When to introduce food allergens to babies
There is a growing body of evidence that early introduction of food allergens—particularly egg and peanut—may prevent allergies to those foods from developing later in life.1 Yet few babies are being exposed to enough allergens in the first year. 2 Whereas the old advice was to wait up to three years to introduce common food allergens, the general consensus today is to introduce major food allergens early. The American Academy of Pediatrics now recommends introducing peanuts before a baby’s first birthday and has declared that there is no reason to delay the introduction of any food allergens to babies starting solids.3
Have a baby with allergies already? See our First 100 Days Meal Plan, which includes 100 days of allergen-free meals and recipes (along with 100 days of introducing common allergens).
Allergies in children are on the rise
In the United States, food allergies in children rose an astounding 50% from 1997 to 2011 and the prevalence of peanut and tree nut allergies tripled during this time.4 Interestingly, this is roughly the same period of time in which parents were advised to refrain from introducing peanuts and other allergens until a child’s third birthday.5 With the new guidelines to introduce allergens early, our hope is that the number of babies and children with allergies will start to decline.
Common food allergens for babies
Today, one in 13 children have a food allergy in the U.S., with cow’s milk and hen’s egg being the most common allergies for babies.6 Of those children with food allergies, 40% will be allergic to more than one food.7
Although it is possible to be allergic to any food, the most common food allergens are those listed below.8 Sesame allergies are on the rise, and because of a law enacted in 2021, products containing sesame will be required to be labeled in the United States starting in 2023.9
Risk factors for food allergies in babies
Most food allergies present themselves during childhood, and there are a few risk factors that increase the likelihood that your child will develop a food allergy. 10 Risk factors for a baby or child developing a food allergy include:
- Allergic Rhinitis (Hayfever)
- Family history of food allergies
If your baby has a family history of allergies or any of the above risk factors, work with a pediatric allergist early on. You can always get a prick-test done to put your mind at ease. Otherwise, try not to be paralyzed by fear and aim to introduce each of the common allergens (starting in very small amounts) before your baby’s first birthday.
Speed of introducing new foods
If you have heard that you can only introduce one new food every 2 to 3 days, this advice is outdated and unnecessary for non-allergenic foods. For common allergens, however, it’s wise to introduce those on days when no new foods are introduced so you know which food was responsible in the case of a reaction. Other than that, our professional opinion is that the benefits of introducing a variety of new foods outweigh the risks of a potential reaction or sensitivity.
A word on FPIES
Food Protein-Induced Enterocolitis Syndrome (FPIES) is a relatively uncommon food allergy in children that can be severe and life-threatening. Unlike most food allergy reactions that occur within minutes of contact with a specific food trigger, FPIES allergic reactions occur within hours after consuming a particular food. For this reason, FPIES is sometimes known as a delayed food allergy. The most common food culprits are cow’s milk products (such as formula), soy, oats, and rice, followed by other foods such as banana, barley, eggs, green beans, peas, meats, poultry, seafood, squash, and sweet potatoes. FPIES is extremely rare in exclusively breastfed infants.11 The classic presentation of FPIES is an infant who recently switched from breast milk to formula or started solids and begins vomiting 1-4 hours and experiencing diarrhea 5-10 hours after ingestion of a specific food. Other symptoms include low blood pressure, low body temperature, extreme pallor, repetitive vomiting, and significant dehydration. Thankfully, most cases of FPIES will completely resolve during toddlerhood. If your child has been diagnosed with FPIES, they must be followed closely by an allergist or immunologist.
A word on contact rashes
Acidic foods such as lemons, limes, oranges, and tomatoes often cause a harmless rash on the skin that comes into contact with the juices.12 The rash, which typically shows up around the mouth and chin, is typically harmless and usually dissipates within minutes once the skin is gently cleansed (pat with a wet washcloth, don’t rub). To help protect the skin from acidic foods you can apply a barrier cream, such as pure petroleum jelly, to the face before meal time.
Ready for more? Let’s talk about how to safely introduce food allergens to your baby.
Dr. Sakina Bajowala, MD, FAAAAI. Board-Certified Allergist & Immunologist
- Food Allergy Education & Research. Learning Early About Peanut Allergy (LEAP) (website) Retrieved March 29, 2020.
- Groetch, M. E., Nowak-Wegrzyn, A. H., Quann, E., Boccella, J., Czerkies, L., Nutten, S., & Carvalho, R. (2018). Introduction of Allergen-Containing Foods: Feeding Infants and Toddlers Study (FITS) 2016. Journal of Allergy and Clinical Immunology, 141(2), AB401. https://doi.org/10.1016/j.jaci.2017.12.943
- American Academy of Pediatrics, Clinical Report Highlights Early Introduction of Peanut-Based Foods to Prevent Allergies. (website) Retrieved November 1, 2019.
- FARE Facts and Statistics (website) Retrieved November 1, 2019.
- American Academy of Pediatrics, New guidelines detail use of ‘infant-safe’ peanut to prevent allergy (website) Retrieved November 1, 2019.
- FARE Facts and Statistics [website] and FARE, Common Allergens (website) Retrieved November 1, 2019.
- FARE Facts and Statistics (website) Retrieved November 1, 2019.
- FARE, Common Allergens (website) Retrieved November 1, 2019.
- FARE. Sesame Allergy. Retrieved July 12, 2021.
- FARE, What Is A Food Allergy? (website). (Retrieved March 3, 2020)
- Nowak-Węgrzyn, A., Chehade, M., Groetch, M. E., Spergel, J. M., Wood, R. A., Allen, K., Atkins, D., Bahna, S., Barad, A. V., Berin, C., Brown Whitehorn, T., Burks, A. W., Caubet, J.-C., Cianferoni, A., Conte, M., Davis, C., Fiocchi, A., Grimshaw, K., Gupta, R., … Greenhawt, M. (2017). International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. Journal of Allergy and Clinical Immunology, 139(4), 1111-1126.e4. https://doi.org/10.1016/j.jaci.2016.12.966
- Paulsen, E., Christensen, L. P., & Andersen, K. E. (2012). Tomato contact dermatitis. Contact dermatitis, 67(6), 321–327. https://doi.org/10.1111/j.1600-0536.2012.02138.x. Retrieved August 14, 2020