Food allergies are scary. But they’re also way more rare than we’re led to believe when we listen to the grapevine advice on how to prevent our kids from developing food allergies:
Avoid eggs in pregnancy! Cut out dairy when you’re breastfeeding! Above all, keep your baby away from peanut butter until preschool!
No, you don’t have to do any of that to prevent allergies. Just the opposite, says a new review in the Canadian Medical Association Journal that underscores the latest research on avoiding food allergies in kids and suggests practical ways to apply it.
You’re not imagining that food allergies are rising: In just 10 years, from 1997 to 2007, food allergies rose 18 percent in the U.S. One child in every classroom is said to have one. And yes, they’re scary serious for that unlucky child.
That’s why prevention is a new focus of attention. And the new recommendation is that many cases of food allergies can actually be avoided altogether if, instead of trying to avoid exposure to suspected foods, you start with exposure very early in life.
Here’s how to do it, according to the Canadian team and other immunology experts:
First, skip the avoidance diets.
Pass the peanut-butter-and-chocolate-chip ice cream! There’s no need to cut out potentially allergenic foods during pregnancy or while you’re breastfeeding in an attempt to prevent your baby from developing food allergies. So-called avoidance diets don’t help and aren’t recommended by the guidelines of the American Academy of Allergy, Asthma & Immunology. What’s more, eggs, dairy, nuts, and fish are great sources of protein and other nutrients your body really needs during the added demands of carrying and nursing a baby.
Introduce the most common allergens at four to six months.
That’s right: Pretty much around the same time your baby is ready to start solids, all those scary suspect foods can be included on the menu. The most common allergens are cow’s milk, soy, peanuts, tree nuts, eggs, wheat, fish, shellfish, and sesame.What happened to waiting? A recent high-profile randomized clinical trial, the Learning Early About Peanut (LEAP) allergy study, put that idea to bed. Introducing peanuts early in life, rather than later, in high-risk kids was found to cut their risk by as much as 80 percent.
That’s why the optimal time to introduce peanuts is between 4 and 11 months, say all the leading allergy medicine groups. (The old window was 12 to 36 months because doctors thought it would help babies’ guts mature—instead, in places like the U.K., peanut allergies tripled when they restricted peanuts. Now doctors pretty much agree that waiting that long to introduce any food actually increases the odds of allergies.)
Make the very “first foods” grains, orange and yellow veggies, and fruit.
That’s the suggestion of the American Academy of Allergy, Asthma, and Immunology. It doesn’t matter if you pick rice cereal or strained peaches first. (As one of our favorite pediatricians suggests: Choose the food that’s the same color as your kitchen floor, because that’s where most of it is going to end up anyway.)
Tip: Cereals have the added advantage of being mixed with breastmilk or formula, so the taste will already be familiar to your baby. This also lets you adjust the consistency, because you can add as much as you want. The most easily swallowed first “bites” tend to have a runny consistency that you can thicken as your baby gets the hang of it.
Add one new food every three to five days, so you’ll be able to notice any reactions.
Then slowly introduce the potential allergens.
Start with just a single taste of cow’s milk, soy, eggs, fish, or nut butter. If there’s no reaction after a day, you can gradually add in more of the food. (Signs of a reaction include red spots, swelling, or a rash on the skin, trouble breathing, nausea, vomiting, or diarrhea. First reactions in babies are almost always mild and show up within a few minutes to a day or two after tasting the food.)
Some safety notes:
- Whole cow’s milk shouldn’t be a baby’s main beverage until one year, doctors say, but cow’s milk protein is perfectly fine for a younger baby in infant formula, yogurt, and cheese.
- Whole nuts are obviously out because they’re a choking danger. Nut butters are fine—just spread them thinly, so your baby won’t gag.
- Introduce possible allergens at home instead of at day care or in a restaurant, so you can closely observe your child and call a doctor in the rare event of any problem. Some babies show a reaction to peanuts the first time but never again.
Keep serving these foods regularly.
It doesn’t really help your child to bravely try eggs one time and then stay away forever out of (misguided) fear. Repeated exposure to potentially allergenic foods helps kids maintain tolerance for them, say the authors of the Canadian review. More PBJ, please!
When NOT to follow this advice.
The vast majority of babies—repeat, vast majority—will do fine on the above plan. But if your baby has moderate to severe atopic dermatitis, a sibling with a peanut allergy, or an immediate reaction to one of the allergens, then the doctors say you’ll want to get a personalized plan set up, probably with a pediatric allergist or immunologist.
But you can be reassured that even kids at higher risk of food allergies like these can now be introduced to certain foods under supervision. One new theory, says Elissa Abrams of the University of Manitoba, is that kids with eczema may get allergies through broken skin if they’re exposed to foods they haven’t already been eating.
And if your baby isn’t one of the comparatively few who’s at higher risk? Well, the new thinking on food allergies represents one less thing to worry about—and a wider, nuttier culinary future for the whole family.