Introducing Allergens to Your Baby (Safely)

Introducing Allergens to Your Baby (Safely)

The American Academy of Pediatrics recommends for all babies and high risk groups to offer a wide variety of foods including potentially allergenic foods as early as 4-6 months. With the latest research from LEAP, introducing allergens to your baby is an important step in their development and can help prevent food allergies later in life.

The top food allergens, often referred to as the “Big Nine," includes milk, egg, peanuts, tree nuts, soy, wheat, fish, shellfish, and most recently added to the list, sesame. These are common foods that most frequently cause allergic reactions in individuals and account for the majority of allergic reactions. 

Important Considerations For Each Of The "Big Nine" Allergens:

• Milk:

• Cow's milk is a common allergen. People with a milk allergy must avoid not only milk but also products containing milk or milk derivatives.

• Eggs:

• Both egg whites and egg yolks can cause allergies. However, according to Mayo Clinic, allergies to egg whites are more common. Egg allergies are common in children but can be outgrown in some cases.

• Peanuts:

• Peanuts are legumes and not true nuts. Although most peanut allergies are often lifelong and can cause severe reactions, fortunately, about 20% of children with peanut allergy will eventually outgrow their allergy.

• Early introduction is recommended to reduce the risk of peanut allergies.

• Based on the LEAP Study, 6g of peanut protein per week (or 2g of peanut protein, 3 times per week) can help reduce the risk of developing a peanut allergy by up to 80%.

• Tree Nuts:

• This category includes various nuts such as almonds, walnuts, cashews, pistachios, and others. It's also considered the most common food allergy in both children and adults.

• Tree nut allergies are usually lifelong.

• Soy:

• Soybeans and soy products can cause allergic reactions.

• Soy is a common ingredient in many processed foods, so individuals with a soy allergy need to carefully read labels.

• Wheat:

• Wheat allergies are commonly seen in young children. Although some children can outgrow their wheat allergy, some individuals remain allergic to wheat throughout their lives.
  

• Wheat allergies and celiac disease can produce adverse reactions in response to wheat, but their underlying causes are different.

• Fish:

• Allergic reactions can occur to various types of fish, including salmon, tuna, and cod. Fish allergies are often lifelong.

• Shellfish:

• Shellfish allergies can be divided into two categories: crustaceans (e.g., shrimp, crab, lobster) and mollusks (e.g., clams, mussels, oysters).

• Shellfish allergies are often lifelong.

• Sesame:

• The newest declared food allergen -- signed into law in 2021 and required to declare as of January 2023.

• About 1 million Americans have sesame allergy.

• Sesame may appear as benne, benne seed, benniseed, gingelly, gingelly oil, gomasio (sesame salt), halvah, sesame flour, sesame oil, sesame paste, sesame salt, sesame seed, sesamol, sesamum indicum, sesemolina, sim sim, tahini, tahina, tehina or til.

• It may also be hidden as a "natural flavor" or "spices" in an ingredient statement.

Previous Allergy Prevention Recommendations are Outdated

In previous years, the American Academy of Pediatrics (AAP) recommended the delayed introduction of the top allergens to children at high risk for food allergies.

Past recommendations to delay the introduction of certain allergenic foods was not well-grounded in scientific evidence and therefore, no longer practiced. Based on the latest research, pediatricians are now recommending the introduction of allergens early (starting at 4-6 months) and often (several times per week).

Preventing Food Allergies: New Research and Medical Guidelines

From a 2008 study, there was a growing body of evidence that showed early introduction of allergens such as peanuts lowered the risk of developing an allergen later in life.

For instance, leading health organizations including LEAP, PETIT, and EAT showed early introduction of a wide variety of allergenic foods lowered the risk of developing food allergies by up to 80%.

Because of the latest research findings, AAP now recommends for all babies and high risk groups to offer a wide variety of foods, including potentially allergenic foods as early as 4-6 months and often (several times/week).

New to Allergen Introduction? Start Here.

