What’s New in Preventing Childhood Food Allergies?

Prevention of food allergies is key because no cure is available once food allergies develop. The only way to safely avoid symptoms is to avoid the food that triggers a reaction.

Changes in Clinical Guidelines

In 2000, the AAP recommended delaying the introduction of highly allergenic foods to children at high risk for developing food allergies, but in 2008 it issued a clinical report stating there was insufficient evidence to justify delaying the timing of complementary foods beyond the ages of 4 to 6 months.

In 2019, the AAP issued a replacement clinical report that noted no evidence that delaying the introduction of highly allergenic foods such as peanuts, eggs and fish prevents atopic disease. The report, in fact, cites evidence that early introduction of peanuts may prevent peanut allergy and that timely introduction of eggs can reduce the incidence of egg allergy.

A food allergy can happen at any age but occurs most often in infants and children younger than 6 years.
(American Academy of Pediatrics [AAP], 2021)

Eve 6 months

Cora has brought her daughter, Eve, to your clinic for her 6-month Texas Health Steps preventive medical checkup. Eve meets the expected growth and developmental milestones, but Cora expresses concern that Eve is a picky eater. She spits out certain foods and seems to gag on others. Cora has heard a lot about food allergies and is worried her daughter has them.

The following questions may help the healthcare provider educate parents and caregivers about food allergies and determine whether treatment is necessary.

“How long has Eve been eating solid foods?”

It may be too soon for Eve to eat solid foods. Her readiness depends on multiple developmental factors such as sitting upright and opening her mouth when offered food.

“Which foods does Eve spit out?”

Eve may not be used to different food textures. Infants need multiple exposures to become familiar with food textures.

“Does Eve have allergic reactions to foods she eats?”

That includes the incidence within minutes and up to two hours after eating of hives and vomiting in infants and shortness of breath, coughing and wheezing in older children.
If Eve has not had reactions indicative of atopic disease, suggest that Cora give her small amounts of age-appropriate foods that contain peanuts, such as peanut butter, and small amounts of egg.
If Eve has had reactions that may indicate atopic disease, consider referring her to a specialist who is enrolled in Medicaid for further evaluation and possible allergy testing.

Introducing Peanuts
“Peanuts cause severe, sometimes fatal, allergic reactions in an estimated 1.1 percent of the global population” (University of Notre Dame, 2023). The most common therapy for a peanut allergy is strict dietary avoidance, but the risk of accidental exposure is high, and no therapy can prevent allergic events (Ibid.).
- Introduce solid non-peanut foods at ages 4 to 6 months, followed by introduction of age-appropriate foods that contain peanuts.
- For infants with severe eczema, egg allergy or both, consider peanut-specific allergy tests before introducing foods that contain peanuts.
Introducing Eggs

Introducing eggs between ages 4 and 6 months does not increase the risk of allergy or egg sensitivity. Infants may benefit from eating eggs, which are nutrient rich, and introducing eggs early may positively affect growth, brain function and development (AAP, 2019).

Why It Matters

Recommendations for introducing highly allergenic foods have changed significantly in the past 20 years. Although food allergies cannot be cured, they may be prevented by following current recommendations for introducing highly allergenic foods into an infant’s diet based on risk and individual circumstances.

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References

American Academy of Pediatrics. (2021). Patient Education: Food Allergies and Your Child.

American Academy of Pediatrics. (2019). Clinical Report: The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods. Pediatrics, 143 (4): e20190281.

American Academy of Pediatrics. (2008). Clinical Report: Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics, 121(1):183-91. (Abstract).

University of Notre Dame, College of Engineering. (2023). Researchers successfully prevent peanut allergic reactions in mice, blocking onset in its tracks.