Leaf Medical, a primary care center in Dumbo is a contributor for health relatic topics. Dr. Stephanie Shaps, a pediatrician at Leaf Medical writes a post about food allergies.
Click more for Dr. Shaps’ article about food allergies.
I’ve always been a lover of all things peanut – salted or unsalted, as nuts or butter spread on everything from bread, to apples, to ice cream. My husband and I would always make sure our cabinets were well-stocked with jars of smooth, crunchy, and honey peanut butter. In our eyes, it was a food group in and of itself! That was until our son was diagnosed with a peanut allergy at 14 months. I remember the smile of pure satisfaction on his face as he tasted creamy peanut butter for the first time – how could he not share our love? Unfortunately, what followed was widespread hives, then tears as I quickly took away his culinary delight! Like most first-time exposure reactions, his was mild. But as any person or parent of a child with a food allergy knows, there’s no way to predict the severity of a future reaction based on the severity of the first. The potential for anaphylaxis – the most severe and potentially life-threatening type of allergic reaction – is a very scary reality. So we said goodbye to peanuts in all their delicious forms, and now find ourselves scrutinizing food labels and ensuring our son is never more than an arm’s length away from an Epi-pen Jr.
According to FARE (Food Allergy Research & Education), food allergies among children increased approximately 50% between 1997 and 2011 but there is no clear answer as to why. Eight foods account for 90% of all reactions: milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. We do know that your risk for food allergy increases if a parent has any form of allergic disease (asthma, eczema, food allergy, or environmental allergies) and that kids with food allergies are more likely to suffer from asthma and other related conditions (such as eczema) than kids who do not have food allergies. Previous thought, supported by initial recommendations from the American Academy of Pediatrics (AAP), was that delaying the introduction of highly allergenic foods into the diet of young children would help prevent the development of allergy. However with food allergies on the rise, this has been called into question and recent data suggests that it may actually be the EARLY introduction of allergenic foods that help prevent the development of food allergy. That exposing a child’s immune system early on to these potential allergens may actually help the body learn to tolerate them. For instance, in countries like Israel where children typically consume peanuts (in the form of a popular puffed snack called Bamba) from infancy onwards, rates of peanut allergy are much lower than in Western countries where there is a delayed introduction of peanuts.
A recent study published in JAMA Pediatrics last month looked at the development of peanut or tree nut allergy in 8,205 children born between 1990 and 1994 and their mother’s diet immediately before, during and shortly after pregnancy. They found that the incidence of peanut or nut allergies was significantly lower in those children whose mothers did not have food allergies themselves and who ate nuts at least five times per month compared to those who ate these foods less than once per month. More studies are definitely needed but the results help support the recommendations that pregnant and breastfeeding women do not need to avoid allergenic foods (if they do not have a food allergy themselves). So go ahead and dig into those nuts!
So what does all this mean in terms of when to introduce these potentially allergenic foods to a baby?
In 2008, the AAP revised its guidelines, citing that there is no clear evidence to support delaying the introduction of potentially allergenic foods, however they did not provide specific guidelines on how and when to introduce these foods. In January 2013, The Journal of Allergy and Clinical Immunology: In Practice did publish general guidelines to help answer this question. In accordance with these guidelines, the recommendations I usually give are as follows:
- Solid foods can be started between 4 and 6 months of age, depending on your child’s signs of readiness (able to hold themselves up, eyeing or tracking your food, putting hands to mouth or opening mouth for spoon). Start one, single ingredient food at a time, introducing a new food every 3 to 4 days.
- Exclusively breastfed babies require additional iron in their diets by 4 to 6 months of age and should be offered iron-fortified cereal or pureed meats as part of their first complementary foods.
- If there is no family history of food allergies and your infant does not show signs of atopic disease (severe eczema) then you do not need to delay the introduction of potentially allergenic foods (egg, wheat, soy, fish, peanut or tree nuts) beyond 4 to 6 months of age. These foods may be introduced once a few typical complementary foods have been tried and tolerated (such as cereal or single fruits/vegetables). *One food not to give to children under 1 year of age is honey due to the risk of botulism.
- Offer cow’s milk based foods such as yogurt or pasteurized cheeses but avoid cow’s milk as a beverage in children under 1 year of age, not because of allergy risk, but because it can lead to iron deficiency anemia.
- Whole nuts are a top choking hazard food so if offering peanut or tree nuts to a baby or toddler make sure to give it in butter form and spread in a very thin layer over bread or a cracker.
- I usually recommend starting potentially allergenic foods at home (rather than at a restaurant) and start with a very small amount at first so you can monitor for a reaction.
- A mild allergic reaction, should your child have one, usually happens within minutes of eating the offending food and usually presents as a rash (hives) with itching. You may also see runny nose or watery eyes. Stop the offending food immediately and it can’t hurt to have some Children’s Benadryl on hand (give a dose based on your child’s weight). A severe allergic reaction (anaphylaxis) is less common with first-time exposures. But if your child was to show any additional symptoms such as difficulty breathing, swelling of the mouth or face, vomiting/diarrhea, or paleness/weakness administer your child’s Epi-pen (if you have one already) and call 911.
You can view the full American Academy of Allergy Asthma & Immunology guidelines on starting complimentary foods here.
So, if I had given my son peanut butter at 6 months of age rather than at 14 months, would the outcome have been different? Who knows? More studies are in the works but for now I say don’t hold back, and have an extra PB&J for me!