Preventing Food Allergies
Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD
Food allergies are becoming more common. A food allergy occurs when ones immune system reacts as if a food is harmful. The body makes antibodies against that food. When someone then comes in contact with that food again, the body releases massive amounts of chemicals and histamine. These cause the symptoms of a food allergy.
- Hives and swelling
- A tingling sensation in the mouth
- Swelling of the lips, tongue, and throat
- Rash or eczema
- Abdominal cramps
- Difficulty breathing
- Gastroesophageal reflux disease (GER, GERD)
- Drop in blood pressure
- Loss of consciousness
- and (very rarely) death
These symptoms typically occur within 1-2 minutes after a person has eaten the food that is causing the problem. In some highly allergic persons, reactions can occur when the food is smelled or touches the skin.
Although the body can become allergic to any food, the most common food allergies are to just eight foods: milk, egg, peanut, tree nuts (walnut, cashew, almonds, pecans, etc.), fish, shellfish, soy and wheat. Someone is typically “sensitized” (become allergic) to a food after being exposed one or more times in the past before an allergic reaction occurs. For some persons with food allergy, the degree of the reaction will be greater with a larger amount being eaten. However, once it is known that a person is food allergic, it is not safe to eat even a small amount of that food as a severe, even life-threatening reaction could occur.
Currently there is no cure for food allergies, making prevention so important. Although many people outgrow their food allergies, peanuts, nuts, fish, and shellfish are considered to be lifelong.
To diagnose a food allergy, we need the help of an allergist. They can review the history and perform tests to determine if an allergy exists. Food allergy testing can be done at any age, even with young infants. The testing usually involves scratch (or prick) skin testing at the first appointment with the allergist. If a food allergy is found, your child will need to periodically follow-up with the allergist. There are many quality allergists here in Columbus, including Dr. Grace Ryu (“you”), M.D., Dr. Tim’s wife. Dr. Grace is with Midwest Allergy. Other practices we commonly recommend include Nationwide Children's Hospital and OhioENT & Allergy.
For children with a stong family history of food allergies or a history of moderate-to-severe eczema, the current recommendation is for these children to be seen by the pediatric allergist to be tested and receive specific recommendations about introduction of foods BEFORE these food items are introduced.
- There is no perfect way to prevent food allergies. Even carefully following the instructions below does not always prevent allergies, but taking these steps can significantly reduce the chances of your child being food allergic. For many years, we were telling everyone that the earlier a young child was exposed to a food, the more likely they were to be allergic to that food. Following that strategy and not introducing foods early is not working: over the last 10-15 years, food allergies continue to be more and more common.
- In order to try to better protect children from developing food allergies, the latest scientific studies show it is best to offer small amounts of these foods at an early age. The hope is that exposing their system to the small amounts at an early age, this will actually “desensitize” their body to that food. So our advice about these foods is that it is only too soon if your child cannot do well yet with the texture of the food. For many infants, that means when they are crawling and picking up small food items with their thumb and index finger, it is fine to introduce these foods. This most commonly happens at 8-11 months of age.
- Peanuts: One ideal food to introduce infants to peanuts is Reece’s Puffs® cereal. Offering 6-12 puffs at a sitting, 2-3 times per week, is a good way to introduce a small amount of peanuts into your infant’s diet. If they are doing well with small pieces of soft bread or toast, it is fine to offer your infant a thin layer of peanut butter on sliced bread or toast a few times a week. If your child is doing well with these, you can increase how often you offer them each week.
- Eggs: Small, soft bits or pieces of waffles and pancakes contain egg and can be offered when your child can feed themselves these foods. Another fine egg product to try at this stage is small pieces of scrambled egg. As long as your child is doing well with these, you can increase how much and how often you offer egg products.
- Fish: When you start offering small bits or pieces of other meats, often between 9-12 months of age, it is fine to offer small pieces or bits of white fish.
- Shellfish: Since the texture of shellfish such as lobster, clams, and crabs are thicker, these often will not be offered until a child is after their first birthday. Once they are eating other foods of this chewy texture, it is fine to introduce these shellfish to their diet.
- Wheat: It is fine to introduce wheat into your infant’s diet when you start cereal (puffs and Cheerios®), pasta, breakfast bars, cookies, and bread. If your infant is ready for the texture, it is fine to start small pieces and bites of these items. As with other foods of this texture, those infants ready for these are crawling and picking up small items with their thumb and index finger.
- Milk and soy: Milk products such as cheese and yogurt are fine to introduce in small amounts at 8-9 months of age and beyond. Please hold off on giving cow’s milk to drink until at the first birthday or just a week or two before. Before the first birthday, cow’s milk does not have enough iron and is not good for your kidneys.
- Tree nuts: The tree nut butters, such as almond butter and cashew butter, are fine to introduce at 9 months of age when the texture is something your infant can handle well.
Another option is spoonfulone®(see www.SpoonfulOne.com). They make Spoonful One Mix-In, which is made with their Foundational Food Blend, which can be added to infant cereal or pureed foods at 4 months and above. The Foundational Food Blend contains foods responsible for 90% of all food allergies. They also make Puffs (which control the same Blend) for when puffs are added sometime after 6 months when your baby is picking up things with their thumb and index finger and getting it to their mouth well. Research shows this can help reduce future reactions to these common food items. These products are available from their website and from www.amazon.com.
For children with a personal or family history of food allergies, a history of eczema, or other allergy history, please discuss with your doctor about when to introduce these foods. There will not be one right answer for all children with these histories.