The importance of early peanut ingestion in the prevention of peanut allergy

Introduction: Peanut allergy appears to have increased in prevalence, is often severe and is typically life-long. Therefore, reducing its incidence through a primary prevention strategy is a priority. Guidelines on peanut introduction have evolved with time and given evidence of peanut allergy risk reduction with early infant ingestion exposure, the current US advice promotes early introduction for infants, particularly targeting those at highest risk. Areas covered: This article describes the evolution of peanut introduction guidelines in infants in the US, as shaped by key research over the last 20–30 years and culminates in the landmark LEAP study. It also compares and contrasts current iterations of peanut introduction guidelines in infants globally. Finally, the early successes and barriers of implementation of early peanut introduction guidelines are discussed. We included literature from original articles, reviews, and consensus guidelines found in database searches through December 2018. Expert commentary: LEAP guideline implementation has proven to be successful, in the study setting, in decreasing the incidence of peanut allergy. However, its implementation in the community has been met with obstacles including low awareness among stakeholders, and access to testing when needed.