Early Allergen Introduction: Tips From an Allergist-Mom

Note from Katie: One in thirteen children in the U.S. suffers from a food allergy. That’s about 2 in every classroom, and rates are rising. I don’t have a lot of firsthand experience with food allergies, so I asked Dr. Katie Marks-Cogan, a board-certified allergist who is also a mom, to weigh in on this important topic. The latest science is evolving at a fast pace and I’m grateful to her for authoring this post on how we as parents can act on the latest food allergy research. While I never thought I’d be recommending a supplement like this for babies, the enormity of the problem and the solid research behind Ready, Set, Food! have thoroughly convinced me. Over to Dr. Katie…

It’s an exciting time to be an allergist because we have a lot of new information about the immune system that has changed the way that we in the medical community think about how to decrease the rate of food allergy development. Specifically, the research shows that rather than delaying introduction of the top allergenic foods (dairy, egg, and peanuts), we should instead introduce these foods early and often to decrease the risk of future food allergy.

I know this finding may surprise many parents who have received the opposite advice. I also know from my experience with my own son how frustrating and time-consuming early and sustained allergen introduction can be.

My hope is that these tips give parents confidence and make it easier for busy families and picky eaters to act on the latest food allergy research.

Why I Now Recommend Early Allergen Introduction

Recent landmark clinical studies have changed the way we think about food allergies in children. Findings from the studies show that feeding babies allergenic foods early and often, starting at 4-11 months of age, can help reduce their risk for developing food allergies by up to 80%.

As a result, the American Academy of Pediatrics (AAP), the National Institutes of Health (NIH), and the American Academy of Allergy, Asthma, and Immunology (AAAAI) have published new guidelines supporting allergen introduction at this early age, which is a paradigm shift from the previous clinical guidelines that recommended allergen avoidance until ages 1-3 years old. In fact, studies show that delaying allergen introduction can actually increase your child’s risk for developing a food allergy.

Introducing allergenic foods to your 4-11 month old can be challenging. As parents, we know that many infants are picky eaters. It can be difficult for us to get our babies to eat enough of any food (let alone enough of each allergenic food). In addition, it can be anxiety-provoking as a parent.

I’ve experienced this firsthand with my son. When he was 5 months old, I spent Sunday nights preparing egg, peanut, and yogurt snacks for him to eat each week. (About 80% of all childhood food allergies consist of milk, peanut, and egg allergy.) However, much of these snacks ended up on his face or on the kitchen floor, and everywhere except in his mouth!

Reducing Food Allergy Risk: What Parents Need to Know

This frustrating experience inspired me to help other parents through the challenges of early and sustained allergen introduction by compiling a brief guide.

1. Consult Your Pediatrician

Discuss the new guidelines at your child’s next well visit, especially if your child has severe eczema. It is currently recommended that parents of infants with severe eczema consult with their pediatrician before feeding their baby allergenic foods, in case baby needs allergy screening first.

2. Choose the Right Time for Your Baby

Choose a time that’s best for baby to introduce allergens.

Pick a time when your baby is healthy and does not have a viral or other illness.
Also, make sure an adult can monitor your baby for two or more hours, in case of a reaction.
Only introduce your baby to one allergenic food at a time. That way, if baby reacts, it’s easier to narrow down the source of a reaction.
Start with a small amount of each allergen, and then slowly increase the amount over time.
After you know that your baby’s immune system tolerates certain foods, you can feed them multiple allergenic foods at once.

3. Start Early, Between 4-11 Months

Scientists believe that infants have a window of opportunity for reducing their risk of developing food allergies in their first year of life, starting at around 4 months of age. During this window, a baby’s immune system develops either positive or negative responses to foods. And consistently feeding babies allergenic foods during this window can promote a positive immune response and reduce the likelihood of a high-risk allergic reaction in the future.

I used a Play-Doh analogy in my Wellness Mama podcast to make the “window” concept easier to understand. I’ll share it again here.

