Food Allergy Friday Newsletter
Dr. Alice Hoyt
Hi there,
For this week’s Food Allergy Friday, here’s the question I hear often from general pediatricians:
“Should we screen babies before early peanut introduction?”
Based on current evidence and expert consensus — including the consensus document by Fleischer et al., JACI: In Practice, 2021 — the answer is no:
➡️ Routine screening (skin testing or specific IgE) before early introduction is not recommended.
➡️ Screening creates unnecessary delays, increases parent anxiety, and does not improve safety.
➡️ Early, home peanut introduction is safe for the vast majority of infants, including those with eczema.
Per the 2021 JACI: In Practice article...
Screening infants for evidence of sensitization to peanut and/or egg before initial introduction is not required, though this may be a preference-sensitive care choice for some families. If screening is performed, the clinician should encourage consideration for offering all sensitized infants an OFC (oral food challenge) to determine an objective outcome of allergy or tolerance, rather than rely on poorly predictive values of sensitization. The key is to minimize delay when peanut is to be introduced, in particular if in-office introduction cannot be done promptly after screening.
"But what if the baby reacts?" you may ask.
In the unlikely chance there is a reaction in a baby, symptoms are typically limited to skin symptoms. The longer introduction is delayed, the increased risk of reacting.
What to Say to Families
The most helpful reassurance you can give families is simple:
“No testing needed. When your baby is around 4 months of age, you can begin to introduce common allergens at home in developmentally-appropriate ways — and I’ll show you how.”
That sentence alone relieves anxiety and keeps families on the preventive path.
Warmly,
Alice
Take the CME course on early introduction.
'Food Allergy Friday' is curated and written by Dr. Alice Hoyt. Dr. Hoyt is board-certified in allergy & immunology, internal medicine, and pediatrics. Her clinical expertise is in food allergies, and she serves patients with her team at the Hoyt Institute of Food Allergy.
