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US guidelines for the prevention of peanut allergy 2017
  1. Ru-Xin Foong1,2,
  2. Helen A Brough1,
  3. Susan Chan1,
  4. Adam T Fox1
  1. 1 Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King’s College London and Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
  2. 2 University College of London and Institute of Child Health, London, UK
  1. Correspondence to Dr Adam T Fox, Departmentof Paediatric Allergy, 2nd Floor Stairwell B, South Wing, St Thomas’ Hospital, London SE17EH, UK;{at}

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This review is of the ‘Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel’. We aim to summarise the key recommendations for the prevention of peanut allergy (PA) for general paediatricians to use in their day-to-day practice.


The prevalence of PA has risen significantly across the developed world over the past few decades, with a recent estimate of around 2% among UK children.1 Severe reactions to peanut are rare, but PA remains a leading cause of fatal food-related anaphylaxis. While there have been important advances in peanut desensitisation, primary prevention remains the most attractive strategy for addressing this rise.

Information about current guideline

The guideline outlines current recommendations on the prevention of PA in infants at various risk levels in the USA. The guideline was developed by the National Institute of Allergy and Infectious Diseases alongside 25 professional organisations, federal agencies and patient advocacy groups and was overseen by an expert panel of 26 members. It was published in September 2016 following a landmark clinical trial suggesting that early introduction of peanut to infants can help prevent the development of PA2 (box 1).

Box 1


  1. Link to full guideline: Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel

  2. Learning Early About Peanut (LEAP) study

    • Website:

    • Link to full text:

  3. Enquiring About Tolerance (EAT) study

    • Website:

    • Link to full text:

Previous guidelines

A previous national guideline for the diagnosis and management of food allergy in the USA was published in December 2010.3 This guideline did not offer any specific strategies for the prevention of food allergies due to a lack of evidence from studies at the time. It did state that …

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  • Contributors All authors contributed equally to writing this review guideline.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.