Highlights
- Peanut consumption among US infants remains very low (6%) despite updated guidelines advocating early introduction.
- Non-Hispanic White toddlers exhibit the highest rates of peanut intake, while Mexican American children/adults have the highest rates of egg consumption.
- Tree nut intake has increased sharply in children and adults over the past two decades but remains minimal in infants and toddlers.
- Persistent racial and ethnic disparities suggest cultural, socioeconomic, and educational barriers to early allergen introduction.
Study Background and Disease Burden
Food allergies affect approximately 8% of US children, with peanut and tree nut allergies being among the most common and potentially severe. Historically, guidelines advised delaying introduction of allergenic foods to infants, but landmark studies such as the LEAP (Learning Early About Peanut Allergy) trial demonstrated that early introduction of peanut significantly reduces the risk of developing peanut allergy in high-risk infants. In response, US and international allergy prevention guidelines now recommend introducing peanut-containing products to infants as early as 4-6 months of age, particularly in those at high risk. However, translating these guidelines into practice remains a public health challenge, given persistent fears, misinformation, and cultural dietary norms. Understanding real-world consumption patterns is crucial for targeting interventions and reducing the burden of food allergies.
Study Design
Researchers led by Hosein et al. conducted a comprehensive analysis of allergenic food consumption patterns using data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2023. The study included 56,394 participants (mean age 34.8 years, 52% women) who completed two 24-hour dietary recalls. Participants were categorized by age (infants 4-12 months, toddlers 13-47 months, children/adults >47 months) and by self-identified race/ethnicity (non-Hispanic White, non-Hispanic Black, and Mexican American). The primary endpoints were self-reported intake of peanuts, eggs, and tree nuts within the recall periods. Temporal trends and differences across demographic groups were analyzed.
Key Findings
Peanut Intake
Infant peanut consumption remained low throughout the study period, with only 6% (95% CI, 4%-8%) of infants reportedly consuming peanuts. This rate increased to 33% (95% CI, 30%-36%) among toddlers (13-47 months), with non-Hispanic White toddlers exhibiting the highest intake at 41% (95% CI, 37%-45%). This group consistently surpassed non-Hispanic Black and Mexican American toddlers, highlighting a significant disparity (P < .001). The data suggest that despite clear evidence and guideline support for early introduction, the vast majority of infants are not being exposed to peanuts during the recommended window.
Egg Intake
Egg consumption was also low in infants (17%, 95% CI, 14%-19%), but increased to 37% (95% CI, 35%-40%) in toddlers and remained steady at 36% (95% CI, 35%-37%) in children/adults. Notably, Mexican American children/adults reported the highest egg intake at 43% (95% CI, 41%-45%), suggesting cultural dietary patterns may influence allergen exposure differently across groups.
Tree Nut Intake
Tree nut consumption was negligible in infants (1%, 95% CI, 0%-1%) and low in toddlers (4%, 95% CI, 3%-5%). However, a significant increase was observed in children/adults, rising from 9% (95% CI, 8%-11%) in 2003-2004 to 21% in 2017-2023. Non-Hispanic White children/adults consistently reported the highest tree nut intake (17%, 95% CI, 16%-18%).
Disparities and Temporal Trends
The findings reveal persistent disparities in allergen consumption by race/ethnicity and age. Non-Hispanic White children and adults are more likely to consume peanuts and tree nuts, while Mexican Americans report higher egg intake. Although tree nut consumption has increased over time in older age groups, the early introduction of peanuts—a critical intervention for allergy prevention—remains uncommon in infants across all groups.
Expert Commentary
The study authors emphasize the importance of culturally tailored public health campaigns to address caregiver fears and promote early introduction of allergenic foods. They note: “Public health campaigns should address caregiver fears and promote early introduction across all communities to reduce sensitization rates; however, based on our findings, these campaigns should account for differences in cultural and familial patterns of allergen consumption.”
These results echo prior research showing that knowledge gaps, parental anxiety, and lack of healthcare provider guidance are barriers to early peanut introduction (Sicherer & Sampson, J Allergy Clin Immunol, 2018). Furthermore, access to allergen-containing foods and concerns about choking or preparation may contribute to low uptake, particularly in under-resourced communities.
Limitations of the study include reliance on self-reported dietary recall, which may underestimate or overestimate true consumption, and inability to assess food allergy outcomes directly. Nonetheless, the large, nationally representative sample and two-decade span of data provide valuable insights into real-world practices.
Conclusion
Despite strong evidence and updated guidelines supporting early allergen introduction, peanut consumption among US infants remains strikingly low, with notable disparities by age and ethnicity. The continued rise in tree nut intake among children and adults reflects broader dietary shifts but does not address the critical prevention window in infancy. Public health strategies must be culturally and socioeconomically sensitive, addressing caregiver concerns and systemic barriers, while ongoing surveillance is essential to monitor progress and guide policy. Bridging the gap between guidelines and practice is vital for reducing the future burden of food allergies in the United States.
References
Hosein EA, Virkud YV, Kim EH, Hoke MK, Thompson AL, Keet CA. Temporal, Age, and Racial and Ethnic Trends in Allergen Consumption from 2-Day 24-Hour Recalls, NHANES 2003-2023. J Allergy Clin Immunol Pract. 2025 Jul 29:S2213-2198(25)00718-4. doi: 10.1016/j.jaip.2025.07.028. Epub ahead of print. PMID: 40744377.
Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2018 Jan;141(1):41-58. doi:10.1016/j.jaci.2017.11.003.
