Should I give my baby peanut butter? What about soy? Or do I need to avoid foods that cause allergies?
Parents have many questions when it comes to food and their babies. The recent changes to the official food allergy guidelines from the National Institute of Allergy and Infectious Diseases add to the confusion. They reverse years of conventional wisdom.
New medical research spurred the change, showing that you can prevent your child from developing a peanut allergy early in life.
“The prevalence of food allergies has doubled over the last 20 years in the United States,” says Jennifer Petts, DO, an allergist and immunologist at The Iowa Clinic. In addition to the serious health ramifications, a food allergy can create social obstacles for kids and economic burdens for their families — and it is rarely outgrown. “For years, we advised new parents to withhold allergenic foods until their child reached one year old. But because we continued to see an increase in food allergies, this strategy fell out of favor,” says Petts.
In 2008, recommendations for avoiding highly allergenic foods were withdrawn. In 2017, the guidelines were updated to specifically address peanut allergies.
Withholding foods from your baby may increase their risk for food allergies.
The landmark Learning Early About Peanut Allergy (LEAP) study, published in The New England Journal of Medicine in 2015, concluded that withholding peanuts from your baby’s diet doesn’t help prevent a peanut allergy. Instead, it has the opposite effect — increasing the likelihood they develop one.
The LEAP study showed that introducing your baby to foods that contain peanuts is safe, even if they already have eczema or an egg allergy, which puts them at high risk for developing a peanut allergy. The introduction of peanuts led to an 81 percent reduction in the development of peanut allergies for the children studied.
“The difference between the two groups in the study was staggering,” says Dr. Petts. “Among the kids who avoided peanuts completely, 17 percent developed peanut allergies. But just 3 percent of the kids who regularly consumed peanuts developed the allergy.”
These results suggest that withholding peanuts may have actually contributed to the rise in peanut and other food allergies in the first place.
Introducing your baby to allergenic foods can help prevent allergic reactions.
Your child can be allergic to any food. But peanuts are the most common culprit. Together with these other common allergens, they make up 90 percent of food allergies in kids:
- Milk – Young children commonly have an actual milk allergy that produces reactions, not merely troubles with digestion as in lactose intolerance.
- Eggs – About 2 percent of children have an egg allergy. Most outgrow it by the time they’re old enough to drive.
- Soy – Soybeans are commonly used in all kinds of products, including baby formula. Children often grow out of a soy allergy by the age of three — 10 at the latest.
- Wheat – A wheat or gluten allergy can happen at any age, but most kids outgrow theirs before they hit their teens.
- Tree nuts – Peanuts are actually legumes, but other nuts, such as walnuts, pistachios, cashews and almonds, come from trees. If you’re allergic to one, you have a higher chance of being allergic to the others.
- Fish – Salmon, tuna and halibut are the most common finned allergens. A fish allergy typically lasts a lifetime.
- Shellfish – Lobsters, shrimp, crabs and other shellfish are biologically different than other fish. Being allergic to one doesn’t mean you’re allergic to the other.
“The LEAP study supports the theory that the human body is designed to develop tolerance to new antigens for only a set period of time, which may be the first year of life. After that, the body may develop an unfavorable immune response, or allergy, to those foods,” says Dr. Petts.
“Introducing allergenic foods — and all foods in general — should occur before the age of one year,” she advises. “And it's important to continually keep those foods in the diet. Based on the LEAP study, giving your child these foods several times a week is probably the best thing you can do to help prevent them from developing a food allergy mediated by the antibodies produced by the immune system.”
Knowing the symptoms of a food allergy can save your baby’s life.
Introduce allergenic foods into your baby’s diet slowly — one at a time in one or two week intervals. Taking a gradual approach helps you recognize any reactions to each food. Be on the lookout for these common signs of food allergies as you feed your baby new things:
- Hives, welts, eczema or rash – If your baby’s skin becomes flush or they start itching, that’s a sign too.
- Swelling – Watch the lips, face and tongue to see if they get bigger or start looking puffy. If your child suddenly has difficulty swallowing, their throat could be swollen.
- Breathing troubles – If your baby doesn’t already have a cold, keep an eye out for wheezing, coughing, nasal congestion and other breathing difficulties. Listen for a hoarseness or a change in their cry.
- Digestive issues – They may throw up, get diarrhea or cry out because of stomach pain.
- Dizziness, lightheadedness or fainting – Monitor your baby’s activity to see if they look weak or pass out when it’s not naptime.
These symptoms can range from mild to severe and can appear in just a couple minutes or up to two hours. If you notice any signs of an allergic reaction, take appropriate action.
“If the reaction is minor, such as minimal hives, you can give your child an appropriate dose of Benadryl,” says Dr. Petts. “But if your child has a severe reaction, it could be a medical emergency.”
What to Do If Your Baby Shows Signs of Anaphylaxis
Anaphylaxis is a severe, life-threatening allergic reaction. It can happen just seconds after exposure to an allergenic food or up to an hour later. Anaphylaxis causes your baby’s immune system to flood their body with chemicals. That can send them into anaphylactic shock, where their blood pressure drops suddenly and their airways narrow, making it hard to breathe.
“If your child has extensive hives, diarrhea in conjunction with hives or wheezing, or any combination of hives, swelling of the lips or tongue, throat closure, wheezing, vomiting, abdominal pain, or loss of consciousness, it is a life-threatening emergency,” Dr. Petts says. “Call 9-1-1; your child needs an injection of epinephrine immediately.”
Even if the symptoms subside, it’s critical that you get medical help. Approximately one-third of people have a second anaphylactic reaction hours later. And you will need to be prepared with an emergency care plan and EpiPen in case it happens again.
If you think your baby might have already experienced anaphylaxis or a milder reaction to food, a skin test will help you know for certain if they have an allergy. By scheduling a skin test with an allergist, you can identify which food your child is allergic to, learn how to develop a diet free of their allergens and create an emergency response plan to prevent a fatal allergic reaction.
JenniferPetts , DO, FAAAAI
Jennifer Petts, DO joined The Iowa Clinic to be a part of an organization where she would be proud to work with other physicians that help provide the best care for her patients. A West Des Moines native, Dr. Petts completed her medical degree at Kansas City University of Medicine, and later did her residency and fellowship at The University of Iowa.
Dr. Petts chose allergy and immunology because of its constant evolving and changing nature and being able to improve her patients’ lives through the different treatment measures available. It is also close to her heart because of her sons’ asthma and peanut allergy.
Outside of work, Dr. Petts enjoys visiting multiple outdoor locations, where she can be found climbing, hiking, and canoeing with her family. She also has a pet slug, Tiger, who they found on one of their climbing trips. Dr. Petts volunteers her time with USA Climbing — Youth Series, where she organizes and runs climbing competitions for youth climbers from multiple states. If Dr. Petts was not a physician, she would have been a climbing or rafting guide.