When you’ve got fresh, new Play-Doh, it’s soft and easy to work with. You can mold it into a zoo animal, or whatever you want. If you leave the Play-Doh out of its can, and find it, maybe three days later, it will feel a bit harder. You can try to mold it, but it won’t be easy.

A child’s immune system works almost the same way. Scientists believe that we have the ability to influence a 4-11 month old’s “new” immune system responses to help it become tolerant to an allergenic food. Consistent oral food introduction helps an infant’s immune system build up the needed tolerance. But, like the three-day-old Play-Doh, it becomes more difficult to influence the child’s immune system towards tolerance as they get older.

4. Continue for Several Months

A baby’s immune system needs sustained early introduction to foods in order to develop a positive response to them. Feeding your baby allergen-containing foods like scrambled eggs, peanut butter, or yogurt only once or twice isn’t enough to reduce their risk of developing a food allergy. In the landmark studies, infants consumed allergenic foods 2-7 times a week for 3-6+ months. In fact, the LEAP study consistently introduced infants to allergens for 4 years. So, make sure to feed your baby common allergens multiple times a week, for several months.

5. Breastfeeding Alone Is Not Enough

Breastfeeding provides a wealth of benefits for both you and your child. Breast milk contains the ideal amount of proteins, fats, and vitamins for your baby’s nutritional needs. Plus, the antibodies in breast milk may help baby fight off viruses and bacteria.

If you choose to breastfeed, you’ll pass food proteins to your baby through your breast milk (the amount varies from mom to mom). This means that if you consume allergenic foods during this time, your baby will get some early exposure to allergens.

However, we don’t have enough conclusive evidence to prove that breastfeeding alone can help lower your child’s risk of developing a food allergy. It is currently recommended that breastfeeding mothers should not specifically avoid allergenic foods with hopes that it will protect against food allergy.

New Options for Parents Concerned About Food Allergy

Is it possible for parents to follow the new guidelines on their own? In a word, yes, but it can be difficult. For one, there’s the concern that many infants are not developmentally ready for solid foods at 4-6 months. In addition, they are often picky eaters (as I saw firsthand with my son).

As seen in one of the recent studies, more than 50% of parents weren’t able to stick with the early allergen introduction protocol (so, they didn’t necessarily see a decrease in food allergy). This underlines just how challenging early and sustained allergen introduction can be.

Fortunately, there are new resources available for parents to help with early and sustained allergen introduction. Families with a history of food allergy especially may want to ensure proper early allergen introduction by using a targeted supplement for this purpose.

I believe that the best product should:

Follow the precise dosing used in landmark food allergy studies. Following these guidelines helps make sure baby consumes the right amounts of allergens at age-appropriate times.
Dissolve into breastmilk, formula, or baby food, making it easy to start at 4-11 months, even if your baby is not developmentally ready for solid food.

Slowly increase the allergen amount over time, and introduce one new food at a time, for maximum safety based on study recommendations and pediatric guidelines.

Contain only organic, non-GMO ingredients, with no artificial additives or added sugar.

When I realized that there wasn’t a solution available for parents that met my standards as a physician and mom, I, along with a team of leading experts, sought out to develop Ready, Set, Food!, which is an easy and all-natural solution to help parents reduce their child’s food allergy risk.

After over a year of research and development, we were able to create a gentle, pre-measured powder with minute doses of the top allergens — egg, peanut, and milk — in a system that is easy for parents to follow and implement.

My Mission: Reverse the Trend in Food Allergies

I’m excited to give parents the tools and information to help reduce the risk of food allergies and in turn, give their children a head-start towards an allergy-free future. The science is very robust and promising and my hope is that we can reverse the trends that we’ve seen over the last several decades and reduce the number of children suffering with food allergies.

This article was medically reviewed by Dr. Shani Muhammad, MD, board certified in family medicine and has been practicing for over ten years. As always, this is not personal medical advice and we recommend that you talk with your doctor or work with a doctor at SteadyMD.

