Maternal eggs and peanuts did not prevent allergy

High maternal egg and peanut intake during pregnancy and breastfeeding did not reduce infant egg or peanut allergy.
*Multisite randomized controlled superiority trial; Level 1b (OCEBM).

Citation

Palmer DJ, Campbell DE, Nanan R, et al. Trial of a Maternal Diet Rich in Eggs and Peanuts to Reduce Infant Allergy. N Engl J Med. 2026;395:1090-1099. doi:10.1056/NEJMoa2605659

Background

Food allergy may begin before infants start solid foods, raising interest in whether maternal diet during pregnancy and breastfeeding can promote tolerance. Prior evidence did not support maternal avoidance of allergenic foods, but randomized evidence on high intake was lacking.

Patients

Pregnant women before 23 weeks’ gestation with singleton pregnancies, planning to breastfeed, whose unborn child had at least two biologic family members with medically diagnosed allergic disease. Women with egg or peanut allergy were excluded.

Intervention

At least 6 eggs and 60 peanuts weekly from enrollment through 4 months after birth during breastfeeding.

Control

Standard diet: no more than 3 eggs and 30 peanuts weekly; this reflected current guidance not to avoid these foods.

Outcome

Primary: infant medically confirmed immune-related egg or peanut allergy at 1 year. Secondary: separate egg allergy, peanut allergy, skin test sensitization, eczema, and safety.

Follow-up Period

Infants were assessed at approximately 1 year of age.

Results

Outcome High egg–peanut diet Standard diet Between-group effect
Egg or peanut allergy (primary) 7.8% 8.4% NS
Egg allergy 6.2% 7.2% NS
Peanut allergy 2.6% 2.6% NS
Eczema by 12 months 42.8% 46.2% NS

The primary relative risk was 0.93 (95% CI 0.69 to 1.26). Analyses were intention-to-treat; per-protocol results were also non-significant. Safety outcomes were similar.

Limitations

Observed allergy rates were lower than expected, reducing power to detect a moderate benefit. Participants were selected higher-risk Australian families, so generalizability to lower-risk families is uncertain.

Funding

Australian public and nonprofit funders; no major industry concern.

Clinical Application

Do not recommend high maternal egg or peanut intake to prevent infant allergy; continue standard infant feeding guidance.