DJ Palmer et al. N Engl J Med 2026;395:1090-1099. Trial of a Maternal Diet Rich in Eggs and Peanuts to Reduce Infant Allergy

Methods: For “The PrEggNut Trial,” a multi-site, randomized trial, “pregnant women whose unborn child had at least two biologic family members with medically diagnosed allergic disease were eligible to participate. Participants were assigned in a 1:1 ratio to follow either a diet high in eggs and peanuts that included at least 6 eggs and 60 peanuts per week (high egg–peanut group [n=1070]) or a standard (control) egg and peanut diet that included no more than 3 eggs and 30 peanuts per week (standard-diet group [n=1067]), from before 23 weeks’ gestation until 4 months postnatally during lactation. The primary outcome was IgE-mediated egg or peanut allergy in the infant at 1 year of age.

Key findings:

• There was no significant difference in the percentage of infants with IgE-mediated egg or peanut allergy between the maternal high egg–peanut group (83 of 1066, 7.8%) and the standard-diet group (89 of 1064, 8.4%) (relative risk, 0.93; P=0.65)
• A potential limitation of the trial was the lower-than-anticipated prevalence of egg or peanut allergy (8% actual vs. 16% anticipated)

My take: Increased exposure to eggs and peanuts during pregnancy did not reduce allergies in infants. Exposure during infancy, however, can reduce the rates of allergies.

Related blog posts:

• In the News: Fewer Peanut Allergies, Possibly Improving Obesity Rates in U.S., Best Fruit for Constipation (2025). Referenced article (Open Access!): S Gabryszeweki et al. Pediatrics e2024070516. Guidelines for Early Food Introduction and Patterns of Food Allergy “Recent (2021³) guidelines …recommended the introduction of peanut, egg, and other major food allergens at age 4 to 6 months, regardless of atopic history or food allergy testing.”
• Allergy Prevention Strategy: Early Exposure Beneficial (Long-term Data for Peanuts) (2024)
• LEAP-ON Study: Early Peanuts Prevent Allergies (2016)
• The “EAT” Study (2016)
• The Peanut Story -From NEJM Blog
• Links: Prevent Peanut Allergy (National Peanut Board)