The American Academy of Pediatrics (AAP) now says to introduce your infant early and often to allergens.
The reason for the change was mounting evidence over the years suggested that delaying introduction of allergens was not preventive.
- The New AAP Guidelines for Introducing Your Baby to Food Allergens – Meghan Moravcik Walbert – March 4th, 2019
- Dietary interventions to prevent atopic disease: Updated recommendations – Scott H. Sicherer, M.D., FAAP and Frank R. Greer, M.D., FAAP – March 18, 2019
- 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 – Frank R. Greer, Scott H. Sicherer, A. Wesley Burks, COMMITTEE ON NUTRITION, SECTION ON ALLERGY AND IMMUNOLOGY – April 2019, Volume 143 / Issue 4
Comments from “The New AAP Guidelines for Introducing Your Baby to Food Allergens”
I am glad that the AAP guidelines have been updated. In truth the guidelines of delayed introduction never made sense and had poor evidence. The goal is early introduction of foods in AT RISK kids but there probably is no harm to introduce them in not at risk kids as well as long as they are developmentally ready.
It’s important to note that ALL of these early introduction recommendations are an extrapolation from the LEAP study that found early introduction of peanut was protective against development of peanut allergy. The hypothesis is that the gut is the appropriate method of exposure to allergens. Patients with eczema have skin barrier dysfunction and are being exposed through their skin which skews their immune system towards generating allergy.
Kids who are at HIGH risk for peanut allergy must be first tested by their pediatrician (by IgE) or by an allergist (skin testing)—and are probably best served seeing an allergist. The testing has poor positive predicitive value meaning a very high false positive rates. Ordering this testing without risk factors can be problematic. I spend a lot of time UNdoing what general pediatricians who sent sent large panels of testing to foods the kid is eating with no issues.
If you are planning to do home introduction to higfh risk foods (eggs, peanut, tree nuts), then their are some additional recommendations:
- Do it in the morning on a day in the week when you can watch your kid the whole day. Also, don’t do it on a day when the roads are bad in case you need to call.
- Have Benadryl on hand and know the dose ahead of time.
- Always start with VERY small amounts first (taste on the lips) and then every 10-15mins give gradually larger dose (“the grandma challenge”). After 3-4 doses then stop for the rest of the day.
- If develops a rash then go see an allergist. In general, if the rash was just a flat red or flushing on the face, or only at the place where the food was smeared, it probably is not an allergy, but obviously, talk with your doctor about it. If there are hives (most likely first symptoms) then probably is allergy. If the rash bothers the parent more than the child, probably NOT an allergy (but again, talk your doctor).
P.S. I’m a pediatric allergist but am not responsible if your child has a reaction. Just trying to add to the above column.