How to Safely Introduce Allergenic Foods to Infants

Introducing solid foods to your baby is a big milestone for many families. It can be exciting, fun and rewarding as you navigate through each phase. For some parents however, regardless of family history, it can also be a stressful time as you worry about safety and “doing it right.”

Food allergy affects 2-10% of the population. If an infant or their first-degree relative (i.e., parent or sibling), has a hypersensitivity or exaggerated immune response (such as asthma, eczema, or food allergy) they are considered high-risk for developing an allergy themselves.

While in the past we thought that avoiding allergens would help prevent allergy development, recent studies have shown exactly the opposite; early introduction of foods actually helps and has a significant impact in the prevention of allergies developing, especially with peanut and egg.

The “Learning Early About Peanut” LEAP study demonstrated that early introduction of peanut significantly decreased the frequency of development of peanut allergy among children at high risk. Of the babies who avoided peanut, 17% developed peanut allergy by five years old. However, only 3% of the children who were introduced to peanut in early infancy developed peanut allergy by the age of five. That translates to a risk reduction of peanut allergy by over 80% in high-risk infants!

Data from multiple studies, like LEAP, mean we no longer recommend avoiding or delaying allergenic foods, but rather introducing them early and methodically, at around six months of age.

The Canadian Pediatric Society recommends:

1. Introduce common allergenic foods (egg, peanut, shellfish) to high and low risk infants at around 6 months, but not before 4 months of age. To be guided by developmental readiness, a baby should be able hold their head steady while sitting, track and reach for food, open their mouth wide for the spoon, and not thrust the food out with their tongue.
2. Introduce common allergens one at a time, so it is easier to identify what may have caused a reaction. You can safely introduce one new food per day when no reactions are noted.
3. If the baby is tolerating the allergenic food, then continue to offer it regularly, a few times a week to maintain tolerance.
4. Continue to breast or bottle feed to ensure a complete diet of essential nutrients is maintained.
5. Keep the texture and size of new solid foods age-appropriate to prevent choking. This means that the solid foods offered should be smooth and small. For example, when introducing peanut butter to babies, it can be mixed in with water, breastmilk, pureed fruit or vegetable, or an infant cereal that your baby has had before.
6. Pre-emptive in-office screening before introducing allergenic foods is not recommended.
7. There is insufficient evidence to recommend modifying the maternal diet (either by avoiding or including) when breastfeeding in order to prevent a food allergy.

 

Happily, the risk of a severe allergic reaction on first ingestion of an allergen in infancy is extremely low. Studies have shown that early introduction of allergenic foods have low rates of reactions (~2%) that are mild, and exclusively skin reactions. Anaphylaxis, and an ER visit, as such, is far below 2%. None of the reactions required epinephrine (i.e. an Epi-pen), and none were life-threatening.

We do have some food limits. Babies under 12 months should not be given honey, as there is a risk of infant botulism (a type of food poisoning). We also advise against introduction of any sugary drinks (soda, energy drinks, or sweetened juices) to young children because they quickly impact young teeth and overall dental health.

Remember, this is an exciting step in your baby’s development. There is plenty of opportunity for motor skill development and creative engagement throughout this process. It’s not all about the food. Your nurse practitioner, doctor, or registered dietitian will have lots more information about the introduction of solid foods to help you through this process. And of course, if you do see any unusual reaction with your infant as you explore new foods, reach out to your healthcare team, or call 911 if their breathing is impacted.