Food allergies and your baby
Over the years, research about when and how to introduce babies to various allergens has progressed, and the corresponding expert advice has evolved. If you have an older child, you might be surprised to learn that pediatricians are no longer advising parents to wait to introduce their babies to peanuts and eggs.
Whereas the common belief not so long ago was that if you expose babies to allergens too early, they’d develop food allergies or asthma, the current recommendation is to introduce potential allergens early and often1,2.
Yes, you read that correctly. Experts today argue that a widespread rise in child food allergies in the United States—the majority of which were diagnosed before age 23—came precisely because pediatricians were telling parents to avoid food allergens: The lack of exposure led young bodies to perceive these foods as a threat to their immune system.
In 2015, results of a study called LEAP led to the National Institute of Allergy and Infectious Diseases’ updated guidance4. In 2019, the American Academy of Pediatrics (AAP) updated its allergen introduction recommendations accordingly5.
In the LEAP study, researchers compared a group of babies who were introduced to peanuts between 4 and 11 months to a second group introduced at 5 years old. At age 5, they found that the first group—those who had eaten peanuts early and frequently—were 86 percent less likely to be allergic to peanuts. They did a few more comparisons, and kept finding that early peanut introduction seemed to lead to peanut allergy immunity6.
What, exactly, is a food allergy?
When your immune system reacts negatively to a food, you’re allergic to it. Typically, this means that your body makes antibodies against the food and then gets activated after exposure.
Food allergies can cause anaphylaxis: Within 60 to 90 minutes of exposure7, a rash might appear on your skin, as your blood pressure drops and your airways narrow, blocking your ability to breathe. It’s serious. If you notice your baby breaking out in hives, in combination with coughing, having trouble breathing, or vomiting, you should call 911 or immediately go to the nearest hospital emergency room.
What is a food intolerance?
Food intolerance is not as easy to test for as a food allergy; there’s no clear test for lactose intolerance, for example, Dr. Panchal says. Symptoms of an allergy tend to be clear and consistent, whereas intolerance symptoms are often more vague, inconsistent, and less severe.
“Most food intolerances don’t cause skin reactions or symptoms, occur several hours after eating, and mainly involve GI symptoms,” Dr. Panchal says. If you have any questions about your baby’s digestive responses to food, ask your pediatrician.
How to introduce allergenic foods to your baby
Follow these five steps to determine readiness and start your baby on the path of trying potentially allergenic foods.
- Know if your baby is ready for solids
- Decide when to introduce allergens
- Figure out which foods to serve, and how
- Watch for a reaction
- If no reaction to a common allergen, keep offering it
Step 1: Know if your baby is ready for solids
At 4 months of age, some signs will start to appear that your baby is preparing to eat solids, including increased trunk and head strength, as well as a clear interest in food. Your little one will have doubled in size since birth, and the extrusion reflex—which causes babies to push solid foods out of their mouth with their tongue—will disappear. By 6 months, your baby will likely be ready for solids.
Step 2: Decide when to introduce allergens
At 6 months old, your baby should be ready to start with solid foods, including potential allergens.
If you know that your child already has an egg allergy, or severe eczema, talk to your doctor. (Experts say eczema is severe when it’s hard to control, you’ve been referred to a specialist, and/or you have multiple prescriptions for your 4- to 6-month old baby.) Keep in mind, however, that severe eczema doesn't necessarily have a direct connection with food allergies, Dr. Panchal says. There's usually no reason to avoid or alter food allergen introduction, and many babies outgrow severe eczema.
Experts recommend giving your baby a new food during the day—morning or lunchtime is ideal—and not within two hours of your baby’s bedtime, so you have enough time to observe a reaction, if any, to the new food, and respond accordingly.
A high percentage of allergic reactions occur within just a couple hours of exposure, says Dr. Panchal. She recommends offering the new food at home, not at your child’s day care center or in a restaurant, so you know exactly what your baby is eating and so you can observe the response.
Step 3: Figure out which foods to serve, and how
Now that you’ve figured out when to introduce allergenic foods, you can plan which foods to offer your child—and how to prepare them. Whereas pediatricians previously advised parents to introduce peanuts and eggs first, Dr. Panchal says, today’s consensus is that the introduction order doesn’t matter.
The nine top food allergens in the United States are:
- eggs
- shellfish
- peanuts
- milk
- wheat
- fish
- tree nuts
- soy
- sesame
Here are some suggestions about how to introduce those foods:
- Serve other foods, such as iron-rich foods and vegetables, first. Make sure that your baby is comfortable eating in general before you introduce a commonly allergenic food. One or two weeks should be a good amount of time for your baby to get used to meals.
- Serve only one new food per day. Let’s say you’re ready to introduce your baby to eggs. Offer it with a food you have observed that your baby likes, such as bananas. Try mashing a hard-boiled egg with half of a banana and some breast milk.
- Start with a small amount. It is very rare for a new food exposure to cause anaphylaxis in a baby. Yet if your child has an allergic reaction to a food you introduce, you want to minimize the exposure. Aim for one teaspoon per meal.
You must wait three to five days after introducing an allergenic food before offering another.
