Feasibility and safety of introducing cashew nut spread in infant diets-a randomized trial

Document Type

Journal Article

Publication Title

Pediatric Allergy and Immunology





First Page


PubMed ID





School of Medical and Health Sciences


Australian Food Allergy Foundation / Telethon Kids Institute / National Health and Medical Research Council / Medical Research Futures Fund (MRFF) Career Development Fellowship / Nova Institute for Health / Telethon Perth Children's Hospital Research Fund / Joondalup Health Campus / Paul Ramsay Foundation / Commonwealth Government of Australia through the Channel 7 Telethon Trust


Palmer, D. J., Silva, D. T., & Prescott, S. L. (2023). Feasibility and safety of introducing cashew nut spread in infant diets-a randomized trial. Pediatric Allergy and Immunology, 34(6), article e13969. https://doi.org/10.1111/pai.13969


BACKGROUND: To reduce peanut allergy prevalence, infant feeding guidelines now recommend introducing peanuts in an age-appropriate form (such as peanut butter) as part of complementary feeding. However, due to a lack of randomized trial evidence, most infant feeding and food allergy prevention guidelines do not include tree nuts. The aims of this trial were to determine safety and feasibility of dosage consumption recommendations for infant cashew nut spread introduction. METHODS: This is a parallel, three-arm (1:1:1 allocation), single-blinded (outcome assessors), randomized controlled trial. General population term infants were randomized at 6-8 months of age to either a one teaspoon (Intervention 1 n = 59) or increasing dosage regime of one teaspoon at 6-7 months, two teaspoons at 8-9 months, and three teaspoons from 10 months of age onwards (Intervention 2 n = 67) cashew nut spread, both three times per week, or no specific advice on cashew introduction (Control n = 70). At 1 year of age, food challenge proven IgE-mediated cashew nut allergy was assessed. RESULTS: Compliance in Intervention 1 (92%) was higher than Intervention 2 (79%), p = .04. Only one infant had delayed (at 5 h) facial swelling and eczema flare to cashew introduction at 6.5 months, but no cashew allergy at 1 year. Only one infant (Control) had cashew allergy at 1 year, and this infant had not been introduced to cashew prior to 12 months of age. CONCLUSION: Regular infant consumption of one teaspoon of cashew nut spread three times per week from 6 to 8 months of age was found to be feasible and safe.



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