Introducing Allergens to Baby

In 2015, a groundbreaking study demonstrated that the early introduction of peanuts to at-risk babies could reduce the risk of developing peanut allergy by as much as 81%. In other words, delaying the introduction of common allergens may increase the likelihood of allergies developing.1 As such, allergists and medical institutions now recommend introducing allergens before a baby’s first birthday.

Is my baby at risk of food allergies?

Before introducing major food allergens, it’s important to know if your baby is at risk of developing food allergies. A food allergy can develop at any point in a person’s life, but there are certain risk factors that you can identify early in a baby’s life.

If your baby has severe eczema, which tends to present as dry, itchy patches on the skin, they may be at an increased risk of developing food allergies.3
If your baby has a sensitivity or allergy to another food, such as milk or eggs, they have a higher risk of developing food allergies.4

If your baby has any of the above risk factors, it would be wise to work with a pediatric allergist early on in your solid food journey. Otherwise, aim to introduce the common food allergens between 6 and 12 months of age.

Although it was previously believed that a family history of food allergies might predispose a baby to food allergy themselves, the consensus has since shifted. Allergy specialists now recommend that siblings of children with food allergies can introduce common food allergens at home without any pre-testing if they are not at high risk due to severe eczema or another pre-existing food allergy. However, if this is anxiety-provoking, discuss allergen introduction under medical supervision with the child’s healthcare team.

Introducing allergenic foods to babies

Introducing food allergens doesn’t have to be terrifying. You can start with a scant amount of the allergen to minimize any possible reaction and slowly work up to larger servings. If you are very anxious to introduce allergens to your baby, make an appointment with a pediatric allergist to discuss the possibility of pursuing a supervised challenge. Even if allergy testing or an oral challenge isn’t necessary, the allergist can offer valuable counseling and help develop a plan for dietary introduction.

What are the Big 8 allergens?

In the United States, there are currently 8 major food allergens:

Milk
Eggs
Peanut
Tree Nut (e.g. almond, cashew, macadamia, pecan, walnut, etc.)
Finned fish (especially cod, halibut, salmon, and tuna)
Shellfish
Soy
Wheat
(Sesame)

As of January 1, 2023, sesame will be recognized as a common allergen in the U.S.. Note that many allergens on this list are also choking hazards, so be sure to use our free First Foods® database to learn how to modify these foods to make the consistency age-appropriate and safe for baby.

Tips for introducing common food allergens to babies

Start small: The smaller the quantity served, the less severe an allergic reaction may be. Start with scant amounts, such as 1/8 teaspoon of a finely ground nut added to your baby’s bowl of oatmeal. If there is no reaction, try gradually increasing the amount over the next few days until you work your way up to larger amounts. Once you’ve ruled out an allergy to that food, aim to offer it to your baby as frequently as you can, but weekly at minimum.
Introduce allergens early in the day: Most allergic reactions occur within two hours of ingestion and often within minutes.5 Consider introducing an allergen shortly after waking in the morning or right after a morning nap. Introducing the allergen in the morning lets you observe your child during the day ahead; should an allergic reaction occur, it is easier to contact your doctor for guidance. For similar reasons, it is best to introduce allergens at home and when at least one adult can focus their full attention on the baby (without distraction from other children or household activities) for at least two hours afterward.
One at a time. Introduce one food allergen at a time. This way, if there is a reaction, you’ll know which food was responsible. A few days of daily ingestion is usually enough to establish that a food is well tolerated; don’t be afraid to offer multiple new foods each week. Pick a pace that feels comfortable and enables you to introduce a wide variety of new foods well before your baby’s first birthday. Need help or ideas for introducing allergens and a variety of foods? Check out the First 100 Days Meal Plan for Starting Solids.
Regular exposure: Once you’ve safely introduced a food allergen to your child, keep that food in regular rotation—ideally offering it to your baby every week, at minimum. Not all babies with allergies will react on the first exposure, so it’s important to keep serving sizes small until you are confident there is no allergic reaction.

If I have allergies or Oral Allergy Syndrome, will I pass them on to baby in my breast milk?

