How to Introduce Allergens to Your Baby

Food allergens with the word food allergy in blocks

Many parents have listed introducing allergens as their biggest stressor when starting solids. This makes sense. The idea that your child could have an allergic reaction to a food is scary. The recommendations for allergen introduction have changed recently, so you may have done something completely different with an older child. Know that these recommendations are to help reduce the risk of allergies, but there is nothing you can do that is guaranteed to prevent allergies. If your child ends up with a food allergy, it is not your fault.

What is a food allergy?

When we talk about food allergies, we are generally talking about IgE mediated reactions. In simple terms, the body identifies a protein as a threat and overreacts to it. There are several theories on why this could happen. There are tests that doctors can do to test the IgE antibodies in the blood, however, just because the antibodies are present, doesn’t mean that you are allergic. The gold standard for food allergy diagnosis is to eat a food and consistently have a reaction to it. Technically, a person can be allergic to any food, but there are 9 top allergens in the United States that make up more than 90% of the food allergies.

Top 9 Allergens

The top 9 allergens are milk, soy, wheat, tree nuts, peanuts, fish, shellfish, egg, and sesame. Sesame was added in 2021. These foods must be clearly labeled on packaging (sesame is not yet labeled but will need to be soon). Because these foods make up such a vast percentage of food allergies, this is where we put most of our focus when discussing allergen introduction. Most of the research on food allergies has been done with peanuts and then extrapolated to other allergens. We do not have research that shows early introduction of other allergens is helpful, but we do have research showing that delayed introduction of peanuts was harmful.

Steps for Introduction

  1. Determine if your child is high risk. A high risk child is a child who has severe eczema (meaning they need several medications to control it) or a child with an egg allergy. These kids are at a higher risk of anaphylaxis with their first introduction of allergens. For these kids, bloodwork is recommended prior to the introduction of peanuts. If the bloodwork is ok, the recommendation is to start peanut introduction between 4-6 months. For all other children, it is not recommended to do bloodwork prior to introduction. Peanuts should be introduced around 6 months or when you start solids.
  2. It’s not recommended to give a top 9 allergen as your baby’s first food. If they were to have a reaction, they could associate that reaction with ALL foods and not want to eat solids. Instead, introduce other foods first. Once your baby is getting the hang of eating, you can begin allergen introduction.
  3. Introduce an allergen as the only new food for that meal. You want to know what caused a reaction, if your child has one. You can serve a food that your child has already tolerated with the allergen.
  4. Watch your child for a reaction. Most reactions happen within 2 hours. Try to avoid introducing a new allergen right before bed. It’s best to introduce at lunch or breakfast, so you can watch for a reaction. Do note that there will be poop changes when starting solids and that not all changes mean an allergy.
  5. If your child does not have a reaction to the food, keep it in the diet. Research shows that it is important to keep the food in the diet to prevent allergies.

Types of Reactions

This is not intended as medical advice. If you have any concerns about your child, please reach out to your physician.

Skinmild rash, some hiveswidespread rash, hives all over the body
Faceitchy mouth, runny nose, sneezinglip swelling, tongue swelling
Gastrointestinalnauseavomiting, diarrhea
Airwaynonecoughing, wheezing, trouble breathing

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