Introducing Allergens: The Right Time for Peanuts and Eggs

When starting solids, many moms ask the same question: Isn't it risky to give peanuts or eggs, shouldn't I wait a little longer? Today the advice has changed. This guide is based on recommendations from the US National Institute of Allergy and Infectious Diseases (NIAID), the American Academy of Pediatrics (AAP) and the UK's National Health Service (NHS).

Why not delay? According to the AAP, new research has shown there is no benefit to delaying allergenic foods. In a large study in 2015, introducing peanuts early and giving them regularly prevented peanut allergy in high-risk babies, and a follow-up study showed this protection lasted. The NHS also notes that delaying peanuts and hen's eggs until after 6-12 months may increase the risk of allergy to these foods.

When to start? The NHS and the AAP recommend only breast milk or infant formula for about the first 6 months. According to the NHS, foods that can cause allergies, such as eggs, peanuts, cow's milk, wheat, sesame and fish, can also be added to your baby's diet from around 6 months, like other foods. NIAID recommends giving other solid foods before peanuts, so you can see that your baby is ready for solids.

Your baby's risk level matters: NIAID's 2017 guidelines divide babies into three groups:

• Babies with severe eczema, egg allergy or both: Peanuts can be introduced as early as 4-6 months, but NIAID recommends strongly considering allergy testing first. So talk to your doctor before you start.
• Babies with mild to moderate eczema: Peanuts can be introduced at home at around 6 months.
• Babies with no eczema or food allergy: Age-appropriate peanut-containing foods can be given freely along with other solid foods.

The NHS also says to talk to your family doctor first if your baby has a diagnosed food allergy or eczema, or if there is a family history of food allergy, eczema, asthma or hay fever.

How to introduce them? The NHS recommends introducing allergenic foods one at a time, so that if there is a reaction you can tell which food caused it. The AAP also recommends waiting at least one day after each new food before moving on to another new one. Start with small tastes, and if there is no reaction, slowly increase the amount.

• Peanuts: The AAP suggests thinning a small amount of peanut butter and mixing it into baby cereal, fruit puree or yogurt, or dissolving it in breast milk or formula and giving it with a spoon. The NHS says peanut butter should not be given on its own but spread on a food such as bread.
• Eggs: The AAP recommends well-cooked eggs. The NHS says eggs without the UK-specific safety stamp should be cooked until the white and yolk are solid, so if you live outside the UK, always cook eggs thoroughly.

Keep going after you introduce them: According to the NHS, once your baby has eaten an allergenic food without any problems, it should become part of their usual diet to minimize the risk of allergy. The AAP also recommends that these foods be included in your baby's diet regularly.

Never whole peanuts: The AAP stresses that whole peanuts and nuts are a choking hazard for babies and young children. Whole nuts can block the airway, and if they get into the lungs, they can cause a severe chemical pneumonia. The NHS and NIAID recommend not giving whole nuts to children under 5. The AAP says to avoid whole peanuts until a child can chew well, usually at least age 4. The safest choice is to wait until age 5. According to the NHS, nuts can be added to food crushed or ground into a powder.

Signs of an allergic reaction: According to the NHS, reactions usually start within a few minutes of a new food, but symptoms can take up to 2 hours to appear. With some allergies, such as cow's milk allergy, this can stretch to as long as 3 days. Watch for:

• Swelling of the lips or face
• Red, itchy, watery eyes
• A red, itchy rash or eczema getting worse
• Wheezing and coughing
• Vomiting, tummy pain, diarrhea or constipation
• Sneezing, a runny or stuffy nose

The NHS notes that most allergic reactions are mild. But according to NIAID, lip swelling, vomiting and hives spreading across the body can be signs of a more serious reaction. Also check the emergency signs below. The AAP recommends stopping a new food and talking to your pediatrician if your baby has diarrhea, a rash or vomiting after eating it.

When to see a doctor, when to call your local emergency number? Contact your pediatrician or family doctor:

• Before introducing peanuts, if your baby has severe or persistent eczema or an egg allergy
• If there is a family history of food allergy, eczema, asthma or hay fever
• If a few bumps around the mouth, a rash, vomiting or diarrhea appeared after a new food and none of the emergency signs below are present
• If you are thinking of cutting out a food completely: the NHS reminds parents that removing a basic food such as milk on your own can leave your child without the nutrients they need.

Anaphylaxis is a severe reaction that starts quickly and needs emergency treatment. Call your local emergency number right away if you see any of these signs listed by NIAID and the NHS:

• Trouble breathing, wheezing or repeated coughing
• Sudden swelling of the lips, tongue, throat or face
• Trouble swallowing or a hoarse voice
• Hives spreading across the body
• Pale or bluish skin
• Your baby suddenly becoming weak, floppy or not responding as usual

If your doctor has prescribed an adrenaline auto-injector, the NHS says to use it first and then call an ambulance.

During pregnancy and breastfeeding: According to the NHS, if you are not allergic yourself, there is no need to avoid foods that can cause allergies, including peanuts, while pregnant or breastfeeding.

Dear mom, it is completely natural for your heart to race as you hold out that first spoonful of peanut butter. Start on a calm day, at a time when you can keep an eye on your baby. Small, steady steps open up a varied and safe table for them.