We recently had an opportunity to chat with Dr. Wendy Sue Swanson, a pediatrician, author, mom, and Chief Medical Officer at SpoonfulOne. She has devoted much of her career to food allergy prevention efforts while bridging the information gap between parents and doctors to drive education around the importance of introducing allergenic foods to infants to help prevent food allergies.
As we’ve highlighted in past posts, food allergies are the rise. This is particularly true with kids. Today, almost eight percent of children in the US under 18 years of age have a food allergy diagnosis—approximately 6 million kids! While we’re still figuring out the “why,” studies are showing that introducing these foods early in life (and continuing to do so frequently) can help prevent kids from later developing food allergies. In fact, last month the USDA released updated dietary guidelines recommending that families introduce peanut and egg in the first year of a child’s life (after four months of age), as it may reduce the risk of developing food allergies to these foods.
Our conversation with Dr. Swanson focused on the latest research and guidance on this topic while covering many of the common questions we hear from parents. Let’s dig in!
Parents often relay concerns about the potential for an allergic reaction when introducing common allergenic foods to their baby—can you respond?
The reality is that most babies will NOT have any reaction, especially if introduction occurs between 4 to 6 months of age. Further, even in the rare case of an IgE-mediated food allergy at first feeding, research shows the two most common signs of an allergic reaction for infants and toddlers are hives and vomiting, both of which typically do not require a trip to the ER.
While it’s understandable to have reservations about introducing common allergenic foods to infants, research shows that the risk of a serious reaction is low. Even during a pandemic.
When should I introduce my baby to solids foods, including allergens?
My strong recommendation is to encourage early and diverse food introduction to infants between 4 to 6 months of age. Once an infant shows signs of readiness, such as sitting without support with good head control, or opening their mouth when food is presented and no tongue thrust, they’re ready for common food allergens like peanuts, fish, eggs, or sesame—just as you’d regularly introduce fruits and veggies, meats, and cereals! It’s also important to expose your child to these foods often, so your baby (and their immune system) can begin registering these foods as safe and will better tolerate them as the child grows up. Research shows that if infants don’t incorporate peanut into their diet until 12 months of age, the risk of peanut allergy increases by 4x. If they wait until 18 months, the risk is even greater: 7x.
Should I wait to introduce solids and new foods to my baby until after the pandemic, in case of a reaction?
You may risk the critical introduction window, especially as the pandemic continues with no end in sight. When it comes to food allergy protection in babies, the 4 to 6-month window is considered a key timeframe for introduction. Not only do we want babies to incorporate common allergens early in their feeding, but we also want parents to keep diet diversity throughout infancy and toddlerhood when the immune system is continuing to develop. Notably, babies, especially those with eczema, are at increased risk for developing a food allergy if they are not introduced to potential allergens during infancy. Introduction isn’t the big risk—waiting is.
We know parents are reluctant to visit their pediatrician for vaccines and routine health visits right now. I’ve spoken to multiple pediatric allergists and ER physicians on the topic, and there are numerous safeguards in place to maximize safety and prevent exposure to COVID-19 for every patient, staff member, and care provider that enters the hospital. Further, pediatric ER visits are very low at the moment due to stay-at-home orders, physical distancing orders, and the fear of seeking care in general. This further decreases the risk of exposure to any viral or infectious pathogens if a family needs to be seen after a food introduction. That said, I would not advise waiting to introduce allergenic foods to your baby.
Five reasons to encourage early, diverse food introduction and inclusion:
Data from around the world, including the LEAP trial, the EAT study, and this food diversity study, show that prevention of food allergies is possible, especially with high-risk infants. Risks for food allergy development increase when a baby or child has eczema, a family history of food allergies, and a lack of diet diversity.
The American Academy of Pediatrics and NIAID guidelines recommend early introduction of diverse foods including common allergens around 4 to 6 months of age.
The Canadian CHILD study demonstrates that avoiding allergenic foods during the first year of life increases the risk of food-specific sensitization. In fact, infants who were not introduced to peanuts by 12 months had a 4x chance of developing a food allergy.
Allergic reactions tend to get more severe as babies and children get older, so starting as early as possible is the safest way to feed potential allergens to your baby. According to a recent JACI publication, when evaluating oral food challenges in infants and children, “severe food allergy reactions and mortality increase with age and are particularly low in infants, supporting early allergen oral introduction.” Infancy, before your baby turns one, is the safest time to feed them common allergens like peanuts, eggs, milk, shellfish, and tree nuts.
The number one indicator that your child is considered high risk for developing a food allergy is eczema. In an ideal world, your baby would first be introduced to food through feeding, which typically allows them to accept and tolerate food safely. However, if a baby hasn’t eaten a food and is exposed another way (such as the skin), things can go awry. The reason: when exposed through the skin, our bodies are trained to react to it as if it’s a foreign intruder. Research shows that when babies are exposed to food first through the skin, they are at greater risk for developing a sensitivity to that food.
Thanks to experts and clinicians like Dr. Swanson, more education and resources are becoming available to support patients and the food allergy community. If you’re looking for brands that make the early introduction and everyday feeding of allergens easier (including SpoonfulOne!) take a look at the Prevention section in Allergy Amulet’s Food Allergy Toolbox.