At what age can egg whites and peanuts be introduced to an infant without a known history of allergies to minimize the risk of developing an allergy, particularly in those with a family history of allergies?

Early Introduction of Egg and Peanut to Prevent Food Allergies

Introduce both egg whites (as cooked egg) and peanuts to your infant at around 6 months of age, but not before 4 months, regardless of whether your child has a family history of allergies. 1, 2

Timing for All Infants

The current evidence-based approach has completely reversed older recommendations that advised delaying allergenic foods. 1

Standard Timing

• Start at around 6 months of age when your infant shows developmental readiness for solid foods 1, 2
• Never introduce before 4 months of age 1, 2
• Introduction can occur anytime in the 4-6 month window, with 6 months being the typical target 1, 3

What This Means for Egg Whites

• Introduce cooked egg (not raw or uncooked pasteurized egg) as part of complementary feeding 1, 3
• The egg should be well-cooked, and evidence specifically supports cooked egg introduction 1, 3
• Once introduced, continue regular consumption (a few times per week) to maintain tolerance 4

What This Means for Peanuts

• Introduce peanut-containing foods in an age-appropriate form (never whole peanuts due to choking risk in children under 4 years) 2
• Options include thinned smooth peanut butter, peanut butter puree, peanut flour/powder, or Bamba® peanut snacks 2
• The effective dose is approximately 2 grams of peanut protein (equivalent to 6 grams of peanuts) given 3 times weekly 2

Special Considerations for High-Risk Infants

If your infant has severe eczema or egg allergy, the approach differs slightly:

High-Risk Protocol (Severe Eczema or Egg Allergy)

• Introduce peanut at 4-6 months, but only after allergy testing 2
• Measure peanut-specific IgE or perform skin prick testing before any peanut introduction 2
• If peanut-specific IgE is <0.35 kUA/L, introduce peanut at home 2, 5
• If peanut-specific IgE is ≥0.35 kUA/L, refer to an allergist before introduction 2, 6

Moderate-Risk Protocol (Mild to Moderate Eczema)

• Introduce peanut-containing foods at approximately 6 months at home without prior testing or specialist evaluation 2

Low-Risk Protocol (No Eczema or Food Allergies)

• Introduce peanut-containing foods with other age-appropriate solid foods according to family preferences 2

Safe Home Introduction Protocol

When introducing these foods at home, follow these safety steps:

Preparation Requirements

• Feed only when your infant is healthy (avoid if infant has cold, vomiting, diarrhea, or other illness) 2
• Ensure one adult can focus complete attention on the infant for at least 2 hours after feeding 2

Introduction Technique

• Offer a small amount on the tip of a spoon first 2
• Wait 10 minutes and observe for any reaction 2
• If no reaction occurs, slowly give the remainder at your infant's usual eating speed 2

Common Pitfall to Avoid

Do not introduce allergenic foods and then stop giving them. Once introduced, regular ingestion (a few times per week) is essential to maintain tolerance. 4 Stopping regular consumption after introduction may increase the risk of sensitization and food allergy. 1

The Evidence Behind This Recommendation

The landmark LEAP trial provided Level 1 evidence showing that early peanut introduction (4-11 months) reduced peanut allergy prevalence at 5 years from 13.7% to 1.9% in high-risk infants. 2 The Enquiring About Tolerance study demonstrated similar benefits with cooked egg. 1

Following publication of these pivotal studies, major organizations including the National Institute of Allergy and Infectious Diseases (2017), American Academy of Pediatrics (2019), and multiple international allergy societies reversed previous avoidance recommendations. 1 The 2021 consensus endorsed by the American Academy of Allergy, Asthma & Immunology specifically recommends introduction of cooked egg and peanut at around 6 months for all infants irrespective of risk. 1

Critical Safety Warning

Never give whole peanuts to children under 4 years of age due to choking risk. 2 Call 911 immediately if you observe any concerning symptoms including respiratory distress, vomiting, or systemic symptoms after food introduction. 2