Peanut Allergy Rates Plummet 10 Years After AAP Early Introduction Guidelines

New data show a sharp decline in peanut and food allergy prevalence, but experts say the real work is just beginning.1,2

A decade after the American Academy of Pediatrics (AAP) endorsed early peanut introduction, new real-world data suggest those recommendations are paying off.3

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 peanut allergies following the 2015 early introduction guidelines (P <.0001), along with a 43% decrease after the 2017 addendum (P <.0001). Rates of any IgE-mediated food allergy also fell by more than a third, offering promise for food allergy prevention.

The findings, published in Pediatrics, 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.4

“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 HCPLive. “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.5

“The data give us hope,” Gupta told HCPLive. 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.”

3 Expert Perspectives:

Stanislaw J. Gabryszewski, MD, PhD: Children’s Hospital of Philadelphia

Ruchi Gupta, MD, MPH: Northwestern University Feinberg School of Medicine

Vivian P. Hernandez-Trujillo, MD: Nicklaus Children’s Hospital

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

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

3. 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

4. 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. doi:10.1056/NEJMoa1514209

5. Gupta RS, Bilaver LA, Togias A. Encouraging Trends in Peanut Allergy Prevention: Real-World Impact of Prevention Guidelines. Pediatrics. Published online October 20, 2025. doi:10.1542/peds.2025-072593