Dr. Katie and I are ready to tackle your food allergy questions! Please leave a comment and let us know what you’d like us to answer next. To learn more about Ready, Set, Food!, which I really do think is a much-needed resource for parents concerned about this issue, head over to their website to check out all of the research in detail as well as an exclusive offer for Wellness Mama families.

About the Author:

Katie Marks-Cogan, M.D., is board certified in Allergy/Immunology and Internal Medicine, and treats both pediatric and adult patients. Originally from Cleveland, Ohio, she received her M.D. with honors from the University of Maryland School of Medicine. She then completed her residency in Internal Medicine at Northwestern and fellowship in Allergy/Immunology at the prestigious University of Pennsylvania and Children’s Hospital of Pennsylvania (CHOP). After finishing training, she moved to Southern California and currently works in private practice. She is Chief Allergist for Ready, Set, Food! and currently resides in Los Angeles with her husband, 3-year-old son, and 10-month-old daughter where she enjoys hiking, building LEGO castles with her kids, and cooking with her family.

About Katie Wells

Katie Wells, CTNC, MCHC, Founder of Wellness Mama and Co-founder of Wellnesse, has a background in research, journalism, and nutrition. As a mom of six, she turned to research and took health into her own hands to find answers to her health problems. WellnessMama.com is the culmination of her thousands of hours of research and all posts are medically reviewed and verified by the Wellness Mama research team. Katie is also the author of the bestselling books The Wellness Mama Cookbook and The Wellness Mama 5-Step Lifestyle Detox.

Comments

27 responses to “What Parents Need to Know About Early Allergen Introduction (From an Allergist-Mom)”

RaeAnna Schroepfer

January 18, 2021

My son is just over 6 months and has been exclusively breastfed and never had any vaccines or antibiotics (both after birth and while in utero). He has had eczema since he was a few weeks old and was extremely spitty and had green bowel movements until we finally pinpointed that he was reacting every time I ate any form of corn and its derivates. In the process of pinpointing this, I’ve been dairy, chocolate, nut, coconut, shellfish, tomato, gluten, and finally corn-free. I’m suspecting that his issues stem from my terrible gut (I grew up eating tons of grains, few veggies, and tons of sugar. I also was given antibiotics almost monthly and took Advil and other over the counter meds almost daily.) My question is do both my baby and I do some kind of gut-healing diet (like the GAPS)? If so how can a breastfeeding mom get enough calories doing that? I’m already struggling to eat enough because corn and its derivatives are in everything (Even fresh foods like bananas, citrus, or cucumbers due to the wax they spray on them or bagged carrots because of the citric acid they use to preserve them). Can you give fermented foods or raw dairy products to a 6/7-month-old? I’m feeling very overwhelmed and none of the doctors in my rural area are very helpful. Thanks

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Rachel DeBoer

November 9, 2020

Hi there,

I had a history of autoimmune disease that I completely turned around with AIP diet. This is all focused on healing my gut, and I don’t consume any of the top allergens. I’m still 100% Paleo. My son is exclusively breastfed and 6 mo old now and we are trying to decide what to do with allergen foods. I know that dairy, peanuts and eggs can be difficult to digest and contribute to leaky gut. How does introducing these foods sooner to a less mature digestive system prevent leaky gut rather than create more damage likely leading to sensitivities?
With an extensive family history of autoimmune disease, plus some asthma and eczema, what is the best option for introducing solid foods to foster a healthy digestive and immune system from the start without setting him up to have allergies?

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1. Katie Wells
  
  November 19, 2020
  
  I thought about this a lot too since there is a history of autoimmune disease in my family too. My personal thought would be to make sure inflammation is low and still introduce the foods in a safe form like this one, even if bigger amounts were not consumed later.
  
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Katie

June 21, 2019

I understand the idea of what’s being presented here, but it still doesn’t make sense that we would introduce cow’s milk so early. It’s not just that it’s a common allergen, but infant/toddler digestive systems really can’t handle cow milk so early on. My naturopathic doctor (and her whole clinic) does not recommend cow milk until the age of 5 because of this. And beyond that, neither my husband nor I drink cow milk – we just don’t think it’s necessary or adds anything to our health. So why would we consistently give it to our infant for months?

