Prevention and Treatment of Peanut Allergy

George Du Toit, M.B., B.Ch., and Gideon Lack, M.B., B.Ch. Published June 24, 2026 N Engl J Med 2026;394:2449-2458 DOI: 10.1056/NEJMcp2314424

Summary

Modeled Effect of Delayed Peanut Introduction
on the Development of Peanut Allergy

Early introduction of peanut protein reduces allergy prevalence by approximately 80%, with efficacy diminishing as introduction is delayed. Appropriate prevention involves ingestion of approximately 2 g of peanut protein weekly for infants at low risk and 4 to 6 g weekly for infants at high risk. Population-level implementation that targets all infants achieves greater reduction in disease burden than approaches that target only high-risk groups, although disparities exist among some ethnic groups and groups with restricted access to care. Peanut immunotherapy initiated in younger children (1 to 3 years of age) shows superior efficacy and higher rates of clinical remission as compared with immunotherapy initiated in older children. The natural history of untreated peanut allergy follows a trajectory of increasing peanut-specific IgE levels and clinical reactivity over time, underscoring the importance of early intervention during this narrow developmental window.

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