Fortunately, allergies and OAS are not passed along to baby through mom’s breast milk. In general, concerns about potential food allergies should not discourage parents from offering breast milk, especially since breast milk offers a variety of nutritional and immune-supporting benefits for baby.6 Also, avoiding common food allergens in an effort to prevent food allergies either during pregnancy or when lactating hasn’t been shown to prevent food allergies and is not recommended.7

If I am allergic to a food, how do I introduce that food to baby?

It can be nerve-wracking to feed your baby a food to which you are allergic. Rest assured that you are unlikely to experience a serious allergic reaction from simply being in the vicinity of your allergen, or even from handling it. The vast majority of patients with food allergies react only upon ingestion. That said, there are steps you can take to minimize your risk of a reaction. When preparing the food, avoid prolonged skin contact with the allergen. If you are not able to wash your hands promptly afterward, wear gloves. If you have a carpet or rug, make sure you place baby’s high chair over a splat mat or move the high chair to a non-carpeted surface or even consider feeding baby outside. This is also a great time for disposable placemats, plates and utensils.

When introducing the allergen, consider offering the allergen at the beginning of the meal and immediately following up with another food to which neither you or baby are allergic. This will reduce the allergen content in baby’s saliva. After mealtime, clean baby’s hands and face thoroughly, wipe down the eating surface and chair, and remove baby’s clothing so it can be washed.

Lastly, model a calm demeanor, even if you are nervous at first; children pick up on the anxiety of the adults around them. As feedings continue successfully, it will get easier and become routine. If you feel very nervous, this is an excellent opportunity for a non-allergic parent, caregiver, relative, or friend to spend quality time with baby.

If baby was diagnosed with CMPA, can they consume other dairy products like yogurt and cheese?

Unfortunately, no. If baby has CMPA (Cows Milk Protein Allergy), they can’t have milk or other dairy products, such as yogurt and cheese.8 Goat and sheep milk products are also not recommended.9 Lastly, soy milk and soy-based formulas are generally not recommended either, as CMPA can also entail sensitivities to soy and soy-based products. Remember that research shows the majority of children with cow’s milk allergy will outgrow it by age 6, and many babies with milder symptoms of milk protein allergy (which can show up as painless blood in the stool) are able to successfully reintroduce cow’s milk as early as their first birthday, with the guidance of their doctors.10

If a recipe requires milk, what is the best milk substitute for a baby with CMPA?

If a baby has CMPA, then they also need to avoid milk from other animals, soy milk, and soy-based formulas, since babies with CMPA can also be sensitive to these.11 12 The best options for a baby with CMPA include breast/human milk (from a provider who is avoiding dairy and soy in their diet) or a CMPA-appropriate formula as recommended by your healthcare provider. For toddlers, fortified pea protein or oat milks are also acceptable substitutes. Do note that when compared to cow’s milk, pea protein milk tends to be lower in calories and oat milk is usually lower in protein and can be included as part of a generally balanced diet. For a full comparison of plant-based milks, see our Milk FAQs. Be sure to connect with your pediatric healthcare provider, such as a dietitian/nutritionist, to help identify the best substitute for your child’s individual needs.

Note: Lactose-free formula or milk are not appropriate for a child with CMPA. In CMPA, the natural proteins in milk trigger the allergic reaction, and lactose-free milk still contains these natural proteins (but is free of a natural sugar called lactose).13

Do I need to buy products like SpoonfulOne?

We generally want to see babies and children encouraged to enjoy a wide variety of whole foods, with their associated tastes, smells, and textures intact (as opposed to powders and formula-type products). So for example the vast majority of babies who are not at increased risk of developing a food allergy (see risk factors), we believe that allergen introduction with real, unprocessed foods is the way to go. This aligns with current recommendations that babies who are not at high risk of developing food allergies introduce food allergens into the diet in accordance with family preference and cultural feeding practices.

Anxious for more? See our full guide, Introducing Allergens.

Or check out our video on Introducing Peanuts, one of the most common food allergies in children.

Next up: Symptoms of an Allergic Reaction

Reviewed by:

V. Kalami, MNSP, RD, CSP

R. Ruiz, MD, FAAP. Board-Certified General Pediatrician & Pediatric Gastroenterologist

S. Bajowala, MD, FAAAAI. Board-Certified Allergist & Immunologist

Information provided by Solid Start.

https://solidstarts.com/starting-solids/allergies/introducing-food-allergens-to-babies/

Introducing Allergens to Baby