Early Introduction to Allergens 

What are food allergies?

Food allergies occur when the body’s immune system is exposed to food and mistakenly sees it as harmful. Symptoms of food allergies range from mild to severe, but some responses include redness, swelling, hives, a stuffy or runny nose, watery and itchy eyes, coughing, or vomiting.

Common food allergies include: 
•    Peanuts 
•    Tree nuts 
•    Wheat
•    Soy 
•    Seafood, including crustaceans, fish, and shellfish
•    Milk and milk products 
•    Sesame 
•    Eggs

What steps can you take before introducing allergens?

Your baby’s healthcare team is a great resource. Contact your baby’s physician, nurse practitioner, or dietitian if you have any questions or concerns related to introducing allergens.

Some general tips include:

•    Breastfeed if possible. Breastmilk contains antibodies, nourishing nutrients, and other factors that may minimize the risk of allergy development. Health Canada recommends breastfeeding for up to 2 years or more following the introduction of solid foods. Current research doesn’t recommend breastfeeding 
mothers restrict their diet or avoid eating common allergens to prevent allergies. 
•    Aim to keep eczema well controlled. If your baby experiences eczema, having it well controlled may help reduce the risk of developing food allergies. 
•    Wait until your baby is ready for solid foods. Most are ready between 4-6 months. Signs that your baby is ready for solid foods are they can steadily hold up their head, independently sit up and lean forward, provide hunger and fullness cues (such as opening their mouth to accept food or turning away to decline food), and they can reach out for and direct food with their hands.
•    Introduce sooner rather than later. When your baby is developmentally ready, try to avoid unnecessary delays to introduce common allergens. Waiting longer than necessary has been linked to an increased risk of allergy development, especially for babies at a higher risk of developing food allergies. Babies are considered to have a higher risk of developing food allergies if they already have another allergic condition (such as eczema or asthma) or allergic conditions run in the family. 

General tips when introducing common allergens:

•    Offer one allergen at a time. When your baby is developmentally ready, start by introducing lumpy, tenderly cooked and finely minced or ground, or pureed foods that don’t include common allergens. After your baby is exposed to a few foods, introduce them to common allergens one at a time to help safely identify foods that cause an allergic reaction if necessary. Aim to offer peanut and egg to your baby before other common allergens as early introduction is especially helpful for reducing the risk of food allergy development in these two foods. 
•    Opt for small portions of smooth peanut and tree nut butters. Avoid whole nuts and large portions of nut butters as these are a choking hazard. Mixing 15-30 mL (1-2 tbsp) of smooth nut butter into breastmilk, warm water, infant cereal, or fruit purees works nicely. When your baby is ready for more textures, thinly spreading 15mL (1 tbsp) of nut butter on toast and slicing it into smaller pieces works well. Softened peanut puff products, such as Bamba®, are also a suggested option by Food Allergy Canada. 
•    Boil, puree, and mix common allergens into tolerated foods. Similar to mixing nut butters into food, other common allergens (such as eggs or fish) can be cooked, finely minced or pureed, and mixed into food. For example, a hardboiled egg can be mashed and added to a few teaspoons of breastmilk. 
•    Offer your baby a small portion of allergen-containing foods at a time and wait. When introducing a common allergen, provide a quarter of a baby spoon at a time and wait 10-15 minutes before offering another bite. In the meantime, you can offer your baby other foods that don’t contain the allergen and watch for whether or not your baby shows signs of an allergy as listed above. Immediately call 9-1-1 or your local emergency if severe symptoms such as difficulty breathing or swallowing, swelling of the mouth, throat, or tongue, pale or blueness in the face of lips, or a worsening rash or hives occur. 
•    Continue to offer tolerated foods. If a common allergen is well-tolerated, continue to offer it to your baby with complementary foods 2-3 times a week. This helps remind your baby’s immune system that a food is safe and prevents an allergy from developing after it was initially introduced.  

For more information:

This article was adapted from the HealthLinkBC article ‘Reducing Risk of Food Allergy in your Baby’. If you have questions about feeding your baby or allergies, contact your healthcare provider. You can also call 8-1-1 to speak to a registered dietitian or registered nurse. 

To learn more about introducing common allergens and recommendations of your baby’s first foods, see:

•    HealthLinkBC article - Reducing Risk of Food Allergy in your Baby 
•    HealthLinkBC file #69c - Baby’s First Foods
•    Appetite to Plays article – Baby’s First Foods
•    Food Allergy Canada’s article – Early Introduction 

Source: Sophia Jiajj, 5th year UBC dietetics student