As you introduce new foods into your baby’s diet, you might find yourself worrying about possible allergic reactions. And that’s a valid concern, given that one in 13 children in the United States has a food allergy, according to the American Academy of Pediatrics (AAP).
“In the first year of life, the most common foods to cause allergies are cow’s milk, eggs and peanuts,” explains Dr. Brian Vickery, Chief of Allergy and Immunology at Children’s Healthcare of Atlanta and director of their Children’s Food Allergy Program. “Babies exposed to these foods earlier have a much lower risk of developing true food allergies than those exposed to them later,” he says in reference to studies that led to the newly updated feeding guidance on preventing food allergies through nutrition. As of 2021, the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology (ACAAI) and the Canadian Society for Allergy and Clinical Immunology jointly recommend introducing both peanut and egg around 6 months, but not before 4 months to prevent peanut and/or egg allergy.
Read on for common questions parents ask as they start introducing new foods into their baby’s diet and get expert answers and insights on food allergy signs, symptoms, steps to take in an emergency and where to go for support.
What is a true food allergy?
The Academy of Nutrition and Dietetics explains food allergies as reactions that happen “when the immune system attacks a food protein that it mistakes as a threat to the body.” Food allergies can be further subdivided into IgE-mediated reactions (develops within 60 minutes) and non-IgE-mediated allergies (develops over hours to days). Food allergies, however, are not the same thing as having “food intolerance,” a problem digesting a particular food such as lactose.
“The difference between food allergies and food intolerance can be confusing,” notes Dr. Brooke Scherer, a practicing pediatrician in Naperville, Illinois. “Typically, when people think about a food allergy, they’re talking about IgE-mediated allergies that have the potential to be life-threatening.”
“The difference between food allergies and food intolerance can be confusing. Typically, when people think about a food allergy, they’re talking about IgE-mediated allergies that have the potential to be life-threatening.”
— Dr. Brooke Scherer, a pediatrician in Naperville, Illinois
How can you safely introduce common allergenic foods into your baby’s diet?
The AAP advises giving your child one new food at a time and waiting at least two to three days before introducing another. While whole cow’s milk is not recommended before your baby’s first birthday, you can introduce processed dairy products (e.g., whole milk yogurt or Greek yogurt). Then, after introducing each new food, watch for any allergic reactions (more on what those might look like in a moment), and contact your pediatrician if any occur.
When her own kids were little, Dr. Scherer remembers being told to delay introducing allergenic foods like eggs and peanuts. “Now, when I discuss the introduction of solids for babies with parents, I encourage regular consumption of foods with egg and peanut,” she says. “Breast milk or formula should still make up the bulk of their nutrition until they’re 6 months old, but it can be a really fun process to start giving the baby tastes of different foods — especially if they seem interested and ready.”
Dr. Vickery, who notably led the Phase 3 clinical trial of Palforzia, a now FDA-approved immunotherapy for children ages 4 to 17 with a confirmed peanut allergy, adds that if your baby has been diagnosed with eczema, they’re at a higher risk for food allergies and benefit most from early dietary introduction of peanut, egg and other foods. “But it must occur by 6 months old to be effective,” he advises. “Parents should discuss early food introduction with their pediatrician or allergist prior to 6 months of age.”
And while widely marketed, Dr. Scherer advises concerned parents to exercise caution before using any at-home food sensitivity test. “These panels are not recommended, because they might show reactions to foods a baby or young child is tolerating without any problem,” she explains. “They can cause families to unnecessarily take foods out of their child’s diet and that increases the chance of developing an allergy to a food they were previously sensitized to.” Additionally, she says none of the tests on the market have been evaluated by the Food and Drug Administration (FDA).
What are common signs of food allergies in babies?
Data shows most allergic reactions in infants are relatively mild and tend to involve the skin. In a 2018 study, researchers discovered that babies who do have allergic reactions tend to have:
- Hives 94% of the time.
- Stomach issues 89% of the time.
- Vomiting 83% of the time.
- Breathing difficulties 17% of the time.
“A baby experiencing an allergic reaction to food might act unreasonably irritable or have dramatic behavior changes right after a meal before other visible symptoms show up,” says Dr. Jeanne Lomas, a board-certified pediatric allergist and director of allergy and immunology at WellNow Allergy in New York who advises parents to lookout for more subtle symptoms.
When Dr. Scherer’s own son was 14 months old, he developed a pink rash on his cheeks, hives on his wrist, and started itching his ears after eating fish. These symptoms of IgE-mediated food allergies generally show up within minutes to two hours after eating the food.
While any food can potentially cause an allergic reaction, the majority of egg, milk, wheat and soy allergies go away before kindergarten as the digestive system matures, according to the AAP. Some allergies like peanut and seafood allergies, however, are more persistent and can be lifelong. In many cases, genetics plays a role in the immune system mistakenly identifying peanut proteins as something harmful.
How are baby food allergy symptoms treated?
