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Practice Uncertainties Page

Does avoidance of peanuts in early life reduce the risk of peanut allergy?

BMJ 2010; 340 doi: (Published 11 March 2010) Cite this as: BMJ 2010;340:c424
  1. Susannah McLean, clinical research fellow,
  2. Aziz Sheikh, professor of primary care research and development
  1. 1Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG
  1. Correspondence to: A Sheikh Aziz.sheikh{at}
  • Accepted 16 December 2009

Peanut allergy has increased in frequency and severity such that it is now responsible for considerable morbidity and in some cases mortality. This has led to conflicting policies aimed at reducing the risk of children developing peanut allergy. Expectant women and parents of young children, as well and their clinicians, are therefore often unclear about whether to avoid peanuts.

What is the evidence of uncertainty?

We searched the Cochrane Library and PubMed using a combination of MeSH and free text terms from the inception of these databases to November 2009 to identify relevant systematic reviews and original studies that had investigated the effect of peanut avoidance in pregnancy, in mothers who were lactating, and in the diets of infants, on the risk of subsequently developing peanut allergy. We also searched Google Scholar and online trial registries ( and to identify unpublished and ongoing randomised controlled trials.

Changing advice on the role of peanut avoidance

In 1998 the UK government advised that those at “high risk” of developing allergy (that is, those with a family history of allergic problems) may wish to avoid eating peanuts and products that contain peanuts during pregnancy, lactation, and weaning (until infant is aged 3 years).1 Similar advice was issued around the same time in several other countries.2 3

This advice on avoidance of peanuts was based on the findings of epidemiological studies, which suggested that exposure to peanuts during this “critical window” in early life may increase the risk of peanut allergy.4 5 Supportive, potentially more compelling, evidence came from the early randomised controlled …

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