <.0001). Rates of any IgE-mediated food allergy also fell by more than a third, offering promise for food allergy prevention.

, provide the first large-scale evidence that national policy changes inspired by the landmark LEAP trial have translated into measurable real-world benefits. The LEAP study, published in 2015, demonstrated that infants who were introduced to peanuts early and kept them in their diet were significantly less likely to develop a peanut allergy later in life.

“An outstanding question after these guidelines was whether we are actually seeing meaningful changes in the prevalence of food allergy, and so that is why we did this study,” Stanislaw J. Gabryszewski, MD, PhD, a trial investigator of the recent analysis and an attending physician at Children’s Hospital of Philadelphia, told 

. “Reassuringly, we did see declines in the rates of both peanut and just overall food allergy prevalence.”

Still, despite encouraging data, experts say implementation remains uneven. Previous surveys show that fewer than 1 in 3 pediatricians, and only 17% of caregivers, fully follow the latest recommendations.

Ruchi Gupta, MD, MPH, director of the Center for Food Allergy & Asthma Research at Northwestern University Feinberg School of Medicine, said the declining rates are a promising signal, even if cause and effect cannot yet be confirmed. She had written a commentary on Hill and colleagues’ paper, praising the team for using AAP’s harmonized electronic health record database to capture real-time, practice-based trends in food allergy prevention.

. She added that it is exciting that the analysis showed a lower incidence of peanut allergy in children born after the guidelines were introduced.

For clinicians, the shift in food allergy prevention has been dramatic. “It’s an everyday conversation,” said Vivian P. Hernandez-Trujillo, MD, a pediatric allergist at Nicklaus Children’s Hospital. “I have it multiple times, especially with parents of young children, because it has just swung so much like in the last 10 years.”

Looking ahead, investigators are expanding their focus beyond peanuts. Gupta’s team is conducting a randomized controlled trial of 1800 infants to determine whether early introduction of other common allergens—such as milk, egg, tree nuts, and sesame—can further reduce food allergy rates.

While the peanut allergy decline marks a major step forward, Gupta emphasized that guideline adoption takes time. “Guidelines take a good 10 to 20 years sometimes to go from publication to actually getting into the general public and having an impact. Having a change happen so quickly is great,” she said. “What I suspect is [that] it was a dip, which is great, but we may see some bouncing around until it stabilizes and actually truly shows that we can decrease and turn the tide of peanut allergy in the US.”

 Northwestern University Feinberg School of Medicine

Relevant disclosures include Horizon Therapeutics plc for Gabryszewski; Kaleo, Genetech, and Regeneron Healthcare Solutions for Gupta; and Kaleo for Hernandez-Trujillo.

Derman C. Early Peanut Introduction Guidelines Linked to Drop in Food Allergy Rates. HCPLive. October 20, 2025. 

https://www.hcplive.com/view/early-peanut-introduction-guidelines-linked-drop-food-allergy-rates

Gabryszewski SJ, Dudley J, Faerber JA, et al. Guidelines for Early Food Introduction and Patterns of Food Allergy. Pediatrics. Published online October 20, 2025. 

Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics. 2015;136(3):600-604.

 doi:https://doi.org/10.1542/peds.2015-2394

Du Toit G, Sayre PH, Roberts G, et al. Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. N Engl J Med. 2016;374(15):1435-1443. 

Gupta RS, Bilaver LA, Togias A. Encouraging Trends in Peanut Allergy Prevention: Real-World Impact of Prevention Guidelines. 

New data show peanut allergy rates have dropped sharply since early introduction guidelines, reducing 27% and 43% after the 2015 and 2017 guidelines, respectively.


Stanislaw J. Gabryszewski, MD, PhD

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