If your baby’s symptoms are mild, Dr. Scherer says your pediatrician might recommend giving them an oral antihistamine at home and closely monitoring them for more severe symptoms such as swelling in the mouth or throat, wheezing, cough, shortness of breath and difficult, noisy breathing. With such a small respiratory system, even a small amount of swelling can make it very difficult for a baby to breathe.
If you suspect your baby is having a serious food allergy reaction and is struggling to breathe, the AAP recommends getting them to an emergency room or calling 9-1-1.
All emergency rooms have protocols for how to treat potentially life-threatening allergic reactions or anaphylaxis. At any age, epinephrine, a hormone that reverses anaphylaxis by constricting blood vessels to increase blood pressure and opening airways to help with breathing, is generally the first line of defense. Brand name examples include EpiPen and Auvi-Q, which was introduced in 2018 and is designed specifically for infants and younger children weighing between 16.5 pounds and 33 pounds.
“Auvi-Q is a really nice auto-injector,” says Dr. Scherer who likes its ability to talk to you and walk you through the administration steps. “But usually, people are going to use whichever brand of auto injector is best covered by their insurance.”
“We know proper diagnosis and treatment can make such a significant impact on a patient’s quality of life.”
— Dr. Jeanne Lomas, a board-certified pediatric allergist
How are babies officially diagnosed with a food allergy?
Your pediatrician might refer you to a pediatric allergist or a pediatric gastroenterologist who can investigate whether or not a food allergy is truly the cause of your baby’s symptoms.
“We can test for food allergies through skin testing and blood testing,” notes Dr. Zachary Rubin, a pediatric allergist and clinical immunologist who also practices in Naperville, Illinois. If the tests do not clearly show a food allergy, Dr. Rubin says he may decide to watch a baby eat while in the office and see if their body reacts. This is what’s called an “oral food challenge.”
Due to a national shortage of pediatric specialists, receiving comprehensive care and treatment for food allergies isn’t always possible. “We know proper diagnosis and treatment can make such a significant impact on a patient’s quality of life,” says Dr. Lomas, who is also a medical advisor for the Allergy Advocacy Association, an organization working to inform, educate and raise awareness about allergies and anaphylaxis prevention. “I’m hopeful the work we are doing every day helps remove barriers to allergy care and ease the stress created by growing demand and a nationwide shortage of allergists.”
If you need help finding a certified allergist near you, try searching the ACAAI’s online directory or talk with your pediatrician about your testing options.
What is a food allergy action plan?
A written food allergy action plan can help guide caregivers on when to use epinephrine versus an oral antihistamine, explains Dr. Rubin. If a baby has a confirmed food allergy, this document (also known as an “anaphylaxis action plan”) may include details such as:
- Strict avoidance of the food or foods in question not only at mealtimes or snack times but also during activities such as art projects or at playtime.
- Instructions on how to manage a food allergy reaction.
- Whom to notify in an emergency and/or call with questions or concerns.
- Guidance on when to use emergency medications like oral histamines, auto injectable epinephrine, and inhalers (if prescribed).
“If prescribed an epinephrine auto-injector device, you’ll also need to make sure all caregivers are trained how to use it and understand that all surfaces, plates, and utensils that your baby eats on must be cleaned prior to eating,” adds Dr. Rubin.
Can a registered dietitian help with baby food allergies?
Registered dietitians (RDNs) can be helpful anytime you’re struggling with how or what to feed your baby, and guidelines from the National Institute of Allergy and Infectious Disease specifically recommend children diagnosed with food allergies receive nutritional counseling and regular growth monitoring.
“RDNs can provide age-based food alternatives and screen for possible nutritional deficiencies related to an elimination diet,” explains Dr. Lomas. While the referral chain for getting access to a RDN (there’s a nationwide shortage of those, too) isn’t exactly standardized, she says you may be able to find one who works within your local hospital system or within a larger academic medical center. Some RDNs even offer telemedicine appointments.
“Most insurers do cover what we call medical nutrition therapy,” explains Emily Sylvester, a registered dietitian and lactation consultant who founded the digital health platform Mother of Fact in 2021. “As dietitians, we work in partnership with your larger care team and do a lot of education to help parents feel comfortable reading and understanding ingredient lists on food labels, making meal plans and continuing to support them – especially if their baby is still breastfed or formula fed.”
In a recent study, mothers of children with food allergies, specifically, reported higher levels of anxiety and poorer health compared to mothers of children without food allergies. “Strict allergen avoidance and safety concerns are a recipe for parental anxiety,” says Sylvester. “I’ve seen firsthand what a difference personalized nutrition support can make on the whole family’s wellness. Food really is medicine.”
The bottom line on signs of food allergies in babies
It’s best to prevent food allergies from developing in the first place with early introduction of peanut, egg, and other foods around 6 months. “Discuss any concerns with your pediatrician or an allergist, but do not delay introduction,” says Dr. Vickery.
While data shows that severe allergic reactions are uncommon in infants, all parents should know what to look for and be prepared. “If your baby is diagnosed with a food allergy, don’t be afraid to ask your doctor for help navigating different scenarios,” Dr. Lomas says. “I also recommend parents and caregivers visit FoodAllergy.org for helpful tips and more information on dietary avoidance and label-reading.”
