Early Peanut Introduction: Real-World Evidence of Allergy Prevention Benefits

Primary-care EHR data show a substantial drop in clinician-diagnosed peanut and overall IgE-mediated food allergies after the 2015 early-introduction guideline and its 2017 addendum.

According to the recent guideline, the finding derives from a U.S. primary-care electronic health record analysis covering more than 120,000 children.

The EHR signal complements randomized evidence such as the LEAP trial by documenting a population-level change after guideline release rather than an efficacy result from controlled exposure. The 2015 guideline and 2017 addendum offered clearer timing and specificity, which appear to have supported broader clinical uptake and measurable reductions in diagnosed peanut and pooled IgE-mediated food allergies.

The retrospective cohort used multistate primary-care EHRs and compared preguideline, post-guideline, and post-addendum cohorts with tailored observation windows. The study used clinician-diagnosed peanut-specific and overall IgE-mediated food-allergy endpoints; cumulative incidence for both outcomes declined after guideline publication.

At the health-system level, the observed declines could reduce allergy-related resource use and specialty referrals. That shift may prompt earlier feeding counseling in well-child care and could lower the frequency of severe peanut events in schools and community settings—while maintaining the need for staff training and accessible epinephrine. Because this evidence is observational, it should be viewed as supportive of guideline implementation and as a stimulus for targeted efforts to improve equitable access to early feeding counseling.