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kendra

May 8, 2019

This is only anecdotal, but I can tell you that your description of how food allergies develop (vaccines, leaky gut) doesn’t match up with my experience. My little started displaying his dairy allergy when he was still on a diet of 100% breastmilk, so surely leaky gut couldn’t have been an issue. Now, he did have a couple vaccines but nowhere near the regular schedule.
All that being said, I still haven’t figured out a cause or solution for the problem.

Good luck with your little!

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1. Tiffany
  
  May 8, 2019
  
  My daughter started breaking out in hives and horrible eczema that looked like chicken pox when she was 4-5 months old and 100% breastfed also. I didn’t know any of this until I started learning about vaccines, the immune system & the gut… but vaccines can be made in different food proteins (called excipients). This is problematic because the vaccine is designed to provoke the immune system into a response… to create antibodies to the toxin and therefore protect from future exposure. Unfortunately, antibodies can be created against different ingredients in the vaccines, causing allergies. Vaccines have also been shown to altar the gut microbiome in peer reviewed medical journals… which can lead to leaky gut. My little only had 3 shots before these symptoms reared their ugly head and I stopped. It seems that vaccines caused my daughter’s autoimmunity. I’m not saying this is what happened to your child, but it’s a possibility. I think genetic risk factors are a big piece of the puzzle as well. I hope your child is doing okay!
  
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  1. kendra
    
    May 8, 2019
    
    Wow. That is interesting. Is this information explained in the book you mentioned earlier?
    
    Reply
    1. Tiffany
      
      May 8, 2019
      
      Some of the above info is in the book Vaccines and Autoimmunity. I have been reading medical journals, books, listening to podcasts by doctors, etc. for over a year now so I have a slew of resources. Dr. Suzanne Humphries as well as Del Bigtree and Robert F. Kennedy are all great people to learn from. That would just be scratching the surface! I’m just trying to get to the bottom of why my sweet baby reacts to every single food so that I can try to help her heal.
      
      Reply
      1. kendra
        
        May 9, 2019
        
        Thank you so much for sharing. Trying to figure all this out from a zero starting point is difficult, not to mention confusing since so much out there is contradictory.
        I have to ask, have you had success with anything?
2. Trisha
  
  May 12, 2019
  
  My son had stomach issues from day one. His eczema only took a few weeks to develop, and it was so bad he couldn’t sleep and would scratch himself until he bled. He was 100% breastfed as a baby, and I had to cut all of the top 8 allergens out of MY diet because he was reacting to the proteins in my breastmilk. He was born reacting to the food- he never had one vaccine. However, contrary to your assertion, I do think it is attributable to leaky gut/dysbiosis.
  
  After years (countless hours!) of research, I think MY leaky gut was affecting him before he was even born…and then our own microbiota gets passed on to our children, so it didn’t get any better after he was born. Today he is 3 and can tolerate most of the foods he couldn’t as a baby. He is still allergic to most tree nuts and eggs (not intolerant, he actually has an EPI pen).
  
  Unfortunately, I don’t think there is one cause or one solution… I think our kids (and our own) bodies are so bombarded with pesticides, hormone-mimicking chemicals, GMOs, vaccines, etc. that it is almost impossible to pinpoint what the tipping point is for each person. Autoimmunity and the accompanying health issues are so common, they are becoming the norm 🙁
  
  Sorry this was so long… Best of luck with your son’s dairy allergy… our allergist is hopeful that many children outgrow egg and dairy allergies, so I pray that is the case for our little ones!
  
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  1. Kendra
    
    May 13, 2019
    
    Trisha, thank you so much for sharing! Yours is a very enlightening story.
    
    May I ask, what is it you did that helped? Was it cutting out the top 8 allergens and then slowly adding them in later?
    
