March 29, 2017

How to avoid food allergies: Start early, go slow

New guidelines suggest introducing foods containing peanuts to children sooner may reduce the risk of their developing a peanut allergy.

You’re a new parent to a beautiful, rambunctious baby and her pediatrician has given you the “all-clear” to start her on solid foods.

It can be overwhelming to introduce new foods to your child, especially if you’re concerned about allergic reactions. Are there foods you should avoid?

It’s now a bit easier: the National Institutes of Health published new guidelines earlier this year that suggest introducing foods containing peanuts to children sooner may reduce the risk of their developing a peanut allergy.

“We used to think it was better to avoid peanuts,” said Javed Sheikh, MD, a chief of service for the allergy department at Kaiser Permanente Los Angeles Medical Center. “But recent studies show that if a child who is at risk of developing a peanut allergy is introduced to peanut butter between 4 and 11 months of age, it reduces her chance of being allergic.”

In most cases, infants may be introduced to allergenic foods once they have started eating other solid foods, around 4-6 months, Dr. Sheikh notes. He recommends introducing a small amount at first in order to gauge its effects. If introducing peanut butter, for example, he recommends dissolving a small amount with formula, breast milk, or water. Infants who already have severe eczema or an existing food allergy are at a higher risk of reacting to peanuts on the first try, said Dr. Sheikh, so consult with your child’s pediatrician before introducing peanut-containing foods.

Dr. Sheikh and Patrice Tim Sing, MD, pediatrician at Kaiser Permanente Hawaii Kai Clinic, agree that parents should proceed in the same way with other foods that commonly cause food allergies.

Similar to peanut butter, Dr. Sheikh advises parents and caregivers to introduce other foods that fall into the common food-allergy groups in small amounts. “Add one new food at a time at least three days apart, to watch for a reaction,” he said.

Most kids are low-risk

Dr. Tim Sing says the estimated food allergy prevalence in the United States ranges from 5 to 10 percent of children, with the highest percentage identified at one year of age. Children typically grow out of these food sensitivities by late childhood.

In addition: studies have shown that children who are exclusively breastfed for 4-6 months have lower rates of food allergies, and allergies in general.

So who is at risk? According to Dr. Sheikh, if one parent has a food allergy, there is an approximately 1 in 3 chance the child will develop some food allergy as well. If both parents have a food allergy, their child’s risk climbs to about 50 percent. And if an older sibling has a known allergy, there’s a chance the infant will also have it.

Signs of allergic reaction and what to do

Dr. Tim Sing cautions that symptoms of allergic reaction can happen any time from a couple of minutes to hours after ingesting the food culprit. Keep an eye out for these symptoms in the following categories:

  • Skin: hives, redness, swelling
  • Mouth: itching, irritation, swelling of the lips, tongue, palate or throat
  • Intestinal: nausea, belly pain, cramping, vomiting, diarrhea
  • Respiratory: coughing, wheezing, shortness of breath, congestion or runny nose, eye irritation

If symptoms are mild, consult with your child’s pediatrician before you consider offering your child that food again. Mild symptoms can sometimes progress into more severe forms. If moderate to severe and/or life-threatening symptoms are present, call 911. When faced with severe symptoms of anaphylaxis, it is important to receive medical attention and medicine immediately. Afterward, contact your child’s pediatrician to discuss next best steps.

If necessary, there are a number of allergy tests that can be completed in order to determine specific food allergies, the severity of each, and approaches on how to manage these allergies.

A simple first step is to have a conversation with your child’s pediatrician about introducing allergenic foods. Ask questions and voice your concerns so that you’ll be fully equipped to give your baby that first taste of nutritious foods.


Ways to expose your child to allergenic foods

Remember to follow the guidelines for introducing these foods.


  • Soft-boiled
  • Lightly scrambled
  • Scrambled eggs diluted with water, formula or milk


  • Pancakes made with milk (and eggs)
  • Macaroni and cheese
  • Yogurt


  • Bread containing wheat


  • Softened peanut butter
  • Nut purees


  • Tofu containing soy
  • Soy milk or soy formula

Fish and shellfish:

  • Pureed (be mindful of mercury content)