Caregiver and expecting caregiver support for early peanut introduction guidelines

Abstract Background Recent guidelines recommend early peanut introduction (EPI) beginning around 4-6 months in infants with either severe eczema and/or egg allergy, and around 6 months for all other infants. Caregiver preferences for such practices are unkown. Methods We explored preferences for EPI and in-office allergy risk assessment (IRA) through a nationally-representative survey of expecting (n=1000) and new caregivers of infants Results Among a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no/vague awareness of the new guidelines, 61% had no/minimal concern for their child developing food allergy, but 54% felt timing of introduction has moderate/strong importance for developing food allergy. Only 31% expressed willingness for EPI before/around 6 months of life, with 40% reporting willingness to introduce peanut after 11 months of life, similar to tree nuts and seafood. However, 60% reported willingness to introduce egg before 8 months. 51% and 56.8% were unwilling to allow IRA methods such as skin testing and oral challenge before 11 months of life, respectively. Odds of willingness to both delay peanut introduction and undergo challenge after 6 months of life were lower among expecting caregivers (OR 0.79, CI 0.65-0.96; OR 0.67, CI 0.54-0.82, respectively). Conclusions Among new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including IRA before introduction. Willingness was better among expecting versus current caregivers. These trends underscore a need for broader formal implementation planning to facilitate early allergen introduction and maximize its preventive benefits