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Ask the Expert: Babies & Food Allergies

It’s normal for new parents to be nervous about introducing allergens for the first time. Not to mention, it’s hard to digest all the information out there about what (and what not) to do. As a dual-certified pediatric and family nurse practitioner who specializes in food allergy treatments, I wanted to share the most common questions I hear from moms and dads. Here’s everything you should know before cracking open a bag of peanut butter puffs.

By Whitney Morgan Block, MSN, CPNP, FNP-BC

Is there a way to prevent food allergies in my baby? 

Although there is no foolproof way to prevent food allergies, the Learn Early About Peanut Allergy (LEAP) study published in 2015 concluded that for babies at high risk for peanut allergy, eating peanut foods early and regularly reduced the risk of peanut allergy by more than 80%. This guidance has been generalized to all foods. According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), the best way to prevent food allergies is to introduce babies to more foods early on rather than to delay introducing foods. In summary, the guidance is to introduce babies to as many foods as possible (except honey due to the risk of botulism or anything that could be a choking hazard) between 4 and 6 months old. 

Why didn’t my pediatrician advise me to introduce foods early to my baby? 

The new guidelines are fairly recent. In one survey, pediatricians were presented a 6-month-old infant at low risk for peanut allergy (mild-to-moderate eczema) and then were asked what to do next. Only 54% of pediatricians chose the correct answer, which is to recommend the introduction of peanut-containing food. The guidelines for introducing foods, especially potentially allergenic foods like peanuts, tree nuts, egg, wheat, soy, and sesame, were updated in 2015 when the LEAP study was published. 

What is the LEAP study? 

The LEAP study was a randomized controlled study of 1,000 babies that proved feeding babies peanut-containing food early and often could reduce the risk of peanut allergy by up to 80%. The LEAP study had such definitive results and powerful conclusions that the American Academy of Pediatrics updated its food allergy recommendations to start feeding infants peanut-containing foods as early as 4 months old regardless of eczema status or history of other food allergies. 

Does it matter if I breastfeed? Will that help prevent food allergies or eczema in my baby? 

Fed is best. Regardless if your infant gets breastmilk, formula or a combination of both, scientific experts agree that having your baby growing and thriving is what matters most. Numerous studies have shown that breastfeeding (no matter how long) does not affect the prevalence of atopic dermatitis (eczema). Breastfeeding mothers should not avoid any foods in their diet unless they themselves are allergic. 

If my child has/develops a food allergy, will they outgrow it? 

Maybe. Milk and egg allergies are two of the food allergies that are most commonly outgrown. Among egg-allergic children, about 53% will outgrow their egg allergy by age 10 and 82% by age 16. About 80% of kids will outgrow a milk allergy by their 5th birthday. Only about 20% of children will outgrow their peanut allergy, most of whom do so by age 8. Shellfish allergy is one of the least likely allergies to be outgrown, with only 4–5% doing so. 

I have one child with a food allergy and am currently pregnant. What are the chances of my new baby having/developing a food allergy? 

If you have a kid with a food allergy, the chances of having another are about 14%. 

If my child does develop a food allergy, is there anything to do about it besides avoid that food? 

If your child develops a food allergy, avoidance is not always the only option. There is a new therapy called oral immunotherapy (OIT) that is done with a trusted allergy specialist. OIT teaches the body not to react when the allergenic food is eaten. Recent data on peanut OIT suggests that the earlier your child starts this therapy (as young as 12 months old) and the lower their level of peanut-specific antibodies, the greater the child’s likelihood of being able to eat about 20 peanuts or about 1.5 tablespoons of peanut butter without having an allergic reaction 6 months after completing OIT. 

What are the signs and symptoms that my child is having an allergic reaction? 

What should I do if my child has an allergic reaction with mild symptoms? 

If your child has an allergic reaction with mild symptoms, follow your food allergy action plan. A food allergy action plan that’s signed and approved by your physician outlines the recommended treatment in case of a flare-up. If you do not have an action plan, then give an antihistamine, like Cetirizine, and follow up with a trusted medical provider. 

What should I do if my child has an allergic reaction with severe symptoms? 

Like a mild reaction, the first thing to do is follow your food allergy action plan. However, if you do not have an action plan, then call 911 or safely get your child on the way to an emergency room or urgent care. If you have an appropriate epinephrine auto-injector, use it immediately. 

Whitney Morgan Block has dual board certifications as a pediatric and family nurse practitioner. Before joining Allergy and Asthma Specialists of Central Florida, Whitney founded and practiced at the National Allergy Center, which specializes in food allergy treatment. Prior to that, she was the lead nurse practitioner at Stanford University’s Sean N. Parker Center for Asthma and Allergy Research, where multi-allergen food desensitization was pioneered. 

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