    Reply
    1. Trisha
      
      May 13, 2019
      
      Yes, so our pediatrician had us introduce things back in at about a year old, I think. Just like you introduce foods to a baby, we did one at a time for a few days to make sure he wasn’t reacting. He could tolerate wheat, soy, peanuts, and goat’s dairy fine once we introduced those. He still had eczema flareups with regular cow’s milk dairy until about a month ago (he’s 3 and a half now). When we tried scrambled egg, he had a severe allergic reaction. So at that point, our pediatrician referred us to an allergist. We hadn’t gotten to tree nuts, which is good because he is allergic to all except almonds.
      
      Sidenote- Our opinions differ a little in our approach- for example, the allergist would rather have him eat cow’s milk and take Zyrtec and use cortisone cream daily to control the eczema, but I just kept him with the goat’s dairy and tried the cow’s milk once in a while until he could tolerate it on his own without medication. Something to be aware of when dealing with conventional doctors… take the good and leave the bad.
      
      On the whole, though, our experience with the allergist has been good. My son’s blood levels for the antibodies were low enough for egg that he was able to do a food challenge for baked egg. He JUST NOW can eat baked egg! So she is hoping he will outgrow that allergy completely one day and be able to eat scrambled/hard boiled eggs.
      
      Is your son eating solids, or still exclusively breastfed? Has he tried dairy? I’m hoping for you that he is one of the kids who outgrows that allergy! It took our son until now to tolerate dairy and eat the baked egg, so it does happen!
      
      We also give him probiotics (rotating different kinds) and eat mostly organic/whole foods, a good amount of bone broth (soups and cook all our rice with it)… basically I have tried to be more gut-healthy for our whole family so maybe that has helped his body heal/mature? There’s no way to prove or disprove that, though.
      
      Reply
      1. Kendra
        
        May 14, 2019
        
        Thank you.
        
        He was exclusively breastfed until 8 months, and I’ve continued breastfeeding still since he cannot seem to kick ear infections (he is 2 now).
        He definitely has a dairy allergy (I’ve only tried cow’s milk), which we discovered when he was a few months old. Every time I would eat dairy, he would get terrible diaper rash. Now, if he gets dairy or I eat a fair bit of it, he gets a rash on his face and lots of mucus from his nose.
        But, he also may have seasonal allergies compounding everything. I get seasonal allergies pretty badly in the area where we live now, and he has had a seemingly unending ear infection or series of ear infections since we moved here. Now, part of that is it is his first year in daycare, but it surely cannot all be due to daycare. He has tubes in his ears now and still has long lasting ear infections. His doctor’s recommendation is to put him on Zyrtec, long-term.
        Long story short, I don’t understand why he has been so sick for so long. We cut out dairy but he still gets lots of mucus. It just doesn’t seem likely to me that seasonal allergies would cause a year-around problem and I don’t like the idea of his being on allergy medication most of the year. So, it must be a dietary problem, but I have not been able to pinpoint any other culprit foods. Our diet is not perfect, but we do eat pretty healthy. Lots of fruits, vegetables, meat and very little bread or sugar.
        
        I should say also that due to the incessant ear infections, he has been on a LOT of antibiotics. I have purchased probiotics for him (not Thrive, but the other ones listed in the resources section of WellnessMama), and he will start taking those consistently this week.
Cori

May 7, 2019

I’ve never fed my babies egg whites until age one, only the yolk with the understanding that the egg white is hard to digest. I feed peanuts and dairy in easier to digest yogurt and kefir form. I occasionally feed cheese as well. What do you think about the digestibility and leaky gut connection with allergic reactions to food?
Perhaps allergies are so high because of many peoples highly processed diets, ei. Feeding rice cereal and puffs from the beginning.

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Hannah

May 6, 2019

I’m really sad to see you promoting this, as well as other items I don’t believe you would have used to have shared if you weren’t being compensated in some form. There hasn’t been substantial enough evidence and research to show this this is actually a good thing and there are many holistic practitioners who highly disagree with this.

