Guidelines on Food Allergy Prevention

Across the United States, food allergies are increasing at an alarming rate.

Since 1997, peanut or tree nut allergies have more than tripled. This drastic increase has put parents on high alert. As much as 3 percent of babies under the age of 3 have some type of food allergy. With numbers on the rise, it is important that you understand why food allergies continue to be a problem in the United States.

Why Do Food Allergies Continue to be a Problem?

Food allergies are a recurring problem that parents see themselves facing. If you’re a parent concerned about this, you can blame it on several select foods. 

In the United States, allergic reactions primarily come from a group of Top 8 Allergens. Just 8 foods that we eat make up about 90 percent of all food allergies. These foods include:

  • Milk 
  • Eggs 
  • Peanuts 
  • Tree Nuts
  • Soy
  • Wheat
  • Fish
  • Shellfish 

Thankfully, some of these food allergies can be prevented. One of the reasons food allergies continue to rise is because of the misconception that you should avoid feeding your babies these foods. Avoidance is not the answer, it’s actually quite to the contrary. 

Several leading health organizations have created recommended guidelines that you should be aware of as a parent. Following these suggestions can help prevent your baby from developing allergies in the first place.

A Brief Overview

Throughout this article you will notice many similarities between the most recent guidelines developed. As a parent, there are a few key points that you need to remember as you begin feeding your baby semi-solid foods.

  • There are 8 major food allergens that cause the majority of allergies. By introducing certain allergens such as eggs and peanuts, you can significantly reduce the likelihood of your baby developing a food allergy. Remember that food allergies develop over time.
  • These allergens need to be introduced over time, gradually. Start with allergens such as peanuts and eggs, but be sure to wait at least 3 to 5 days before adding anything new to your baby’s diet. 
  • Babies with eczema, especially severe eczema, are at high risk of developing food allergies. With this in mind, it is especially important that you introduce your baby to allergens as early as possible (as early as 4 months). It should also be noted that babies who have siblings or parents with food allergies are more susceptible as well. 
  • All organizations mentioned were influenced by recent studies and their findings. The three landmark studies on food allergy prevention are LEAP, EAT, and PETIT.  The LEAP study centered around peanut allergies. Another key study (EAT) focused on a wider variety of allergens such as milk, peanut, sesame, fish, egg, wheat. Finally, the PETIT study focused on egg introduction.

National Institute of Allergy and Infectious Diseases (NIAID)

In 2017 the National Institute of Allergy and Infectious Diseases created an updated version of their food allergy prevention guidelines.  Within these new findings are 3 separate guidelines for infants at different risk levels for the development of peanut allergy. You should be sure to pay close attention to these changes.

Dr. Anthony Fauci, Director of the NIAID, emphasizes the importance of these food allergy prevention recommendations: “For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention. We’re talking about saving thousands and thousands of kids from peanut allergies.”  

“We’re talking about saving thousands and thousands of kids from peanut allergies.”

– Dr. Anthony Fauci, Director of the NIAID

1. Severe Eczema, Egg Allergy, or Both 

Does your baby have eczema?

Babies with severe eczema have a 67 percent chance of then going on to have food allergies such as peanut and egg. With that in mind, the NIAID recommends that parents strongly consider evaluation for various food allergies such as peanuts. You should ask your pediatrician to recommend testing methods such as sIgE measurement and/or SPT and, if necessary, an OFC.

These tests are taken prior to allergen introduction to ensure that your baby doesn’t already have a predisposition for certain foods such as peanuts. After receiving testing results (assuming your baby is not allergic to peanuts), the NIAID recommends introducing peanut-containing foods. This should be done as early as 4 to 6 months of age.

2. Mild-to-Moderate Eczema

Babies with mild-to moderate eczema are still more likely to have peanut related allergies than those without. Given this fact, they recommend that you introduce peanut-containing foods at 6 months of age. 

3. No Eczema or Food Allergy 

Babies without eczema or other food allergies are less likely to develop a food allergy. Even so, you should still gradually introduce your baby to allergens such as peanuts. According to the NIAID this introduction should be age appropriate, in accordance with family preferences and cultural practices.

American Academy of Allergy Asthma and Immunology (AAAAI)

The AAAAI made relatively recent updates (2017) to their guidelines on food allergy prevention. In its report, it offers several suggestions you should consider.

1. Babies with Food Allergies or Eczema

Babies who have siblings with food allergies or eczema are the most at risk of developing food allergies. About 1 in 8 food-allergic children will have a sibling with the same diagnoses compared to 1 in 12 for the general population.

Even given these statistics, it is not recommended that mothers avoid certain allergens while pregnant or breastfeeding. According to the AAAAI, evidence suggests that there is no significant allergy prevention benefit to your baby in doing this.

2. Early Introduction

Early introduction is most important for babies with eczema, but all babies should be introduced to allergens. The AAAAI recommends introduction between the ages of 4 to 6 months. During this period foods such as egg, dairy, peanut, tree nuts, fish and shellfish should all be introduced within this time frame.

3. Gradual Introduction

Not only should your baby be introduced to allergens early, they should be introduced often. While in the critical 4 to 6 month time frame, your baby should be introduced to 1 new food at a time. 

After 3 to 5 days of introducing your baby to a certain food, you can begin to introduce others. Prior to this, you should wait because you need to be able to pinpoint the food causing an allergic reaction if it were to arise.

Food and Drug Administration (FDA)

In September, 2017 the FDA made a groundbreaking recognition. At this time, they acknowledged a connection between peanut introduction at a young age and food allergy prevention.

Scientific evidence from the LEAP study found that early peanut introduction reduced the likelihood of developing allergies. This was especially important for babies with eczema and egg allergies. As such, the FDA determined that babies should be introduced to peanuts between the ages of 4 and 10 months of age. If done consistently between the recommended start time and the age of 5, there is a reduced chance of developing an allergy.

American Academy of Pediatrics (AAP)

The 2019 AAP brought about discussions of early allergen introduction as well. It acknowledged that there is now evidence that early introduction of peanuts may prevent peanut allergy.

Using information provided by the LEAP, EAT, and PETIT studies on food allergies, the AAP concluded that there was no convincing evidence of benefit for delaying the introduction of allergenic foods beyond 4 to 6 months. Given this information it suggested feeding your baby allergens within the time frame as a measure of defense against food allergy development.

United States Department of Agriculture (USDA)

In 2020 the USDA released its newest guidelines. This was the first time they included babies ages 0 to 24 months, emphasizing the importance of their newest findings. Understanding the new Dietary Guidelines for Americans will help inform you when making health conscious choices for your baby.

There is increasing evidence that the first 24 months of your baby’s life are critical to their development. This is especially true with food allergies, but on an even more narrow timeframe within the first 4 to 6 months. The new guidelines suggest that you feed your baby peanut and egg starting at 4 months of age to prevent severe food allergies.

Key Takeaways for Parents

Food allergies are steadily on the rise in the United States. Luckily, parents like you can help reduce the likelihood of your baby developing a food allergy by up to 80 percent. By following the recommendations of these reputable organizations, you can minimize the risk of your baby developing food allergies.

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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. 

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