Global Variation in Timing of Allergenic Food Introduction for Food Allergy Prevention: An International Survey of Healthcare Professionals.

Abstract

IgE-mediated food allergy prevention guidelines are now established in many countries, but their implementation in routine clinical practice globally remains unclear. An anonymous online survey was distributed to healthcare professionals (HCPs) through the World Allergy Organization network between December 2024 and April 2025, collecting data on food allergy prevention recommendations in daily clinical practice. The analysis included 731 healthcare professionals from 80 countries worldwide: Asia (36.7%), Europe (27.1%), North America (15.9%), and Rest of the World (20.0%; Russia, South America, Africa, Oceania). Unsupervised clustering revealed two distinct practice patterns-one favoring early allergen introduction and one favoring later introduction-with timing varying by allergen type. For peanuts, clusters diverged between early (median 6 months of age) and late (median 18 months of age) introduction recommendations for high-risk infants. Allergen introduction timing was independently driven by region and specialty: North American HCPs recommend peanut introduction 6.7 months earlier than those in Asia (5.48 <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>±</mo></mrow> <annotation>$$ \pm $$</annotation></semantics> </math> 3.32 vs. 12.18 <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>±</mo></mrow> <annotation>$$ \pm $$</annotation></semantics> </math> 7.27 months; p < 0.001), and pediatric allergists globally advocate for introduction 2.37 months earlier than non-allergists (8.72 <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>±</mo></mrow> <annotation>$$ \pm $$</annotation></semantics> </math> 5.85 vs. 11.09 <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>±</mo></mrow> <annotation>$$ \pm $$</annotation></semantics> </math> 7.14 months, p = 0.024). This disparity is more pronounced in high-risk infants than in normal-risk infants. The variability in allergen introduction practices, driven by geography and medical specialty, highlights a persistent gap in prevention guidelines adoption. This divergence likely reflects both suboptimal implementation of existing recommendations and regional differences in food allergy epidemiology. These findings underscore the need for population-tailored allergen introduction strategies across diverse healthcare settings.