David Stukus, MD, on how early allergen introduction lowers food allergy risk

Infant feeding recommendations have undergone significant changes over the past 2 decades. “The 2000 guidelines actually recommended against feeding allergenic food. So we advised no milk until 1 year of age, no eggs until 2, no peanuts, or seafood until 3,” said 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 in Columbus, Ohio.

By 2008, recommendations shifted, though they still did not actively promote early allergen introduction. A major turning point occurred with the Learning Early About Peanut (LEAP) trial published in 2015. “This was the first prospective, randomized clinical trial that took a group of infants and exposed them to peanut on a regular basis early in life, and compared them to a group of infants that avoided peanut, and what they showed after that trial was 81% reduction in peanut allergies in those infants who ate it on a regular basis,” Stukus said.

Since then, multiple prospective clinical trials and meta-analyses have demonstrated that introducing allergenic foods early and maintaining them consistently in the diet is both safe and effective for preventing food allergy.

Counseling families during well visits

Despite the evidence, many parents remain fearful or uncertain. Stukus advised clinicians to address concerns proactively. “Reassurance is the key, I think, some humility as well,” he said. He noted the importance of acknowledging how prior evidence differed from current recommendations. Pediatricians can integrate food allergy prevention discussions into routine visits, including newborn, 2-, 4-, 6-, and 9-month checkups. Handouts and consistent messaging can further support families.

True severe allergic reactions as a first exposure are rare, Stukus emphasized, and families should be reassured while also receiving practical advice on how to safely introduce allergenic foods.

The role of allergy testing

Parents may request screening tests before introducing foods, but these should be discouraged without a clinical indication. “IgE tests are really designed to detect specific IgE, but they’re not designed to diagnose anything. We get a lot of false positives. Panel tests cause a lot of overdiagnosis, misdiagnosis, and really talking about the harm that comes from a wrong diagnosis,” Stukus explained.

In cases where parents insist, a focused discussion on specific concerns may help guide next steps. If testing is pursued, clinicians should clarify how results will be used and consider in-office food introduction when feasible.

Sustaining early introduction

Introducing allergenic foods only once is not enough. “It’s really intentionally keeping it in the diet consistently,” said Stukus. While strict dosing guidelines are not necessary, families can be encouraged to make regular inclusion part of the routine. Revisiting the topic at future visits is also important.

Integrating guidance into practice

Many families never receive counseling on food allergy prevention. Stukus suggested systematic approaches, such as checklists or standardized handouts, to ensure discussions occur. “It takes effort, just like anything else that we do in medicine; it’s really making sure that you put this into your blueprint that you have for a visit,” he said.

By embedding food allergy prevention into routine pediatric care—particularly for underserved or high-risk populations—clinicians can help reduce future allergy burden.

Disclosure:
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.