The Importance of Introducing Food Allergens Early – And How to Do So Safely
There are many things that can be stressful for new parents -- from leaving your baby with someone else for the first time to caring for your baby during their first cold. Introducing food allergens to your little one can often be one of those stressful and scary moments. While food allergies are not new, the number of children with food allergies has increased by 50% in the past decade and at an even higher rate for Black and Hispanic Americans. Approximately 32 million people in the United States and ~8% of children have a food allergy.
Kerry Jones, MPH, RDN, LDN and CEO of Milestones Pediatric & Maternal Nutrition specializes in helping families create healthy eating habits and navigate food allergies. She put together this helpful guide for Without A Trace to share with parents and caregivers on introducing food allergens.
Why Should Parents Introduce Food Allergens Early?
There are nine major food allergens – milk, eggs, wheat, fish, soy, peanut, tree nuts, crustacean shellfish, and sesame – that are responsible for not only the majority of the food allergic reactions in the United States, but also the most serious food allergic reactions. Contrary to previous belief that parents should hold off exposing their children to common food allergens, recent research has shown that it is beneficial to introduce food allergens early and repeatedly. In fact, we have seen in research studies that by introducing food allergens, specifically cow’s milk products, egg, and peanut early we are able to lower the risk of developing food allergies by 78-86%.
How Early is Early Enough?
Research has shown that the earlier we can introduce common food allergens the better chance we have at preventing food allergens later in life. However, it is important to remember that we want to make sure that infants are developmentally ready to accept foods – able to sit with support, good head and neck control, doubled birth weight, interest in food, and loss of extrusion (or tongue thrust) reflex – prior to introducing any foods, including the common food allergens. This is why the American Academy of Allergy, Asthma, & Immunology (AAAAI) and American Academy of Pediatrics (AAP) recommend that infants be gradually introduced to common food allergens between 4-6 months of age. If your child has already started solids, but has not yet been introduced to food allergens, don’t worry! Research shows that introducing infants to food allergens regularly before their first birthday helps to reduce their risk of food allergies.
If your child already has a known food allergen or has eczema, it is important to talk to your child’s pediatrician or food allergist prior to introducing common food allergens. They may want to have your baby complete an oral food challenge in their office to watch for any allergic reactions or may recommend adjusting the timing of introducing commonly allergenic foods.
What Do You Mean by Repeatedly?
While it is important that we introduce food allergens early, research has also shown that it is also important that infants are exposed to those food allergens regularly in order to maintain their tolerance. Research has shown that when infants consume 0.35-6 grams of common food allergens weekly, they are able to reduce their risk of developing food allergies. They also found it is even better when the food allergens are introduced in tiny amounts throughout the week to meet that weekly gram amount. That may seem like a lot, but just know that these amounts are fractional amounts of food. For example, 1 large egg is about 50 grams, so having even a strip of an egg omelet weekly would help your infant meet these recommendations.
How Can I Introduce Food Allergens Safely?
We know that we want to introduce common food allergens early and repeatedly, but we also know we want to do it safely. Before introducing any foods make sure that your baby is developmentally ready shown by:
- Being able to sit with support
- Having good head and neck control
- Having doubled their birth weight
- Being between 4-6 months (based on corrected age, if they were premature)
- Showing interest in food
- Losing their extrusion reflex (also called tongue thrust reflex)
If your baby meets all of the criteria above, it is important to start introducing some of the foods that are not common allergens first either as purees or following the baby-led weaning method. Once your baby has tolerated eating a few foods, then it is time to introduce common food allergens. As a reminder, if your child already has known food allergies or eczema, talk to your child’s pediatrician or food allergist prior to introducing commonly allergic foods.
Here are some tips for introducing commonly allergic foods:
- Introduce food allergens at the right texture for their stage of development. It is important to avoid choking hazards for all children under age 4 years old, such as whole peanuts or tree nuts or un-toasted bread.
- Give your baby your full attention while they are eating. Eating new foods is hard, so it is important to make sure that you are there to make sure your baby is eating safely and that you are able to respond if they start choking or having an allergic reaction.
- Introduce all foods (including commonly allergic foods) one food at a time. If your child has an allergic or adverse reaction, this will allow you to deduce which food is causing the issue. Once you have identified multiple safe foods for your infant, then it is okay to start mix foods together, such as strawberry & banana puree.
- Wait 3-5 days between new food introductions. While most allergic reactions occur within 2 hours after ingesting the food, it is important to wait a few days to make sure that your child is not having an adverse reaction to a particular food.
- Introduce new foods early in the day. As mentioned above allergic reactions typically occur within 2 hours after eating a food. Therefore, it is important to make sure you introduce new foods early in the day, so you can observe your baby for signs of an allergic reaction instead of those potentially occurring while your baby is sleeping.
- If your child is experiencing an allergic reaction, such as: hives, vomiting, shortness of breath, coughing, or swelling, call 911 immediately and stay with your baby.
It is important that all foods, including food allergens, are introduced to babies at the right texture for their stage of development. Below are some ways to introduce the 9 major food allergens:
- Peanuts: Mix 2 teaspoons of peanut butter or peanut powder with 2 teaspoons of water and add to a food that has already been safely introduced, such as oatmeal or fruit puree.
- Tree Nuts: Mix 2 teaspoons of tree nut butter or tree nut powder with 2 teaspoons of water and add to a food that has already been safely introduced, such as oatmeal or fruit puree.
- Eggs: Offer your baby strips of an omelet, a quartered hard-boiled egg, or a pureed egg.
- Wheat: Offer your baby whole wheat rotini or penne pasta, toasted wheat bread cut into strips, or wheat porridge.
- Soy: Give your baby strips of soft tofu, pureed, shelled edamame, or pureed soft tofu.
- Fish: Give your baby cooked, flaked salmon pieces (deboned) or pureed fish, such as tuna or sardines.
- Shellfish: Give your baby shelled, deveined, butterflied, cooked shrimp (tails removed) or pureed shellfish (such as crab or shrimp).
- Sesame: Offer your baby hummus made with tahini or sprinkle ground sesame seeds on a food that has already been safely introduced.
- Milk: Offer your baby whole milk, plain yogurt or whole milk ricotta cheese or melt cheese on a strip of toasted bread.
Introducing the common food allergen can seem scary, but when these foods are introduced safety and regularly, there can be a significant reduction in your child’s likelihood of developing food allergies and it can be fun to watch your baby explore new foods and develop new skills.
- Centers for Disease Control: Trends in Allergic Conditions Among Children: United States, 1997-2011
- American College of Allergy, Asthma & Immunology: Temporal Trends in Racial/Ethnic Disparity in Self-Reported Pediatric Food Allergy in the United States
- JAMA Network: Prevalence and Severity of Food Allergies Among US Adults
- Pediatrics: The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States
- Nutrition Today: Recent Surveys on Food Allergy Prevalence
- The Journal of Allergy and Clinical Immunology: Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel
- JAMA Network: Prevalence and Severity of Sesame Allergy in the United States
- Pediatric Allergy and Immunology: Time of Food Introduction and Development of Food Sensitization in a Prospective Birth Cohort
- New England Journal of Medicine: Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy
- New England Journal of Medicine: Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants
- American Academy of Pediatrics Committee on Nutrition: Effects of Early Nutritional Interventions
- aaaai.org: Primary Prevention of Allergic Disease Through Nutritional Interventions
- Lancet: Another Step Towards Prevention of Food Allergy