Even if you're a first time parent or a seasoned parent - introducing allergens can be daunting. Fortunately, we have new guidance from the National Institute of Allergy and Infectious Diseases to help you determine your baby's risk of developing a food allergy. Guidelines 1, 2, and 3 below will help you determine which category of risk your baby falls into - and where to start!

Guideline 1

At 4-6 months of age, start to introduce peanut-containing foods if your child has any of the following:

• Severe eczema
• Egg allergy

• Or, both

These conditions may increase the risk of a peanut allergy and it's recommended to introduce peanut-containing foods as early as 4-6 months of age to reduce the risk of developing a long-term peanut allergy.

Always check with your healthcare provider first. A blood test and/or prick test may be requested in advance before introducing peanut-containing foods to your baby. The results of these tests will determine if peanut should be introduced into your baby's diet - and if so, the safest way to introduce them.

Guideline 2

At 6 months of age, start to introduce peanut-containing foods if your child has any of the following:

• Mild eczema
• Egg allergy

• Or, both

The guidelines highlight that if your family's dietary preferences do not include peanuts as part of your family's diet (and your infant does not have severe eczema, egg allergy, or both), then you can wait to introduce peanuts starting at 6 months of age.

For guidelines 1-2, it's recommended to introduce peanut-containing foods either at home, or in your doctor's office under supervision.

Guideline 3

If your infant does not have eczema or any food allergy, you can introduce peanut-containing foods into his or her diet when starting solids. The introduction of allergens can be done at home.

Introducing Allergens to Your Baby: Why You Should Start Today

• Reduce the Risk of Food Allergies:

• Early introduction of allergenic foods, such as peanuts and eggs, may help reduce the risk of developing food allergies.

• The LEAP (Learning Early About Peanut Allergy) study, for example, found that introducing peanuts to infants early in life (starting at 4-6 months) can significantly reduce the likelihood of developing a peanut allergy.

• Development of Tolerance:

• Introducing allergenic foods early (4-6 months) and often (several times a week) may help the baby's immune system develop tolerance to these foods, reducing the likelihood of an allergic reaction later in life.

• Delaying the introduction might actually increase the risk of sensitization.

• Early and Often is Key:

• Once your baby has been exposed to an allergen, regular exposure is important for maintenance of tolerance.

Square Baby Launches "Peanut Powder" - A Science-Based and Delicious Way to Introduce Allergens Early & Often. *Available to current subscribers.

• Cultural and Dietary Considerations:

• Early introduction of allergenic foods aligns with the cultural and dietary practices of many communities around the world. For example, sesame and soy are popular ingredients in Asian cooking. 

• In some cultures, certain allergenic foods are commonly consumed. For example, Thai and African food can be peanut-rich while Indian masala sauce can be made with tree nuts and dairy.

• Practical Considerations:

• Early introduction of allergenic foods can help normalize the inclusion of a diverse range of foods in the baby's diet like Thai, Indian or African food.

• It can also make it easier for caregivers to incorporate a variety of foods into the baby's meals, promoting a balanced diet. 

Quick Tips to Introducing Allergens to Baby

How To Introduce Food Allergens Safely

Before starting solids, always consult with your pediatrician, especially if you have a family history of allergies.

1. Introduce One Allergenic Food at a Time

• Introduce one new allergenic food at a time and wait a few days before introducing another. This helps you identify any potential allergic reactions and pinpoint the specific food causing the reaction. 

• The onset of an allergic reaction can vary widely among individuals and depends on several factors, including the type and severity of the allergy, the person's sensitivity, and the amount of allergen exposure.

• Allergic reactions can occur within minutes to hours after exposure to the allergen. 

2. Choose the Right Foods

• Common allergenic foods include peanuts, tree nuts, eggs, cow's milk, wheat, soy, fish, shellfish, and sesame.

• You can start with small, age-appropriate portions of these foods.

3. Prepare the Food Appropriately

• Prepare the food in a way that is suitable for your baby's age and developmental stage. For example, you might introduce pureed or mashed versions of certain foods.

