Early Allergen Introduction Advice from a Pediatrician (and Dad!)
Have you ever wondered why you could bring as many peanut butter and jelly sandwiches to school as you wanted as a child, but now peanut butter is banned from most schools? In 2000, the American Academy of Pediatrics (AAP) recommended that parents wait until their child was 3-years-old before they introduced peanuts into their toddler’s diets. From 2000-2010, there was a four-fold increase in peanut allergies. Many people think that this “waiting to introduce” was a contributing factor to the large spike in food allergies.
Two recent studies have taught us more about the ideal timing for allergen introduction. In 2015, the New England Journal of Medicine published one of the first papers on early introduction of allergens to babies, focusing specifically on peanuts. The LEAP study (Learning Early About Peanut allergy) found that babies at high-risk for developing peanut allergies who were introduced to peanuts between 4 to 11 months of age were about 80 percent less likely to develop an allergy by age 5 than children who avoided peanuts.
The following year, a similar study, called the EAT Study (Enquiring About Tolerance), looked at other allergens such as wheat, dairy, egg, fish and sesame. Similar findings to the LEAP study were seen, showing that allergens may safely be introduced early and be consumed regularly to help reduce incidence of allergies. While most parents are aware of peanut allergies, it is important to remember that 77 percent of people with one food allergy have allergies to other foods as well.
Despite the official AAP allergen introduction recommendation changing in early 2017, after the studies were published, it was only very recently that I have started to receive more questions on the timing and logistics of introducing allergens. I have spent much more time discussing allergen introduction with parents at both the 4- and 6- month well checks recently, and have been fielding questions on how, when, and how often to introduce allergens into their child’s diet.
As a father and a Pediatrician, my advice to patients’ families for introducing allergens is the following:
1. Check with your child’s pediatrician that your child is ready to start solids
2. Confirm with your child’s pediatrician that there are no other medical issues that would require different handling of allergen introduction
3. Start with a few non-allergenic foods first (like banana, sweet potato, or avocado) to get baby used to the idea of eating and seeing their response
4. Next, include all the major allergens (tree nuts, peanuts, wheat, egg, fish, shellfish, dairy, soy and sesame) in your infant’s diet between 4 and 6 months
5. Introduce potential allergens one at a time to help identify problematic reactions, while continuing with familiar foods
6. Include these allergens regularly in your infant’s diet once you confirm they do not react to them
7. Always call your child’s pediatrician if you have any questions or think your child may have had a reaction to any foods
Many caregivers ask me the best method for feeding allergens to their children. Allergens should always be prepared in an age appropriate size and texture, as per AAP guidelines. Allergens may be prepared at home (for example: full fat yogurt mixed with fruit, thinned out peanut butter). However, it may be time consuming or difficult to appropriately prepare all of the major food allergens for a 4-6 month old child.
I am hopeful that with increased awareness of the new allergen introduction recommendations, we will reduce the number of children with severe food allergies in 5-10 years making the question of “what to pack for lunch” slightly less stressful!
Michael Friedberg, MD, MA, FAAP
General Pediatrician, Pediatric Health Care at Newton Wellesley,
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