No Testing Required: Reframing Early Allergy Introduction
For families navigating a suspected food allergy in infancy, one of the most persistent misconceptions is that allergy testing must come first. Marcus Shaker, MD, of Dartmouth Geisel School of Medicine at Dartmouth Health Children’s, pushed back on that assumption in his Eastern Allergy Conference (EAC) 2026 presentation, emphasizing that no testing is required before early introduction of allergenic foods in most cases.1
Key Takeaways from Shaker's EAC 2026 Presentation
- No allergy testing is required before early introduction of allergenic foods
- Early introduction should be pursued with small amounts, advancing as tolerated; any reaction warrants a pause and physician consultation
- Children who develop food allergies may be strong candidates for rescue refeeding via early food immunotherapy, which carries a low rate of severe reactions
- Home-based OIT models, including Dartmouth's published approach, can improve access and cost-effectiveness
- The best general approach: feed early and feed often—but with open communication between families and clinicians throughout
Using a case-based approach, Shaker walked through the case of a child with a suspected egg allergy as a clinical illustration. While further evaluation with a board-certified allergist-immunologist would be appropriate before additional egg exposure, he noted that peanut introduction could proceed without testing. Families could try a small amount, approximately a sixteenth of a teaspoon of peanut flour mixed into a soft food, advancing as tolerated. If any reaction occurs, the guidance is clear: pause and seek evaluation.
“There's very good data that this is a safe and effective approach with a low rate of severe reactions, even safer in infants,” Shaker told HCPLive. “We have health economic data that [shows immunotherapy] can save potentially millions or even billions of dollars over time.”
Rescue Refeeding: A Viable Path When Allergy Develops
For children who develop food allergies, Shaker emphasized that a diagnosis is no longer a one-way door to indefinite avoidance. In 2026, he noted, early food immunotherapy represents a viable "rescue refeeding" approach, with strong supporting evidence for both safety and efficacy.
Oral immunotherapy in early childhood is effective and safe in preschoolers, with particular safety advantages in young infants.2 Shaker described the rate of severe reactions as low and characterized the evidence base as solid.
For families of a child with a confirmed egg allergy, Shaker outlined a collaborative path: working with a board-certified allergist-immunologist to review and implement a rescue refeeding protocol as a long-term partnership, rather than a discrete intervention.
