Table 1. Recommendations for primary prevention of food allergies through nutrition and potential impacts on social disparities.

Consensus recommendations from the Academy of Allergy, Asthma, and Immunology (AAAAI), American College of Allergy, Asthma, and Immunology (ACAAI), and Canadian Society for Allergy and Clinical Immunology (CSACI),¹² with consideration for social disparities.

Recommendation	Strength of recommendation	Potential impact of social disparities
1. Consider infants with severe eczema at the highest risk of developing FA.	Moderate	Living in an inner city associated with increased odds of atopic dermatitis.51 Increased atopic dermatitis prevalence, severity, and persistence in Black and Hispanic compared to White children in the US.52
2. Introduce peanut-containing products to all infants, irrespective of their relative risk of developing allergy, starting around 6 months of life, although not before 4 months of life.	Strong	White children may be introduced to peanut earlier than non-White children.22 Urban populations may introduce peanut earlier than suburban populations.23
3. Introduce egg or egg-containing products to all infants, irrespective of their relative risk of developing allergy, around 6 months of life, though not before 4 months of life.	Strong	No difference in timing of egg introduction by race.22 Urban populations may introduce egg earlier than suburban populations.23
4. Do not deliberately delay the introduction of other potentially allergenic complementary foods (cow’s milk, soy, wheat, tree nuts, sesame, fish, shellfish), once introduction of complementary foods has commenced at around 6 months of life but not before 4 months of life.	Moderate	White children may be introduced to cow’s milk earlier than non-White children.22 Urban populations may introduce fish or seafood earlier than suburban populations.23
5. Upon introducing complementary foods, infants should be fed a diverse diet, as this may help foster prevention of food allergy.	Weak	Minoritized and low-income infants may have less access to diverse and nutritious foods.53, 54
6. Do not routinely prescribe or recommend the use of any hydrolyzed formulas for the specific prevention of food allergy or development of food sensitization.	Strong	Minoritized and low-income children may have less access to formulas than White children.19
7. Do not recommend maternal exclusion of common allergens during pregnancy and lactation as a means to prevent food allergy.	Weak	Non-Hispanic Black infants are less likely to be breastfed than other racial or ethnic groups.20, 21 Factors associated with decreased likelihood of breastfeeding include race, ethnicity, geographic location, lower maternal education, younger maternal age, shorter maternity leave, lack of work-related breastfeeding support, household food insecurity, neighborhood disadvantage and segregation, and housing insecurity.20, 21