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How to Introduce Food Allergens

Instruction for the 4-6 Month Wellness Check

Below are instructions for home feeding provided by your doctor. Please discuss any questions you may have with your doctor before starting.

Key points

  • Getting allergenic foods into the diet between 4-6 months of age is an important way to prevent food allergies.
  • Only introduce one new allergenic food at a time and keep an eye on your baby for the first 2 hours after eating to monitor for reactions.
  • It is most important to introduce peanut and eggs early.
  • Always stop feeding a food that is causing reactions and seek emergency care for any reaction that seems severe.
  • Keep your pediatrician in the loop if you are struggling with food introductions or have further questions.

Introduce a new food allergen on a day that...

  • Your infant is well with no sick symptoms (no vomiting/diarrhea, fever, etc.).
  • Your infant has no rashes, no hives, stable/controlled eczema.
  • You can feed at your home (not at daycare or restaurant).
  • At least 1 adult can focus all of their attention on the infant for at least 2 hours after ingestion for signs/symptoms of allergic reaction.

Introducing food allergens

Once you receive approval from your pediatrician to start solids, it is very important to introduce high risk food allergens by mouth (not by rubbing on the skin) as soon as possible to try to prevent food allergies.

Feeding

  • Prepare 1 serving of one food allergen at a time (not multiple allergens at once). Start by feeding 1 pea sized amount, then watch 10-15 minutes, if no reaction, introduce larger serving then observe for 2 hours.
  • Try to spoon the food directly into the mouth to avoid contact reactions to food (as this helps minimize rubbing or prolonged contact of the food on their skin/face). For infants who are rash prone, apply Vaseline to the skin and try to complete the feeding within a few bites.
  • Separate each new food introduction by 48 hours (introduce the same food daily x 2 days), then keep in diet 2-3 times per week. It is very important to keep the food in the diet, if it is removed from the diet, they may develop a food allergy.
  • You can introduce a new food allergen on the third day (after 2 days of last allergen).
  • If your child has eczema – sometimes it may flare with these foods. Manage with moisturization and topical steroids as per your eczema plan. We recommend against food elimination as this may lead to a lifelong food allergy. If eczema worsens significantly, see an allergist to discuss and create an eczema and feeding plan.

Signs/symptoms of allergic reaction to monitor for:

  • With any reaction – stop feeding the food, and contact your pediatrician
  • Mild symptoms
    • A few hives around the mouth or face
    • If present - administer Zyrtec (cetirizine) 2.5ml, then observe. If any further symptoms develop, go to ER
  • More severe symptoms (can occur alone or in combination)
  • If present – go to ER or call 911
    • Sudden intense fussiness -or- intense fatigue (uncharacteristic behavior for baby)
    • Lip swelling
    • Face/tongue swelling
    • Difficulty breathing
    • Wheeze, repetitive coughing
    • Vomiting
    • Pale skin tone

Order of introduction (#1-3 ideally should be introduced age 4-6 months)

Disclaimer: In general, we recommend that you feed your child according to the family' dietary preferences. If there are foods below that your family does not eat, you do not have to introduce them into your child's diet. Keep in mind that this approach does not guarantee the prevention of food allergies. Also, many children go years without trying some of these foods and never develop a food allergy. In addition, some foods like nuts and seafood can be tolerated for years before a food allergy develops in adulthood.

  1. Peanut
    • Option 1 (preferred): 2 teaspoons smooth peanut butter mixed with 1-2 tablespoons of previously tolerated cereal or puree. Stir ;until blended.
    • Option 2: 2 teaspoons smooth peanut butter mixed with 2-3 teaspoons hot water. Stir until blended, then let cool.
    • Option 3: 21 pieces of peanut bamba softened with 4-6 teaspoons of water.

    Once the child is older, could advance to 21 sticks of crushed bamba for variety as the ideal goal is 2g three times a week until age 5 years.

  2. Stovetop egg
    • Option 1: Hard boil 1 egg, smash with fork and mix with formula/breast milk.
    • Option 2: Scramble 1 egg, make sure it is very cooked with no clear egg white (the more clear egg white, the more allergenic it is)
  3. Mixed tree nut (ideally to include cashew and walnut)
    • Option 1: 2 teaspoons mixed tree nut butter mixed with 1-2 tablespoons of previously tolerated cereal or puree. Stir until blended.
    • Option 2: 2 teaspoons of mixed tree nut butter mixed with 2-3 ;teaspoons hot water. Stir until blended and let cool.
    • Option 3: If individual tree nut introduction desired, we recommend starting with cashew and then walnut. You can use 1-2 teaspoons of cashew butter or 1 pulverized cashew mixed with a few bites of previously tolerated puree or cereal. If this goes well, in a few days, try 1-2 teaspoons of walnut butter or 1 pulverized walnut half mixed with a few bites of previously tolerated puree or cereal.

    Other allergens to consider after: cow's milk (yogurt) wheat (wheat cereal), sesame (hummus)

If your infant develops symptoms concerning for an allergic reaction to any of these foods, keep the prior foods they tolerated in the diet, avoid the food they reacted to, and stop further foodallergen introduction. Call your pediatrician for further guidance.