Pediatric Allergies Explained

Make The Leap!

How To Introduce Foods To Your Infant From An Allergist’s Desk.

Contributed by Dr. Manisha Relan, MD FAAP FAAAAI FACAAI

Dr. Manisha Relan is a pediatric allergist and clinical immunologist at a private practice in central New York, where she sees both children and adults for asthma, allergic rhinitis/conjunctivitis, eczema, food allergy, bee allergy, medication allergy, hives, angioedema, and clinical immunology. She earned a Bachelors in Nutrition and Food Sciences with Honors from Wayne State University where she also went to medical school. She trained in Pediatrics at the University of Rochester in Rochester, NY followed by a year as a NICU hospitalist, and then Allergy/Immunology fellowship at SUNY Buffalo. She loves learning and teaching. She is in charge of the anaphylaxis training at her practice and passionate about women’s health, food allergies, rhinitis, and immunotherapy. She maintains a personal professional Instagram account @pedsallergymd where you can follow and reach out to her with questions. 

In today’s modern world, peanut allergy (and food allergy in general) is on the rise. It is unclear exactly why this is the case. From 1997 to 2008 the rate of peanut allergy tripled. Chances of naturally outgrowing a peanut allergy is presently 20% by late teens.

A landmark year in the field of Allergy and Immunology was 2015. Dr. Gideon Lack and others published their Learning Early About Peanut allergy (LEAP) trial which revolutionized how and when to introduce allergenic foods into an infant’s diet. They evaluated more than 600 infants 4 to 11 months of age and showed those most at high risk of a peanut allergy were unlikely to develop one if they started peanut in their diet early in infancy versus waiting 5 years. A follow-up study published in 2016 proved the preventative effects lasted even after peanuts were not regularly eaten in the diet for a year (between year 5 to year 6).

It is not uncommon to be anxious about how to feed your child. The rules seem to be constantly changing. Before 2015, it was advised to wait until 12 months for dairy, 2 years for egg, and 3+ years for peanuts. Everyone around you will have an opinion; some offer their thoughts without being asked. But, what are the actual facts?

Based on the current data available, start introducing solid foods between 4 to 6 months of age, when your infant demonstrates they are interested in trying food and capable of doing so (ie, able to hold their head upright, loss of tongue thrust). If you are unsure, ask your child’s doctor about other cues.

After your infant has tried 2-3 foods and tolerated them well, consider peanut introduction. The food product should not pose a choking risk. Examples of safe forms of peanut include: peanut-flavored puffs; smooth peanut butter thinned with water; smooth peanut butter, peanut flour, or peanut powder mixed with pureed fruits/veggies.

Start with a small amount when your child is healthy (no fevers, sicknesses) and consider avoiding nap time or late evenings. Be able to monitor your infant for a reaction. If doing well, increase the quantity to get at least 2 teaspoons. Next, make sure peanut is a regular part of their diet. This means offering it 3 times a week. Go slow and introduce one new allergenic food at a time.

Personally, I recommend tree nuts (especially almond, cashew, walnut), wheat, eggs, dairy, and seafood, depending on the family’s preference. Some families are vegan whereas others may have a different food allergy or intolerance in a sibling/parent.

The exception to the above, and when it may be necessary to consider seeing a pediatric allergist first, is if your infant has moderate to severe eczema or if they already have a food allergy (typically egg). In these cases, your allergist is likely to recommend skin testing first. Skin prick testing is like a scratch of the top layer of skin, typically with a plastic tip. Results are available in 15 minutes and more sensitive than blood testing. Guidance is provided thereafter. If you still have questions, please reach out to your doctor!