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

The sharp drop in peanut allergy rates reported in a new Pediatrics study reflects a rare public health success story—one that appears to have translated from trial findings to real-world impact.1,2

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 HCPLive.

The 2015 Learning Early About Peanut Allergy (LEAP) 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.

References

1. 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.

2. 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