Conclusion
To our knowledge this is the first trial to explore a novel pragmatic strategy for the primary prevention of tree nut allergy in infants at highest risk of tree nut allergy, and if effective will provide evidence for a management guideline for direct translation into clinical practice for reducing the risk of development of multiple nut allergies for infants with peanut allergy. It is expected that supervised introduction of several tree nuts in the first year of life will prevent tree nut allergy, facilitate ongoing ingestion, improve parental anxiety and quality of life and reduce the healthcare costs associated with the management of multiple nut allergies.