Food Allergies and the Importance of Early Introduction

When it comes to deciding when and how to introduce solids to your infant, food allergies can complicate things.

From discomfort to (in extreme cases) death, food allergies can wreak mayhem on kids and adults alike. In addition to being scary, they are also becoming more common, with the rate of pediatric food allergies tripling since 1997. These days, 1 in 13 kids develop a food allergy, often to peanuts, milk, and/or eggs, which combined represent more than 80% of childhood food allergies.

When did food get so mean?

For years, pediatricians and allergists recommended delaying the introduction of highly allergenic foods – like peanuts, milk, and eggs – until after the baby was older. You know, give those little baby bodies some time to beef up and prepare themselves for whatever shenanigans highly allergenic foods might bring to the literal table.

Trouble is, science now indicates keeping babies from these foods actually increases their risk of developing an allergy.

The importance of early introduction to reduce food allergies.

Multiple studies have recently been published that show the safest, most effective way to lower your child’s risk for developing a food allergy, especially to peanuts, milk, and egg, is to introduce them early and often. Three studies stand out:

The LEAP study

Based off the idea that prolonged exposure to peanuts starting at a young age would elicit a protective response, rather than an allergic one.

How it worked: 600 kids were monitored over the course of several years. A portion of kids were exposed to peanuts several times a week (in different forms as they aged), and a portion of kids refrained from any peanut products.

The results: 3% of the children who had early and sustained exposure to peanuts developed peanut allergies, while 17% of kids who had zero peanut exposure in that time frame developed peanut allergies. To sum it up, “in high-risk infants, sustained consumption of peanut beginning in the first 11 months of life was highly effective in preventing the development of peanut allergy.”

The EAT study

The aim of this study was to see if early and sustained introduction of allergens, along with breastfeeding, could prevent the development of food allergies.

How it worked: Over a 1000 families participated and were randomly assigned to either eat or avoid peanuts, egg, milk, wheat, sesame, and white fish, starting at 3 months.

The results: This one was a little tricky, with 43% of families reporting an inability to adhere to study guidelines (read: their kid didn’t eat what they were offered, even if good science was at stake – which comes as a surprise to no parent, ever). That said there were still two interesting takeaways.

1. Early feeding didn’t appear to have a negative effect on breastfeeding.
2. Findings were supportive of early introduction to potential allergens as a way to reduce allergies. In their words, “The consumption of 2 g per week of peanut or egg-white protein was associated with a significantly lower prevalence of these respective allergies than was less consumption.”

The PETIT study

Designed to see if exposure to egg product starting in a low quantity and slowly increasing in amount, would keep high-risk kids from developing an allergy to eggs.

How it worked: Nearly 150 infants participated in this study. Roughly half consumed .88g of egg protein per week, while the other half didn’t.

The results: This study was actually stopped early because of how quickly it became clear that early exposure was beneficial. In science speak, “Introduction of heated egg in a stepwise manner along with aggressive eczema treatment is a safe and efficacious way to prevent hen’s egg allergy in high-risk infants.”

What does this all mean?

If you, like me, aren’t an actual scientist, allergist or pediatrician, this might be hard to digest (I swear that’s the only food pun). The good news is actual scientists, allergists, and pediatricians have already gone through these studies, and are standing behind them.

The American Academy of Pediatrics, National Institute of Health, and American Academy of Allergy Asthma and Immunology agree that starting controlled and continued exposure to peanuts at an early age decreases the risk of developing an allergy. These organizations are also developing similar guidelines for other allergens, such as egg.

As counterintuitive as it may seem, this idea of early, consistent exposure is especially important for kids who are deemed high risk – meaning they have a history of eczema and/or a history of other food allergies, though you will need to formulate a plan with your allergist before trying anything.

Okay, so now what?

This does not mean you can take your infant to the local breakfast buffet and go hog wild. Straight peanut butter in the pie hole is a terrible idea. Instead, start talking to your pediatrician and/or allergist about the best time for you to introduce these foods to your child.

If your medical provider is on board with you introducing solid foods, or your child has already been deemed high risk and you want to try and put the kibosh on future food allergies (with the blessing of your allergist, of course), here are a few tips:

• Make sure to do this when your child is healthy so you’ll know if anything changes after the introduction.
• Go slow, and only introduce one allergen at a time. Give a taste of something, then wait about 10 minutes while you monitor the child for symptoms like hives, rashes, swelling, vomiting, or difficulty breathing.
• Make sure what you’re giving has an appropriate texture for the age of the child. Children who are 4-6 months need pureed food products, and should never be given whole peanuts, or even straight peanut butter (more on that below) due to the high choking risk.
• Be sure the child is with an adult for at least two hours after the introduction. Don’t do it right before dropping your baby off at daycare, or right before bed.
• Once introduced, try to expose the baby to the food several times a week. Studies show that sustaining continuous exposure is key when it comes to reducing their risk of developing a food allergy.

What’s the easiest and safest way to introduce these foods?

• Peanuts can be introduced to babies as young as 4 months old by watering creamy peanut butter down (2 tablespoons of creamy peanut butter diluted to a soupy, pureed texture with warm water), and slowly spoon-feeding a bit of the mixture. For babies who are a little older, there are a handful of peanut products out there, including Bamba puffs, which were actually used in portions of the LEAP study.
• Eggs can be hard-boiled, mashed, and mixed with enough breastmilk, formula or water to make a soupy pureed mixture. Don’t add any dairy (like butter or milk) because you want to introduce one food at a time.
• Dairy is a little more flexible, with yogurt being an easy option in the beginning, and cheese as they get older. The current recommendation is to hold off on substituting cow’s milk for breastmilk or formula until around 12 months of age. However, small amounts of cow’s milk, yogurt, or cheese can be effective methods for early and sustained allergen introduction.

What if my child has a reaction?

• If your child is having trouble breathing, becomes pale or limp, or has more than one body system involved (like hives AND vomiting), call 911 immediately.
• If you aren’t sure, call your pediatrician, and let them walk you through your options. You can have a delayed allergic reaction to a food, but it’s generally more along the lines of vomiting, diarrhea, or hives, which are still sucky, but aren’t as urgently dangerous as anaphylaxis.
• If after feeding your baby a new food anything wonky happens, it’s never a bad idea to check in with your doctor. Even if you just end up feeling stupid, they’d rather you ask if eating peanut butter can result in a new affinity for nipple chomping than potentially miss something as important as an allergy.

Food allergies may be on the rise, but hopefully, these studies will help shift the way we think about the best way to protect our babies from potential allergens. Now go forth and feed! (You know, as long as your baby is an appropriate age, and your doc says it’s cool.)

Our next recos: The New Baby Food Guidelines