• Square Baby offers age-appropriate, allergen introduction meals like Almond Butter & Banana (almonds, wheat), Hazelnut Pumpkin Pie (hazelnuts, soy, egg), and Blueberry Crush (yogurt/milk). 

4. Observe for Allergic Reactions

• Research suggests infants are more likely to experience skin and gastrointestinal-related reactions such as itching, rash, hives, vomiting, diarrhea, hoarse voice, or sudden behavioral change.

• Infant anaphylaxis is rare on the first ingestion of a new food (and typically less severe) when compared to older children and adults.

• However, anaphylaxis is a medical emergency that requires immediate intervention, typically with an injection of epinephrine.

• For example, severe signs of an allergic reaction include shortness of breath, difficulty swallowing, coughing, or weak pulse. If you notice any of these symptoms, call 911 immediately.

5. Gradually Increase Quantity

• After the initial introduction without any allergic reactions, gradually increase the quantity of the allergenic food in your baby's diet.

• Based on the LEAP Study, 6g of peanut protein per week (or 2g of peanut protein, 3 times per week) can help reduce the risk of developing a peanut allergy by up to 80%.

6. Be Consistent

• Consistency can help maintain tolerance.

• Repeated exposure (several times per week) is key.

• Continue to include allergenic foods in your baby's diet regularly once they have been successfully introduced. 

7. Seek Professional Guidance

• Always consult with your pediatrician before introducing allergenic foods, especially if you have a family history of allergies or if your baby has any pre-existing health conditions. 

Square Baby Launches "Peanut Powder" - Simply scoop 1 Tbsp of peanut powder into any Square Baby meal, stir, and serve. You can also add the powder to 4oz of breastmilk, formula, or water.

Introducing Allergenic Foods: A Gentle Reminder

Remember that every baby is different, and what works for one may not work for another. The guidelines mentioned here are general recommendations, and your pediatrician will provide guidance based on your baby's individual health and needs.

It's important to note that these nine allergens are not an exhaustive list, and individuals can be allergic to other foods as well. Additionally, the severity of allergic reactions varies, with some people experiencing mild symptoms and others having more severe, life-threatening reactions known as anaphylaxis.

Food allergies are a serious health concern, and individuals with known allergies or suspected allergies should consult with a healthcare professional, such as an allergist, for proper diagnosis and management.

Square Baby's Allergen Introduction Menu Can Help!

We get it - you're a busy parent! That's why we're here to help. Square Baby Meals like Almond Butter & Banana (almonds, wheat), Hazelnut Pumpkin Pie (hazelnuts, soy, egg), and Blueberry Crush (yogurt/milk) are a delicious and simple way to offer allergens early and often.

Also, you can add scrambled egg, nut butters or powders, yogurt, or cooked, deboned fish to Square Baby meals as another way to increase their exposure to allergens during the week.

Our "Peanut Powder" makes it easy and delicious to follow the science-based recommendations for allergen introduction and exposure. Square Baby's Peanut Powder is currently available to meal delivery subscribers only. 

Check out our easy, allergen introduction recipes on our blog!

Tips and Tricks

Try adding Beet Berry to cooked oatmeal -- you'll taste the earthiness of beets, the subtle sweetness of strawberries, the heartiness of quinoa and oats, and the creaminess of Straus Family Whole Milk Yogurt for a balanced, veggie-forward, allergen introduction meal.

Or, add Almond Butter and Banana on a slice of whole wheat bread or bagel for a nutrient-dense powerhouse snack with protein, fiber, healthy fats, and vitamins and minerals! 

For more recipes and ideas including Baby Led Weaning and Early Allergen Introduction, visit our blog here. 

Don't hesitate to reach out with any questions - we're happy to help!

~ Katie & Kendall, Cofounders and Chief Mamas


Please note: This blog post is for information purposes only and shouldn’t be used as personal, health, nutritional, or medical advice. Always consult with your pediatrician before making any decisions about your child's health or readiness for various foods.