A randomized trial evaluated the effectiveness of early peanut consumption versus avoidance in infants at high risk for peanut allergy. The study enrolled 640 infants with severe eczema, egg allergy, or both, who were randomly assigned to consume or avoid peanuts until 60 months of age. Participants were stratified based on skin-prick test results for peanut allergy. The primary outcome was the proportion of participants with peanut allergy at 60 months. Among infants with negative skin-prick test results, peanut allergy prevalence was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). For those with positive results, the prevalence was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). Peanut consumption significantly reduced the risk of peanut allergy, with an 86% relative reduction in the negative skin-prick group and a 70% reduction in the positive group. No significant differences were found in serious adverse events between groups. Peanut-specific IgG4 antibody levels increased predominantly in the consumption group, while the avoidance group showed higher peanut-specific IgE levels. Larger wheal sizes on skin-prick tests and lower IgG4:IgE ratios were associated with peanut allergy. The study found that early peanut consumption reduced the prevalence of peanut allergy and modulated immune responses. The findings suggest that early introduction of peanuts may prevent peanut allergy in high-risk infants. The study was funded by the National Institute of Allergy and Infectious Diseases and others. The results indicate that early peanut consumption is more effective than avoidance in preventing peanut allergy in high-risk infants. The study also highlights the importance of immune markers such as IgG4 and IgE in understanding the immune response to peanuts. The study's main weakness was the lack of a placebo group, but objective food challenges helped mitigate this. The study also found that peanut consumption was associated with a significant increase in IgG4 and IgG4:IgE ratios, which may indicate immune tolerance. The study concluded that early peanut consumption significantly reduced the risk of peanut allergy in high-risk infants. The study also found that peanut avoidance was associated with a higher frequency of clinical peanut allergy compared to consumption, suggesting that deliberate avoidance may not be an effective strategy for preventing allergy. The study's results support the recommendation for early peanut introduction in high-risk infants.A randomized trial evaluated the effectiveness of early peanut consumption versus avoidance in infants at high risk for peanut allergy. The study enrolled 640 infants with severe eczema, egg allergy, or both, who were randomly assigned to consume or avoid peanuts until 60 months of age. Participants were stratified based on skin-prick test results for peanut allergy. The primary outcome was the proportion of participants with peanut allergy at 60 months. Among infants with negative skin-prick test results, peanut allergy prevalence was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). For those with positive results, the prevalence was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). Peanut consumption significantly reduced the risk of peanut allergy, with an 86% relative reduction in the negative skin-prick group and a 70% reduction in the positive group. No significant differences were found in serious adverse events between groups. Peanut-specific IgG4 antibody levels increased predominantly in the consumption group, while the avoidance group showed higher peanut-specific IgE levels. Larger wheal sizes on skin-prick tests and lower IgG4:IgE ratios were associated with peanut allergy. The study found that early peanut consumption reduced the prevalence of peanut allergy and modulated immune responses. The findings suggest that early introduction of peanuts may prevent peanut allergy in high-risk infants. The study was funded by the National Institute of Allergy and Infectious Diseases and others. The results indicate that early peanut consumption is more effective than avoidance in preventing peanut allergy in high-risk infants. The study also highlights the importance of immune markers such as IgG4 and IgE in understanding the immune response to peanuts. The study's main weakness was the lack of a placebo group, but objective food challenges helped mitigate this. The study also found that peanut consumption was associated with a significant increase in IgG4 and IgG4:IgE ratios, which may indicate immune tolerance. The study concluded that early peanut consumption significantly reduced the risk of peanut allergy in high-risk infants. The study also found that peanut avoidance was associated with a higher frequency of clinical peanut allergy compared to consumption, suggesting that deliberate avoidance may not be an effective strategy for preventing allergy. The study's results support the recommendation for early peanut introduction in high-risk infants.