Early Allergen Introduction in Infants: Reducing Food Allergy Risk Without Routine Testing

At the 2026 Eastern Allergy Conference (EAC) in Palm Beach, Florida, Marcus Shaker, MD, from Dartmouth Geisel School of Medicine, Dartmouth Health Children’s, highlighted one of the most important shifts in modern allergy prevention, which is the move toward early introduction of allergenic foods in infancy.¹ While the concept is now widely recognized, Shaker emphasized that translating research findings into everyday clinical practice remains a challenge for both healthcare providers and families.²

Using a case-based approach, he explored a common scenario: a child with a family history of food allergy whose parents are unsure when and how to introduce allergenic foods.¹ The discussion centered on helping clinicians offer evidence-based guidance while acknowledging the realities and anxieties that many families face.

Why Routine Allergy Testing Before Food Introduction Is Not Recommended for Most Infants

A key theme of Shaker’s presentation was that routine pre-introduction allergy testing is generally not required before introducing common allergenic foods. He noted that several landmark studies demonstrated a reduction in allergy risk when foods such as peanuts are introduced during infancy.

However, he cautioned against overinterpreting these findings. Although some infants may benefit from targeted evaluation, broad testing strategies can create confusion and unintended consequences. Positive test results do not always predict true clinical allergy, particularly in children who have never eaten the food in question.

Shaker explained that avoiding foods solely because of test results may prevent families from introducing foods that could be tolerated and potentially beneficial. Instead, decisions should be individualized, taking into account the child’s history, risk factors, and family circumstances.

Why Shared Decision-Making Is Key to Food Allergy Prevention Counseling

Shaker stressed the importance of shared decision-making. Parents bring their own values, preferences, and concerns to the discussion, and clinicians must balance scientific evidence with practical considerations.

He also noted that current practice parameters support a conditional recommendation for early allergen introduction, reflecting both the strength of the evidence and the need for flexibility in implementation.

For attendees, the message was clear: early introduction remains a valuable tool for food allergy prevention, but success depends on thoughtful communication, individualized care, and helping families navigate decisions with confidence.

Shaker has no reported disclosures.

References

1. Shaker M. Food Allergy Prevention and Rescue Refeeding in 2026. Poster presented at EAC 2026 on May 28.

2. Derman C. Early Peanut Introduction Guidelines Linked to Drop in Food Allergy Rates. HCPLive. Published on October 20, 2025. Accessed June 1, 2026. https://www.hcplive.com/view/early-peanut-introduction-guidelines-linked-drop-food-allergy-rates