Creative ideas for introducing your baby to 9 common food allergens
Dr. Panchal
Pediatrician
Pediatricians recommend introducing babies to common food allergens as soon as they’re able to handle the size and texture. This means giving your baby a taste of one at a time: If you see an allergic reaction, you know which food was the culprit. After a safe introduction to one of these foods, try to keep it in your child’s weekly rotation.
- Scrambled
- In an omelet cut in strips
- Baked in muffins
- Hard-boiled, mashed with avocado
- Salmon, cod, halibut, sole, all cooked soft
- Fish cakes
- Canned salmon, tuna, or sardines (choose salt-free)
- A bit of melted peanut butter mixed in oatmeal or full-fat yogurt
- Bamba puffed peanut snack
Avoid these choking hazards: chunky peanut butter, whole nuts, or a spoonful of nut butter.
- Whole-milk plain yogurt
- Whole-milk plain Greek yogurt
- Plain full-fat cottage cheese
- Full-fat ricotta cheese
- Melted cheese on strips of toast
- Shrimp broth (you can just boil the shells)
- Crab, with shells removed, cooked soft and shredded into bits
- Crab cakes
- Puree of shrimp and sweet potatoes
- A whole jumbo shrimp, peeled
- Cooked soft tofu
- Mashed edamame
- Plain soy yogurt
- Soy milk mixed into oat or rice cereal
Watch out for whole edamame, as it is a choking hazard. You can chop it up or puree it.
Tree nuts include almonds, Brazil nuts, macadamia, cashews, hazelnuts, pecans, pistachios, and walnuts.
- Nut butter mixed in yogurt or oatmeal
- Nut butter in a smoothie
- Nut butter spread on a piece of whole-grain toast
- Sesame seed sprinkles on anything, including steamed vegetables
- Hummus containing sesame oil mixed with a veggie puree, yogurt, or plain oatmeal
- Tahini mixed with a veggie puree, yogurt, or plain oatmeal
- Whole/mixed-grain baby cereal including wheat, mixed with breast milk
- Whole/mixed-grain baby cereal including wheat, mixed with banana or other fruit
- Strip of whole-wheat toast with smashed avocado or unsalted butter
Step 4: Watch for a reaction
Allergic reactions to foods normally occur within two hours of eating the food, but not always. The most common food allergy reactions include:
- tingling or itching in the mouth
- hives, itching, or eczema on the exterior skin
- swelling of the lips, face, tongue, throat, or other parts of the body
- wheezing, nasal congestion, teary eyes, or trouble breathing
- abdominal cramping, diarrhea, nausea, or vomiting
- dizziness, lightheadedness, or fainting
In some babies, a food allergy can trigger a severe allergic reaction called anaphylaxis. This can cause life-threatening signs and symptoms, including:
- constriction and tightening of the airways
- a swollen throat, or the sensation of a lump in the throat that makes it difficult to breathe
- shock with a severe drop in blood pressure
- a rapid pulse
- dizziness, lightheadedness, or loss of consciousness
If your child shows signs of anaphylaxis10, develops rashes or lip swelling, or begins vomiting shortly after introduction to a common food allergen, call 911 immediately. If you already have an Epipen from your doctor for your baby, and know how to use it, give it as soon as you can. It is usually better to give it unnecessarily than to be too late.
Step 5: If no reaction to a common allergen, keep offering it
Once you’ve established that a particular food is safe for your child to eat, start feeding it to your baby on a regular basis. Studies show that one exposure isn’t enough to reduce your baby’s chances of developing an allergy.
The bottom line: Many experts believe that introducing allergens early and often can help prevent food allergies. If you are exposing your baby to these foods on a regular basis, starting at 6 months, you’re on the right track.
Other things you can do to prevent food allergies—and allergies in general—include exposing your child to dirt11, treating any eczema12, using fewer antibiotic soaps and detergents13, ensuring that your child gets an adequate amount of vitamin D14, and even getting a dog15.
When in doubt, talk to your pediatrician. Every child and situation is different, and yours need to be taken into account. And if your baby appears to have a food allergy, don’t blame yourself. Food allergies affect an estimated 8 percent of children under age 5. And even if your child does have a food allergy, it might not be permanent.
“Many children outgrow food allergies, so this could just be temporary,” Dr. Panchal says.
References
1 https://www.ncbi.nlm.nih.gov/pubmed?term=27654604
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308770/
3 https://pediatrics.aappublications.org/content/pediatrics/111/Supplement_3/1631.full.pdf
4 https://www.leapstudy.co.uk
5 https://publications.aap.org/pediatrics/article/143/4/e20190281/37226/The-Effects-of-Early-Nutritional-Interventions-on?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000
6 https://www.nejm.org/doi/full/10.1056/NEJMoa1414850
7 https://www.aaaai.org/Conditions-Treatments/Allergies/Anaphylaxis
8 https://pediatrics.aappublications.org/content/106/Supplement_4/1274.1
9 https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx
10 https://www.aaaai.org/conditions-treatments/allergies/anaphylaxis
11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080537/
12 https://pubmed.ncbi.nlm.nih.gov/25210971/
13 https://www.cell.com/cell/fulltext/S0092-8674(20)31677-9?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867420316779%3Fshowall%3Dtrue
14 https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/vitamin-d-food-allergy
15 https://onlinelibrary.wiley.com/doi/abs/10.1111/all.13868
Additional resources
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