We sat down with Dana Broussard-Perry, M.D., of Pediatrix ENT of Orlando to learn more about introducing infants to high-risk foods.
A: While any food can trigger an allergic reaction, the foods with the most common allergens are:
A: Yes. Over the last 30 years, we’ve seen an increase in peanut and tree-nut allergies. This is concerning since these foods carry a higher risk for severe, potentially life-threatening allergic reactions, called anaphylaxis. While foods like milk and eggs can also cause anaphylaxis, the reaction is usually short-lived and less intense than with nuts.
A: No. Recent research has turned previous advice on its head. While allergists and OBGYNs used to advise pregnant women to avoid these foods, we now believe there’s a protective benefit transferred to the infant if the mother drinks milk during her pregnancy, for example. Early exposure to allergens, including in utero, reduces babies’ risk of intolerance.
A: We used to advise parents to hold off on introducing those foods, but we have learned over the last few years that delaying allergens can increase the chance of a child developing an allergy. In 2015, researchers in the United Kingdom (U.K.) found that Israeli children living in the U.K. had a lower rate of peanut allergies than other children in the U.K. They learned that Israeli children are often given puffed peanut stacks as infants, exposing them to peanuts at an earlier age than other children. This allowed them to build up a tolerance to these foods when other children did not.
This discovery altered 25 years of medical practice. Now, we advocate a completely different approach. Unless your infant has a known egg allergy or moderate to severe atopic dermatitis (eczema), you should start introducing allergens, including peanuts and tree nuts, between 4 and 11 months of age. Then, you should continue giving your child those foods three times a week through age 5.
If your child is allergic to eggs or has eczema, he or she should be tested for nut allergies before introducing these foods.
A: The findings in the Learning Early about Peanut Allergy (LEAP) trial in the U.K. led researchers to investigate milk and egg introduction in the same way. In an Australian study, kids given cow’s milk before 3 months of age had a lower risk of developing milk sensitivity than other kids. Similar studies found the same was true with eggs as well. We’ve found that 70% of children with a sensitivity to fresh milk and eggs can tolerate them in baked goods. We encourage parents to provide baked items made with milk and eggs often, which can help improve kids’ tolerance to those products in fresh form.
A: No. Please don’t stop giving your child allergens. Research shows that when children stop eating them before age 5, they can develop a sensitivity to an allergen when it is reintroduced in the future. We now know that there is a protective effect when allergens are introduced early and given regularly.
A: Unfortunately, allergies tend to be genetic, so if one parent has some form of allergy, even asthma or seasonal hay fever, the child has an increased risk of having some type of allergy too. In addition, research has shown the incidence of a peanut allergy is higher among children with eczema or an egg allergy.
A: Be sure to offer food allergens in the morning or early afternoon so you can monitor your child’s reaction during the day. Avoid feeding them and going straight to bed since you may miss any possible reactions if they’re sleeping.
If your child has a food allergy, you may notice:
These symptoms will appear in 15 minutes to two hours.
A: If your child is high risk for an allergic reaction, administer any epinephrine prescribed by his or her doctor. Then, call 911 so emergency medical services (EMS) can determine if a second shot is needed or if the child should be taken to the nearest emergency department.
A: Yes. About 70% of infants with an intolerance to milk or eggs will outgrow it by about age 12. However, only about 20% of kids will outgrow a nut allergy.
Parting advice: In general, more and more people are developing both food and environmental allergies. If you know you have a family history of food allergies or other allergies, talk to your pediatrician or allergist about your child’s risk of having allergies too.