Infants and Food Allergies

Food allergies are a common worry for new and seasoned moms alike. If you are looking for some some basic info and a few personal experiences from both a newbie mama and a pediatric dietitian, you are in the right spot .

What are the most common food allergens? The most common food allergens (AKA the big 8) are peanuts, tree nuts, fish, shellfish, milk, eggs, dairy, and soy. People can certainly be allergic to other foods, but these are the most common ones.

How do I know if my child will have allergy? Without testing, there is no way of knowing that I child will have a food allergy prior to exposure. We do know that family history can increase a child’s risk of developing a food allergy. Food allergies, asthma, seasonal allergies, eczema, and other autoimmune conditions in either parent can increase a child’s risk for developing a food allergy.

What can I do to decrease my child’s risk for food allergies? This is a million dollar question. There is LOTS of research ongoing about this, and quite a bit of this research is controversial (some studies find associations, and some find none). The most evidence based recommendations include exclusive breastfeeding until 6 months, introduction of solids around six months (when baby is developmentally ready), and introducing the big 8 allergens early and often. Other recommendations, although less evidence based, include avoiding dietary restrictions while pregnant and breastfeeding (unless medically indicated, of course), diets high in antioxidant rich fruits and veggies, adequate vitamin D consumption (or supplementation), and probiotic supplementation.

Can you tell me more about allergy testing in infants? Two excellent resources to learn more about allergy testing is the Food Allergy Research and Education group and the American Academy of Allergy, Asthma, and Immunology. Allergy testing is usually only recommended in infants 6 months and older, although some high risk infants may be tested a bit younger than this. There are several types of allergy testing including blood, skin, and intradermal. Blood tests will look for an antibody to a protein found in a suspect food, but false negatives are fairly common. Skin tests (aka prick or scratch tests) involve a small amount of an allergen place at the end of needle that lightly scratches the skin. Intradermal test involve small amounts of allergens being injected under the skin.

Is a skin (i.e. scratch or prick) test painful? Nope! A skin allergy test is very quick with minimal discomfort. You can always ask your doctor to prick you with the needle so you can feel it first. I did this and felt so much better about baby girl getting tested. It felt like touching the end of a thumb tack. I was surprised that she didn’t even notice it was happening!

How should I introduce allergens? Always talk to your pediatrician before introducing solids and be sure to review your plan about introducing solids with them. If your doc has given you the green light to introduce allergens, they should ideally be introduced early and often. The big 8 allergens should also be introduced separately so as to identify the culprit of any allergic reaction.

Below are some different ways to present allergens to baby.

• Peanuts – Trader Joes Bamba peanut puffs, peanut butter spread thin on toast, peanut butter swirled into oatmeal, smoothies, or baby cereal
• Tree nuts – Nut butter spread thin on toast, nut butter swirled into oatmeal, smoothies, or baby cereal
• Fish – grilled or baked salmon (cooked well), canned sardines (plain or seasoned), tilapia fishcakes
• Shellfish – sautéed or grilled shrimp, crab cakes, lobster cakes
• Dairy – ghee, butter, whole-fat unsweetened yogurt, cottage cheese (no added sodium), finely shredded low sodium cheese, quesadilla strips. If you would like to be cautious, you can start with something with less dairy protein, such as ghee and butter, and progress to something with more dairy protein, such as yogurt and cheese. Please note, cow’s milk should not be used as a substitute for breastmilk or formula for infants under 1 year.
• Wheat – whole grain toast with butter, whole grain freezer waffle strips with smashed raspberries, whole wheat pancakes, wheat germ in applesauce
• Eggs – well-cooked scrambled egg strips, hard boiled egg slices, pancakes, crepes. Some children who are allergic to eggs can still tolerate eggs in baked goods. Treat the introduction of eggs in baked goods and whole eggs (like scrambled eggs) as separate allergen introduction.
• Soy – tofu scramble, tofu strips, edamame hummus, mashed edamame beans

Am I out of the woods if I give a food once and there is no reaction?Unfortunately, no. In order for the body to launch an immune response to an ingested food (i.e. an allergic reaction), the body must be sensitized to that food. In the case of a food allergy, the body will create antibodies to a food at one exposure (often the first exposure) and then develop a reaction at the second exposure. SO, it is often the second exposure to a food where someone will develop a reaction.

What is my story with food allergies? I have NO allergies. None. No seasonal allergies, food allergies, or medication allergies. My husband… he has an anaphylactic tree nut allergy, seasonal allergies, asthma, and oral allergy syndrome. Because of this, I knew that baby girl was at risk for food allergies. Our pediatrician prescribed baby girl an EpiPen before starting solids due to her risk and my worry. This did help me feel much more comfortable introducing allergens in our high risk kiddo. She did great with several introductions like peanuts, wheat, and dairy. We introduced eggs in pancakes and scrambled eggs (once) and she did great. The second egg exposure came from powdered egg protein in a Trader Joe’s veggie burger. That night, baby girl vomited several times. We assumed it was the stomach flu (very scary experience). We continued on as normal, and gave her scrambled eggs for breakfast the next week. She vomited shortly after breakfast. At this point, we suspected an allergy and gave her Benadryl (check with your doctor before providing any medications to your infant) which stopped her reaction. It took TWO reactions before we realized she was allergic to eggs. At this point, we scheduled an appointment at a pediatric allergist for a skin test. After her egg reaction, I stopped the introduction of all new allergens until she could be tested. The results of baby girl’s scratch test revealed that she is indeed allergic to eggs, as well as tree nuts (just like her daddy). Luckily, her doc suspects that she will grow out of her allergies, as the results of the skin test were mild. Baby girl will be back for another skin test in 6 months. In the meantime, we will avoid all tree nuts and solo eggs (we will continue to offer eggs in baked goods because she tolerates them well).

Phew, that was a doozy of a blog post. Enjoy the baby feeding!