Parental confusion may hinder early peanut introduction for allergy prevention

Early introduction of peanut-containing foods during infancy is a well-established strategy to reduce the risk of peanut allergy, yet new research suggests that persistent parental confusion may be limiting the effectiveness of these guidelines in routine pediatric care. Findings from a qualitative study published in JAMA Network Open indicate that misunderstandings about the purpose, timing, and safety of early peanut introduction remain common several years after national recommendations were issued.^1,2

Peanut allergy affects approximately 2% of children in the United States and is among the food allergies least likely to be outgrown. In response to landmark clinical trial data demonstrating more than an 80% reduction in peanut allergy development among high-risk infants, national guidelines issued in 2017 recommended introducing peanut-containing foods early in life. Despite these recommendations, uptake has been inconsistent across clinical and community settings.

Study examines how parents interpret early peanut introduction guidance

The new study sought to better understand how parents perceive and implement early peanut introduction recommendations. Investigators conducted semistructured interviews with 49 parents of infants aged 8 to 13 months who were receiving care at academic pediatric clinics, federally qualified health centers, and private practices in Chicago. Participants represented a range of racial, ethnic, educational, and insurance backgrounds.

Using thematic qualitative analysis, researchers examined parental knowledge, beliefs, practices, and information sources related to early peanut introduction. While most parents reported some awareness of the guidelines, their understanding varied substantially.

Misconceptions about purpose fuel anxiety and delays

One of the most prominent findings was confusion about the primary goal of early peanut introduction. Some parents correctly understood that early and regular exposure helps train the immune system and reduce the risk of peanut allergy. Others, however, believed the purpose was to test whether their infant was allergic, which increased anxiety and led to delayed introduction.

“While some parents we talked to understood correctly that starting their baby on peanut foods trains the immune system in order to prevent the development of peanut allergy, other parents mistakenly believed that the purpose is to test if their baby is allergic – a misconception that fueled fears of severe allergic reaction, leading to hesitation and delays in peanut introduction,” said lead author Waheeda Samady, MD, a hospital-based pediatrician at Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor of pediatrics at Northwestern University Feinberg School of Medicine.

Timing and consistency remain unclear for many families

Parents also reported uncertainty about when to begin peanut introduction and how frequently peanut-containing foods should be offered after the initial exposure. Inconsistent practices ranged from a single exposure to intermittent feeding without a sustained schedule.

“For prevention of peanut allergy, timing and consistency are of the essence,” Samady said. “We encourage peanut introduction as soon as the baby starts eating solids, before or around 6 months of age. It’s also important to continue peanut exposure twice a week through the first year and into toddler years. Feeding babies peanut foods just once or twice is not enough.”

Eczema risk often overlooked by parents

The study also identified widespread lack of awareness regarding eczema as a major risk factor for food allergy development. Most parents believed family history was the primary determinant of risk and did not recognize that infants with eczema may benefit most from early peanut introduction.

“If a baby has eczema, peanut introduction should start early, around 4 months of age, if possible, to maximize peanut allergy prevention coupled with good skincare,” Samady said. “Pediatricians need to reinforce this message, given that most parents we interviewed were not aware that eczema increases the baby’s chances of developing food allergies.”

Fear of allergic reactions remains a key barrier

Fear of allergic reactions—particularly severe reactions—emerged as a central barrier to guideline adherence. Even parents who supported early peanut introduction often delayed implementation due to safety concerns.

“Parents need to be reassured that if their baby is allergic to peanut, they may see hives, some swelling, or vomiting, but allergic reactions in infancy are usually mild,” Samady explained. “We should empower parents with information and action plans so this does not stop them from participating in early peanut introduction.”

Pediatricians play a central role in guideline implementation

Across interviews, parents consistently identified pediatricians as their primary and most trusted source of information about early peanut introduction. Clear, directive guidance from clinicians was associated with greater adherence to recommendations.

“Pediatricians are key to successful guideline implementation, but they need better resources for families to provide comprehensive information during busy well-child visits,” Samady noted. “Overall, we found that parents are accepting of early peanut introduction, but they need clearer guidance and more support.”

Clearer messaging may improve uptake of prevention strategy

The authors concluded that improved communication strategies are needed to bridge the gap between evidence and practice. Messaging that emphasizes early peanut introduction as a preventive strategy—rather than a diagnostic test—along with clear guidance on timing, frequency, eczema-related risk, and expected reactions may help pediatricians better support families and increase adherence to national recommendations.

References

1. Ann and Robert H. Lurie Children's Hospital of Chicago. Most Parents Aware of Early Peanut Introduction Guidelines, But Confused About Details. Newswise. December 15, 2025. Accessed December 19, 2025. https://www.newswise.com/articles/most-parents-aware-of-early-peanut-introduction-guidelines-but-confused-about-details/?sc=mwhr&xy=10069075
2. Samady W, Jibrell H, Malik SW, Herbert LJ, Rolling C, Gupta R. Parental Understanding and Implementation of Early Peanut Introduction. JAMA Network Open. 2025;8(12):e2550915. doi:https://doi.org/10.1001/jamanetworkopen.2025.50915