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Randomised trial · The New England journal of medicine · 2015Conflicts declared

Peanut consumption in infants at risk for peanut allergy

Du Toit G, Roberts G, Sayre PH, et al · Free full text

What it found

In infants at high risk of peanut allergy, eating peanut regularly from before 11 months of age led to far fewer cases of peanut allergy at 60 months than avoiding peanut.

The trial was in people.

What they found

Studies in people

Peanut allergy at 60 months

Among 530 infants with a negative skin-prick test, 13.7% of those avoiding peanut had peanut allergy at 60 months, compared with 1.9% of those eating peanut. Among 98 infants with a positive skin-prick test, 35.3% of avoiders had peanut allergy, compared with 10.6% of eaters.

Serious adverse events

There was no significant difference between the groups in the number of serious adverse events or hospitalizations. More mild events like upper respiratory tract infection, viral skin infection, gastroenteritis, hives, and conjunctivitis were reported in the peanut-eating group.

Immune markers

Peanut-specific IgG4 antibody levels rose more in the peanut-eating group, and fewer in that group had very high IgE antibody levels. A larger skin-prick test wheal and a lower ratio of IgG4 to IgE were linked to peanut allergy.

Adherence

The median weekly peanut protein consumption in the first 2 years was 0 g in the avoidance group and 7.7 g in the consumption group. Bed dust from the consumption group had much higher peanut levels than dust from the avoidance group.

What the authors conclude

“The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts.”
Du Toit G, Roberts G, Sayre PH, et al, 2015

Also in their conclusions

  • They conclude that the early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts.
  • They state that early, sustained consumption of peanut products was associated with a substantial and significant decrease in the development of peanut allergy in high-risk infants.
  • They advise that peanut avoidance was associated with a greater frequency of clinical peanut allergy than was peanut consumption, which raises questions about the usefulness of deliberate avoidance of peanuts as a strategy to prevent allergy.

How it was done

Peanut allergy among children in Western countries has doubled in the past 10 years, and guidelines had recommended avoiding allergenic foods in high-risk infants. The authors wanted to find out whether early introduction or avoidance is the better strategy to prevent peanut allergy.

They randomly assigned 640 infants with severe eczema, egg allergy, or both, who were 4 to 11 months old, to eat peanut or avoid it until 60 months of age. The infants were split into two groups based on a skin-prick test for peanut allergy, and peanut allergy was assessed at 60 months.

What it can’t tell you

  • The trial did not include low-risk infants or those with large skin-prick test wheals (greater than 4 mm), so the results do not apply to them.
  • The study did not test whether the protection lasts if peanut consumption is stopped, and that question is under further study.
  • The trial lacked a placebo regimen, so participants knew whether they were eating peanut or avoiding it.

The paper

Title
Randomized trial of peanut consumption in infants at risk for peanut allergy
Type
Randomised controlled trial
Evidence
Studies in people
Summarised from
Full text
Cite
Du Toit G, Roberts G, Sayre PH, et al (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. The New England journal of medicine. doi:10.1056/NEJMoa1414850Free full textPubMed 25705822DOI

Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error