Telling a first-time parent to introduce their four- month-old to a common allergen would make most anxious. But it shouldn’t!
“It’s important for parents to know that in the three landmark clinical trials on early introduction with over 2,000 babies as early as four months, there weren’t any cases of a severe reaction or hospitalizations,” says Ready, Set, Food! co-founder and pediatric & adult allergist, Dr. Katie Marks-Cogan. “In addition, newer research suggests that allergic reactions get more severe as your baby gets older, so starting as early as possible is the safest way to feed allergens to your baby. That’s why it’s so important to start early and, if your baby is not yet ready for solids (as many aren’t at 4 months), Ready, Set, Food! packets can be added to a bottle with breast milk or formula.”
What are the top allergens?
Nine foods/food groups are responsible for causing most food allergies: milk, eggs, peanuts, tree nuts, wheat, soy, fish, sesame and shellfish. “However for children, peanut, egg and milk represent the most common childhood food allergens to cause allergic reactions,” Dr. Marks-Cogan.
It’s important to note that there are ways to tell if your baby may have a sensitivity early on. “Very often babies with sensitivities have early onset eczema or dry skin,” says Dr. Gideon Lack, the lead investigator on the LEAP and EAT Studies, the head of pediatric allergy at King’s College and the co-founder of Mission MightyMe. “Food proteins are prevalent in our environment and the theory is that when babies are exposed to food proteins through the skin, that can lead to sensitization and potentially a food allergy, whereas exposure to food proteins through the gut by eating the food leads to tolerance. Because eczema causes breaks in the protective skin barrier, these babies are at an increased risk, which is why getting potential allergens into their diet early is so important.”
Not yet convinced to give your little one some thinned out peanut butter?
In the landmark Learning Early About Peanut (LEAP) study on peanut allergy prevention, children were randomly divided into two equal groups: the first group was fed peanut regularly and the second group avoided peanut completely until age 5. “Comparing the two groups, those infants consuming peanuts were over 80% more likely to not have a peanut allergy at 60 months of age,” says Dr. Marks-Cogan. “Therefore, the study revealed that early, consistent peanut introduction significantly reduces peanut allergy risk whereas avoidance was associated with an increased risk of peanut allergy. These findings were further reinforced by similar findings from two other landmark studies on food allergy prevention, the Enquiring about Tolerance (EAT) study and the Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT) study.”
Unfortunately when you introduce babies to food allergens once or a few times, it will not effectively reduce their risk of developing food allergies – it’s not that simple. “Oral tolerance requires repeated exposure,” says Dr. Marks-Cogan. “There’s no evidence that introducing allergenic foods only once is effective. In the LEAP study, infants were fed peanuts consistently for up to five years of age. I would recommend that parents consistently feed their infants allergens multiple times a week for several months.”
What are the best tactics for introducing potential allergens and at what age?
“In high-risk infants with family history of allergy or early eczema, we would want to introduce potential allergens shortly after four months of age and in lower-risk children at about six months of age,” says Dr. Lack. “Make sure foods are offered in an age-appropriate form. Nuts and nut butters are a choking hazard for babies so parents can try thinning creamy peanut butter with warm water, adding peanut powder to purees or using quick-dissolve peanut puffs like Mission MightyMe Proactive Peanut Puffs.”
As for serving sizes, according to Dr. Lack there’s very good evidence for peanuts and eggs suggesting that two grams of food protein equivalent be given per week (this is about half a tablespoon of peanut butter, or a whole egg per week). “There’s no good evidence for quantities relating to other foods and in the absence of any evidence, it’s recommended to give similar amounts as you would with peanut/egg, i.e. roughly two grams of each food protein per week. For high-risk babies with severe eczema, the American Academy of Pediatrics recommends six grams of peanut protein per week.”
What are signs that there may be an issue?
“If your baby persistently refuses the food while liking other foods, and/or develops flushing of the skin, rash, hives, swelling, vomiting or breathing difficulties, these could be symptoms of allergy,” Dr. Lack.
Most importantly, be mindful that a mild to moderate reaction when you introduce babies to food allergens can sometimes quickly develop into anaphylaxis. “This is true even for someone who has never had a food allergic reaction or who has only had mild to moderate reactions previously,” says Dr. Marks-Cogan. “When the symptoms of a food allergic reaction are severe and involve more than one organ system, the reaction is classified as anaphylaxis and anaphylaxis can be life-threatening.”