Many parents have listed introducing allergens as their biggest stressor when starting solids. This makes sense because 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. These recommendations are to help reduce the risk of allergies, but there is nothing you can do that is guaranteed to prevent allergies. Remember: if your child ends up with a food allergy, it is not your fault (and if they’re starting school with an allergy, check out these tips).
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What is a food allergy?
When we talk about food allergies, we are generally talking about IgE mediated reactions. Non-IgE mediated allergies include diagnoses like FPIES. 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. Because these tests aren’t great, 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. The Food and Drug Administration added sesame as a top allergen in 2021. Top allergens 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
The amount of time for introduction will vary depending on how comfortable you are introducing the foods. There is no research showing an optimal number of times to introduce a food before moving onto the next one.
- 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. Because of this, 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. Introduce peanuts at around 6 months or when you start solids.
- Start with other foods first.
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.
- Introduce the 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.
- Watch 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.
- Keep it in the diet.
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. You can get more information on these steps in my Introducing Allergens Handbook. These banana oat muffins include egg, wheat, dairy, and nuts. You can freeze them and keep them in rotation to keep 4-5 of the major allergens in the diet.
Types of Reactions
This is not intended as medical advice. If you have any concerns about your child, please reach out to your physician.
|Skin||mild rash, some hives||widespread rash, hives all over the body|
|Face||itchy mouth, runny nose, sneezing||lip swelling, tongue swelling|
|Airway||none||coughing, wheezing, trouble breathing|
Krystyn Parks is a Registered Dietitian and Lactation Consultant who specializes in feeding children. She has a Master’s Degree in Nutritional Science from California State University Long Beach. She is an International Board Certified Lactation Consultant and has been registered with the Commission on Dietetic Registration since 2013.