Language barriers linked to lower early peanut introduction rates

Infants from families who speak a language other than English at home are substantially less likely to have peanut introduced on schedule, even after accounting for income and neighborhood, according to research presented at the 2026 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Phoenix, Arizona.¹ The findings point to a gap in the reach of early introduction guidance that socioeconomic factors alone do not explain.

"Our findings suggest that language, on its own, is a barrier," said lead author James Senter, MD, MPH, of Chicago, Illinois.¹ He stressed that the disparity "isn't about families not caring about their child's health."¹

Early peanut introduction rates by caregiver language at 6- and 9-month visits

Senter and colleagues reviewed charts of 3,170 children seen for 6- and 9-month well-child visits from 2021 to 2026 at 2 pediatric primary care sites within a large academic children's hospital.¹ Of these, 240 came from families who spoke a language other than English at home, representing 25 languages.¹

Documented peanut introduction was 27.5% at the 6-month visit and 68.3% at the 9-month visit.¹ After adjustment for atopic comorbidities, gestational age, financial stress, neighborhood Child Opportunity Index percentile, and other demographic and socioeconomic variables, children in non-English-speaking families had lower odds of peanut introduction at 6 months (OR, 0.21; 95% CI, 0.09–0.48; P < .001) and 9 months (OR, 0.48; 95% CI, 0.28–0.81; P = .006).¹ The change in odds between visits was not significant (OR, 1.35; 95% CI, 0.74–2.45; P = .33), suggesting no meaningful catch-up.¹

LEAP trial evidence and current early peanut introduction guidelines

Current recommendations trace to the LEAP trial, which randomly assigned 640 infants aged 4 to 11 months with severe eczema, egg allergy, or both to peanut consumption or avoidance.² Among infants with a negative baseline skin prick test, peanut allergy at age 5 years occurred in 1.9% of the consumption group vs 13.7% of the avoidance group (P < .001).²

A 2021 consensus from the American Academy of Allergy, Asthma & Immunology, ACAAI, and the Canadian Society for Allergy and Clinical Immunology broadened that guidance, recommending peanut introduction around 6 months of age, but not before 4 months, for all infants regardless of risk, without required prior screening, followed by regular ongoing consumption.³

Population-level data suggest the approach is working. A 2025 Pediatrics analysis found that peanut allergy diagnoses among children younger than 3 years fell from 0.79% to 0.45%, a 43% decline, after the 2015 and 2017 early introduction guidance.⁴

Language access and disparities in infant peanut allergy prevention

The ACAAI data raise concern that these gains may be unevenly distributed. Because the model adjusted for financial stress and neighborhood opportunity, the investigators conclude that language itself acts as a barrier, and the release noted that clinics may need better tools to reach non-English-speaking families.¹ Effective counseling covers timing, age-appropriate peanut forms that avoid choking risk, and the need for sustained regular feeding,³ details that may be lost in a brief visit or an English-only handout.

References

1. American College of Allergy, Asthma and Immunology. Language barriers may keep families from introducing peanuts early. News release. November 12, 2026. Accessed November 12, 2026. https://acaai.org/news/language-barriers-may-keep-families-from-introducing-peanuts-early/

2. Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813. doi:10.1056/NEJMoa1414850

3. Fleischer DM, Chan ES, Venter C, et al. A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. J Allergy Clin Immunol Pract. 2021;9(1):22-43.e4. doi:10.1016/j.jaip.2020.11.002

4. Gabryszewski SJ, et al. Guidelines for early food introduction and patterns of food allergy. Pediatrics. Published online October 20, 2025.