For the past two years, University of Georgia registered dietitian nutritionist Ali Berg has been leading efforts to close a critical information gap that could be the key to reducing peanut allergies and the life-threatening reactions they can cause. 

Berg, an associate professor in the College of Family and Consumer Sciences, also serves the state as a nutrition and health specialist with UGA Cooperative Extension, where she coordinates health education programs and interventions focusing on chronic disease prevention and health promotion.

Peanuts are one of the nine most common food allergens – impacting up to 2% of people in the United States, she said. Allergies typically start in childhood and persist throughout life, and range from mild reactions to severe, life-threatening anaphylaxis. Peanut allergies have raised significant public health concerns, especially in schools and other environments where food is shared.

Early introduction reduces the risk of allergy

Since 2008, the National Institute of Allergy and Infectious Diseases (NIAID) has been developing clinical guidelines for diagnosing and managing food allergies, Berg said. While the anxiety surrounding peanuts remains, a pivotal study published in 2015 revealed that introducing peanut-containing foods between 4 and 6 months of age can reduce the risk of developing a peanut allergy by up to 86% for those considered high-risk.

In response to these findings, NIAID, alongside 25 professional organizations, federal agencies and patient advocacy groups, created additional guidelines in 2017 aimed at preventing peanut allergies through early diet introduction. This advice became part of the Dietary Guidelines for Americans in 2020, shifting from clinical guidelines for physicians to public health guidelines for nutrition educators, policymakers and the public.

While the recommendations are older than most of the children they are directed toward, the information isn't reaching the public as it should, creating a critical gap in understanding, Berg said.

Identifying the knowledge gap

With funding from Southern Peanut Growers, Berg and her team conducted focus groups in south Georgia to gauge parents’ awareness and perceptions of these guidelines and better understand why this information is not more widely known despite the existing foundational research and official dietary guidelines.

Across all focus groups, parents had not heard about these guidelines from their pediatricians or other healthcare sources, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which serves about 40% of all infants in the U.S., Berg found.

“It’s not necessarily that health care providers are opposed to sharing this information with parents, but more likely that, amid all the other important things being discussed during office visits, there simply isn’t enough time to cover everything,” she added. “Parents were really surprised to learn about this and excited to know they have some control over whether their child developed a food allergy.”

One of parents’ main concerns about these guidelines is fear of choking when feeding peanut products to young infants. “The recommendation is to stir peanut butter or peanut powder into formula, breast milk or soft foods like applesauce to make it safe for infants to consume,” Berg said.

The focus groups also revealed that parents hesitate to introduce new foods if their child exhibits picky eating behaviors, but research shows it may take upwards of 10, 20 or even 30 tries before a child accepts a new food, even into toddlerhood, Berg explained. 

“It’s important that parents don’t give up too quickly,” she said. “We recommend offering peanut-containing products to infants at a cadence of 2 teaspoons three times a week and continuing to do so, as continued exposure is crucial to reducing allergy risk over time.” 

Extension training and resources for child care providers and parents

The results from focus groups with parents and pilot training modules with child care providers revealed a significant lack of understanding about food allergies, including which foods are most likely to cause them and how allergies progress or diminish over a person's lifetime. Drawing on those insights, Berg and her team developed training materials to help county Extension agents support families and child care facilities in safely implementing recommended nutritional guidelines both in school settings and at home.  

“Our school nutrition and child care provider trainings include crucial information to help providers understand who’s at risk and how to manage nutrition safely within their facilities,” Berg said. These training materials, approved by the Georgia Department of Early Care and Learning, are available through contacting your local Family and Consumer Sciences Extension agent.

For parents, hands-on programs conducted in person by agents offer immediate, direct feedback. Upcoming events and additional resources can be found on the Peanut Allergy Prevention website from UGA Extension. 

The outreach effort to child care facilities and schools has already reached more than 270 school nutrition workers in Georgia. “These individuals are important messengers in the community,” Berg noted. “They were very surprised by the early introduction guidelines and eager to use and share the information.”

Efforts to share the information with as many parents and caregivers continue through social media campaigns and other outreach efforts. “Our goal is to ensure that as many people as possible are aware of these guidelines and feel confident in implementing them,” she added.

Expanding allergy prevention and boosting the local economy

By bridging the knowledge gap and advocating for early peanut introduction, Berg and UGA Extension are playing a crucial role in both improving public health and supporting Georgia’s agricultural economy, with the state producing nearly half of the nation’s peanut crop. As the project continues, Berg is focused on refining and expanding the program.

“We’re always learning and adapting based on the feedback we receive,” she said. “The materials we’ve developed are just the start. We need to keep supporting parents and caregivers, ensuring they have the tools and confidence to make informed decisions about their children’s health.”