How to Prevent Food Allergies when Introducing Solids
by Dr. Emily Lesnak
Starting solid foods with your baby can be an exciting time, but also a little nerve wracking when you are getting ready to start adding in common allergens. Research shows that introducing allergic foods early and often can prevent food allergy later in life. Having a plan when introducing allergens can help this process go as smoothly as possible.
So, what are the common allergen foods and what is a good approach to introducing these foods? Below are the principles and approaches I recommend!
1. Early and often
Allergenic foods can be started at the start of solid food introduction. Most babies are ready for solid foods around 4-6 months of age when they are able to sit up mostly by themselves and they have an interest in solids.
You can start by introducing the allergenic food in small amounts. About ⅛ teaspoon is considered an exposure. If your baby does fine with that amount then you can increase the amount offered the next day and if no reaction (hives, vomiting, etc…) then consider that food good to go. Once you have successfully introduced an allergenic food, then it is recommended to incorporate this food about 2-3 times per week.
2. One at a time
There is no need to wait days in between introducing new foods, but it is recommended to only offer when no other common food allergens are in that meal. For example, you wouldn’t introduce both peanut and egg on the same day since those are both common food allergens.
Below is the list of foods that are considered common allergens with ideas of how to introduce these.
Egg (well scrambled egg or cooked in a muffin)
Peanut (peanut butter mixed with pureed sweet potato or thinned with breast milk or formula)
Finned fish (flaked salmon)
Shellfish (flaked crab)
Wheat (cream of wheat or toast strips)
Sesame (tahini mixed with sweet potato)
Soy (tofu strips)
Cow milk (yogurt or cheese, avoid liquid cow milk until age 1)
Tree nuts (almond flour mixed with puree or almond butt on toast strips)
3. Which babies are high risk for food allergies?
Babies with moderate to severe eczema are considered higher risk of developing a food allergy. If your baby, has more severe eczema, then discussing with your pediatrician a specific plan for introducing allergens or perhaps a consult with allergist prior to food introduction. If your baby already has a diagnosed food allergy, then they are at higher risk for developing another food allergy.
4. Tips for introducing allergens
Introduce allergens in the morning, so that if there is a reaction you can monitor during the day and it is more likely that your pediatrician will be able to answer questions if something was to happen.
If your baby has an allergic reaction, wait to introduce that food again until you have discussed a plan with your pediatrician or consulted with an allergist.
A contact rash on the face from acidic foods is different from hives resulting for an allergy. Citrus fruits, pineapple, tomato, pasta sauces will commonly cause an irritant rash on the face, this is not a food allergy.
You do not need to purchase pre-mixed food allergen powders to have your baby get exposure to food allergens.
Do you have additional questions around this topic? Click here to schedule a visit!
See you in clinic,
Dr. Lesnak
References:
Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013 Jan;1(1):29-36. doi: 10.1016/j.jaip.2012.09.003. Epub 2012 Nov 22. PMID: 24229819.
Fleischer, D. M., Chan, E. S., Venter, C., Spergel, J. M., Abrams, E. M., Stukus, D., Groetch, M., Shaker, M., & Greenhawt, M. (2021c). A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. The Journal of Allergy and Clinical Immunology: In Practice, 9(1), 22-43.e4. https://doi.org/10.1016/j.jaip.2020.11.002
Gupta, R. S., Walkner, M. M., Greenhawt, M., Lau, C. H., Caruso, D., Wang, X., Pongracic, J. A., & Smith, B. (2016, September). Food Allergy Sensitization and Presentation in Siblings of Food Allergic Children. The Journal of Allergy and Clinical Immunology: In Practice, 4(5), 956–962. https://doi.org/10.1016/j.jaip.2016.04.009