The possibility of an allergic reaction after eating gives many Americans pause when making food choices. No one wants to worry that a bite into a savory sandwich or decadent dessert will cost them a swollen lip—or worse, a trip to the E.R. As adults, we have more control when it comes to the foods we are exposed to, but what about children? Or better yet, infants? When should we introduce potentially allergenic foods to our babies? Parents may have the brunt of food allergen concerns, especially when selecting foods for their infants, and with good reason. According to Food Allergy Research & Education (FARE), food allergies among kids have increased over the last couple of decades. Faced with uncertainty, many parents avoid feeding their babies certain foods in the hope of preventing a potential allergic reaction. But is such avoidance helpful in the long run?
Food allergies are a public health concern
The U.S. Food and Drug Administration recognizes eight major food allergens: milk, eggs, fish, shellfish, tree nuts, wheat, peanuts and soybeans. Allergic reactions can vary from person to person and may also result from foods not included in the “Big Eight.” If you are allergic to an allergenic food, eating that food activates your immune system, causing your body to think the food is an “invader.” When your immune system is unnecessarily activated, many parts of the body—including your gut and other organs and tissues—can be affected. Sometimes, one allergic reaction can make you more sensitive to other allergens. Food allergies are serious, and they can be life-threatening, especially for infants, who cannot tell you when something feels wrong.
Currently, one in 13 children in the U.S. has food allergies. Food allergy rates have steadily increased over the past couple decades, presenting a major concern for parents, health care workers and public health professionals alike. To help families identify potential allergens, legislation (like FALCPA) has been passed, which requires companies to list major allergens directly on food packages. While such laws have a preventive effect, they cannot fully resolve the issue of food allergies. Keeping a close eye on one’s diet is still of the utmost importance.
Pediatric food allergies and guidance
Diet plays a large role in infants’ growth and development, and the foods infants eat can also affect their risk for certain health conditions later in life. Thus, parents must know what foods to include in a baby’s healthy diet—and when to introduce them. Although it was previously thought that potentially allergenic foods should be introduced later in life, we now know that introducing potentially allergenic foods with other complementary foods can help prevent food allergies and optimize infants’ long-term health. The American Academy of Allergy, Asthma, and Immunology and the American Academy of Pediatrics recommend introducing common food allergens at around six months of age when other complementary foods are introduced, and the 2020-2025 Dietary Guidelines for Americans echoes this recommendation. Introducing peanuts, for example, at or around six months of age can help reduce the risk of developing a peanut allergy. Infants who are at increased risk for a peanut allergy (meaning they have egg allergies, severe eczema, or both) should receive their first peanut-containing foods even earlier, between four and six months. The one exception is for cow’s milk, as a beverage, which should be introduced at 12 months or later.
In the U.S., our diets continue to change drastically. Our curiosity about what is in the foods we eat and how food is produced shows a growing public interest in our food environment. This is especially true for households in which one or more people have food allergies. According to IFIC’s 2019 Food and Health Survey, one in six people has someone in their home with a food allergy. Most commonly, these allergies are to peanuts, milk, and shellfish. Following updated recommendations on introducing potential allergens can help families reduce the risk of infant food allergies while increasing quality of life for the entire household.
What steps can you take?
Food allergies can start at an early age and are sometimes lifelong. Because there is no cure for food allergies, it is essential to identify which foods may cause you or your children to have allergic reactions and to avoid them. This can undoubtedly be a learning process, especially for parents of small children who often cannot verbally communicate an allergic reaction. Still, identifying allergens is essential for keeping babies safe and healthy. If you are a new parent or a caregiver, prepare to introduce the “Big Eight” to your infant’s diet according to the resources we’ve provided. Doing so will reduce the likelihood of your child developing food allergies. When you introduce a potentially allergenic food, remember to pay attention to physical reactions as your child is eating it. Are there any skin reactions? Does your child become more agitated or cry after eating certain foods? Be sure to document these changes and consult a health care professional in the event of a reaction. By applying this information and sharing what you’ve learned with loved ones, we can keep our babies safe and help them to enjoy a rich and healthful diet. Here’s to messy mealtime faces!
Guidance for Industry: Questions and Answers Regarding Food Allergens (Edition 4), U.S. Food & Drug Administration, 2006.
Labeling That Saves Lives: Understanding FALCPA, IFIC, 2021.
Prevention of Allergies and Asthma in Children, American Academy of Allergy, Asthma, and Immunology, 2020.
“Early introduction of foods to prevent food allergy,” Allergy, Asthma & Clinical Immunology, 2018.
2020–2025 Dietary Guidelines for Americans, U.S. Department of Agriculture, 2020.
This article was written by Casey Terrell, MPH, RD