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1. Katie Wells
  
  May 6, 2019
  
  I’m not being compensated for this article and am publishing it because I’ve read the research and feel that it’s compelling enough to go deeper, especially considering how many children are getting serious allergies even after exposure is delayed for years…
  
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  1. Alison Myburgh
    
    September 25, 2019
    
    Hi Katie. This research is discussed a lot in La Leche League groups. Doctors are telling mothers to start solids before 6 months. Truth is, like a lot of other research out there, they have mis-published the findings. What was actually found, is that allergens introduced before the cessation of breastfeeding, mean the stomach has a higher chance of learning to digest them. It’s got nothing to do with starting them earlier, and everything to do with keeping up with breastfeeding for the full 2 years. Please read more up on this. It’s worth it to share the truth.
    
    Reply
    1. Katie Wells
      
      October 4, 2019
      
      I agree with you on doctors pushing solids before six months and don’t share their opinion. That said, the science is showing that introducing allergens in this very specific way once babies start solids (at around six months) does have a measurable effect on allergen rates.
      
      Reply
Emily R

May 6, 2019

When should you introduce seafood– shrimp, crab legs, scallops?

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kendra

May 5, 2019

What would you recommend for a 2 year old with an already established dairy allergy?

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Rosemary

May 5, 2019

While I’m sure some of this information is sound, I just can’t get behind the idea of starting solids at 4 months. This goes against what lactation consultants, breastfeeding-friendly pediatricians, and even the World Health Organization recommend, that breastmilk be the only food for babies until about 6 months. Babies are rarely developmentally ready for other foods at 4-5 months. Developmentally ready for solid food means that they are able to sit on their own (how many 4-month-olds are sitting on their own??), are starting to get teeth, are able to grasp food on their own and bring it to their mouths. Spoon-feeding mush into a baby who is reclining (because they can’t sit yet) is not only unnecessary, but also dangerous, as they are at an increased risk of choking. Early introduction of common allergens may be useful, but why not say to start around 6 months instead of 4? A lot of important development happens in those two months.

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Joyce

May 5, 2019

Are there any at home allergy tests for kids? Or do I need to go see an allergist to see what allergies my kids have. I have a 3 and 5 year old.

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Caitríona

May 5, 2019

My daughter Hannah allergic to pine nuts. A very difficult one as they are everywhere, in every restaurant. She has had a few accidental exposures and had been very sick but recent exposures have been less severe – her reaction has definitely improved over the years, proving the theory that small exposure where possible, works best. We never followed the advice to avoid all buts because this just didn’t make sense to me.

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Tiffany

May 5, 2019

The root cause of food allergies is gut dysbiosis/leaky gut or other environmental factors like vaccines, is it not? Not the timing of introducing the allergens. Gut issues can arise anytime, hence why food allergies can start anytime. The issue would be protecting the baby’s immune system by feeding them whole, organic foods and decreasing the toxic load (filtered water, natural cleaning products, no/little vaccines, etc) wherever possible. For example, metals can bind to food proteins causing the immune system to attack that food (Vaccines and Autoimmunity by Shoenfeld & colleagues, ch.5). Did these studies show other environmental factors besides when allergens were introduced? This seems to be putting the wrong kind of pressure on parents, in my opinion. (I have 2 out of 4 children with food allergies… who also have genetic risk factors for gut dysbiosis and issues detoxing/methylating. One of them is pretty sick and I have been researching my little heart out on food allergies/vaccines/autoimmunity for about a year. She is 18 months and can eat 5 foods.) Thanks for all you do, I don’t mean to sound so critical! I just think this approach is a vast oversimplification of the food allergy epidemic.

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1. Stephanie
  
  June 20, 2019
  
  Exactly! The adjuvant in vaccines is designed to incite the immune system. Any food proteins contained in the vaccine or consumed around the time of vaccination have the potential to cause food allergies.
  
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Peggy

May 5, 2019

If your infant does exhibit signs of an allergic reaction during your planned exposure to these allergens, should you then stop or still continue in an effort to minimize this reaction or build immunity.
?

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Kathy

May 4, 2019

Do you have any advice for food allergies (almonds, hazelnuts and raw onions) that start later in life (13 years old)? My daughter had no food allergies.prior to this.

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