Where to start with introducing allergens to baby

This is one area of starting solids that panics, overwhelms and causes so much anxiety for parents and families. We now have good data to support the introduction of common allergens early and before 12 months of age. Outdated advice used to state the avoidance of certain allergens such as peanut until 2 years of age. That’s now not the case, based on groundbreaking research over the last decade.

Are food allergies common?

Around 5% of children have a food allergy and it is thought that food allergies are on the rise. The 9 most common allergens that account for 90% of reactions include:

• Peanut
• Egg
• Tree nuts
• Wheat
• Soya
• Milk
• Fish
• Shellfish
• Sesame

Where to start?

In the UK, for the general population it is recommended to start solids at around 6 months of age and of course when baby is developmentally ready. This includes being able to support their own head, have good hand-eye coordination, and can swallow food rather than spit it back out.

There is also research showing to start earlier, at around 4 months of age and when baby is developmentally ready, in those that are considered high risk. This includes babies that have moderate - severe eczema (particularly early onset from the first few months of life) or already have a food allergy. Always consult with a dietitian or other Health Care Professional (HCP) if you are unsure.

 

Top tips

Introducing allergens does not have to be anxiety provoking. You can start with very small amounts to help minimise a possible reaction and build up to bigger volumes. Before starting, do not rub the allergen on your baby’s skin, this will not help identify if baby has an allergy. Instead, offer directly using the tips below.

Once your little one is established on first tastes then start to introduce common allergens one at a time.

• Ensure your baby is well before starting.
• Introduce earlier in the day so that you can monitor throughout the day rather than just before bed or a nap.
• Start small (such as a tip of teaspoon and build up over the course of the week).
• Offer regularly, this is key, once it’s in the diet keep it in 2-3 times a week to help maintain tolerance.

• Continue to expose to other foods alongside. It’s important that your baby has a diverse diet to aid in key nutrients and development.

Which allergens should I introduce first?

The best evidence is to introduce well cooked egg and peanut first. There is limited research regarding other allergens and consideration of family’s lifestyle and choices should be noted. 

When introducing egg, ensure it is well-cooked (such as a hard-boiled egg) this is because most reactions to egg are from loosely cooked/uncooked egg whereas when cooked or in baked form they are more likely to be tolerated.  Aim for 1 egg over the course of a week. Offering either off the spoon or it can be mixed with other foods such as puree veggies, cereals, or rice. Raw egg should never be given as first exposure.

For peanut, start with peanut butter or peanut flour. Note, peanut butter can a be a claggy consistency and therefore a choking hazard, when introducing you may wish to consider thinning down with either water/breast milk/formula (1 teaspoon for peanut butter with 1 tablespoon of water/breast milk/formula). The aim is to introduce 2 teaspoons of peanut a week.

 

What do I do if I suspect a reaction?

If you suspect a reaction, stop giving that food and seek medical advice. There can be different types of allergic reactions. Those that are immediate (referred to as IgE mediated) happen quickly within minutes and up to 2 hours after ingesting the allergen. Those that are delayed (non IgE mediated) happen from 2 hours up to a few days after.

Many foods can also irritate the skin such as tomato, citrus and berry fruits, which can cause a red rash around the mouth. This is not food allergy and the food does not need to be avoided. Always speak with your HCP if you are unsure. 

Thank you to Lydia Collins-Hussey, Specialist Paediatric Dietitian for writing this blog.

Lydia has over 11 years’ experience in working in the NHS, charity sector and private practice and her passion is helping families cut through the nutrition noise so that they feel confident feeding their baby. Lydia has her own private practice www.themilkallergydietitian.com and Instagram @themilkallergydietitian.