Baby allergies seem to be on the increase, so it’s natural that you might be nervous about introducing foods that could cause problems.
Here, Consultant Paediatric Allergist Dr Adam Fox answers all those important and common questions around food allergies.
1. Q: How can I protect my baby from potential food allergies?
A: Food allergies effect 5-6% of infants and are most common amongst babies who have eczema. Avoiding particular foods during pregnancy or breastfeeding does not seem to make any difference in the changes of your baby having allergies. The best thing you can do is aim to breast feed, exclusively for 4-6 months. There is emerging evidence to suggest that introducing complementary foods, especially egg and peanut from 17 weeks may be protective against developing allergies to these foods. Back to top
2. Q: Are allergies genetic?
A: The tendency to get allergies and allergic problems, such as hayfever, asthma and eczema, is known as atopy as is inherited from one or both parents. It is more common to be atopic if both, rather than one of the parents has this atopic tendency. However, specific allergies are not inherited. Back to top
3. Q: Does breastfeeding reduce the likelihood of my baby developing food allergies?
A: There are numerous reasons to breast feed and this is widely accepted as the best thing you can do for your baby. This includes reducing the risk of allergies although breast feeding does not mean that your child will definitely not get allergies. Back to top
4. Q: Does age of weaning have anything to do with the development of allergies?
A: It has become clear that the previous advice to delay the introduction of allergenic foods, such as milk, egg or peanut is not helpful. In fact, there is now excellent evidence to suggest that early introduction of egg and peanut, from 17 weeks can reduce the risk of allergy. However, if there is a high risk of allergy e.g. eczema or a strong family history, then it makes sense to get your baby allergy tested before you do this.
This was initially based on an observation that in some countries such as Israel, for example, where peanut is used in a snack called Bamba given to infants. This early weaning with peanut seemed to relate to the level of peanut allergy being very low, even among high risk children. In 2015, doctors at St Thomas’ Hospital in London were able to show that children who ate products containing peanuts between the ages of 4 and 11 months, and regularly thereafter, had a 70% reduced risk of developing an allergy to peanuts compared with children who ate them for the first time when they were older. This had led to a change in the weaning guidance in the USA. Back to top
5. Q: My husband and I have food allergies; will my baby develop the same food allergies as well?
A: No, but there is a good chance they will inherit an allergic tendency. If they don’t then it seems that it is environmental factors that will influence which allergies the baby then gets. Back to top
6. Q: I’ve been told to introduce allergenic foods one at a time? How much time should I leave between introducing each new food so that I can identify any food that causes a reaction?
If your baby is at high risk e.g. has eczema or a strong family history, then it would be sensible to get allergy testing done just before weaning to help guide safe introduction of common allergenic foods such as milk, egg and peanut. If not, then as reactions usually happen very soon after exposure, there is no need to leave long gaps between food introductions, just introduce one food at a time. It is important not to delay introduction of allergenic foods as this may increase the chance of allergy developing.
7. Q: How do I know if my baby actually has an allergy, or whether it’s just an intolerance? I don’t want to withhold foods unnecessarily.
A: There are 2 sorts of allergy- immediate allergies cause rash, swelling and hives within minutes of the food being eaten, usually around the mouth. Delayed allergies can cause your baby to have eczema, reflux, colic or diarrhoea. If you are concerned about either of these, you should consult your GP.
8. Q: What are the most common foods that cause allergic reactions?
The most common cause of immediate type of food allergy are egg, milk, nuts, fish, sesame and shellfish. Wheat, kiwi and soy are also important allergens. With delayed allergies, milk and soy are the most common causes.
9. Q: What is wheat allergy and why is this different to Coeliac Disease?
A: Wheat allergy is an allergy reaction caused by wheat. It is uncommon and usually found in children who have eczema and other food allergies. It is usually outgrown in childhood. Gluten is present in wheat and other grains like barley and rye. Coeliac disease is different to a wheat allergy as it is an auto immune disease triggered by the gluten in grains. Coeliac disease has a strong genetic component so often runs in families. Symptoms include chronic diarrhoea, tummy ache, faltering growth and smelly poo. Coeliac disease can be diagnosed by a blood test but you need to be have wheat in your diet when you have the test done so should always see your doctor before you cut it out entirely. Coeliac disease sufferers must avoid all gluten which can be hidden in food like soups, sauces, fish fingers, chicken nuggets and salad dressings.
Annabel Karmel’s recommendations on what to substitute for wheat if you child is a Coeliac or has a gluten allergy.
- You can substitute wheat free and gluten free flours for plain flour in many of my recipes. My advice however is that it is generally best to substitute where there is a low ratio of flour to other ingredients as then you are less reliant on gluten to hold the mixture together. Always grease and line cake tins well – gluten free baked products tend to be more fragile.
- Crushed cornflakes or Rice Krispies make a good coating for homemade fish fingers or chicken nuggets
- Rice flour, polenta, buckwheat flour and potato flour are all suitable for coeliacs
- Rice noodles make a good substitute to pasta
- Quinoa and rice are good to have instead of bread
10. Q: Is a certain amount of allergens needed to trigger an allergic response in my baby?
A: Immediate allergies can be caused by very small exposures to allergen although severe reactions will not happen unless the food is eaten. Contact with the skin will only cause minor reactions. With delayed reactions, where milk or soy in the diet causes chronic symptoms such as eczema, reflux or colic, will be worse, the more of the allergen is consumed.
11. Q: If my baby is allergic to one food, is he/she likely to develop other food allergies?
A: Having one food allergy does increase the risk of having further food allergies. Certain allergies commonly go together such as egg with peanut allergy, peanut allergy with allergy to tree nuts and sesame.
12. Q: Will my baby outgrow his food allergies?
Fortunately, allergies to milk, egg, soy and wheat are usually outgrown during childhood which whilst allergy to peanut, tree nuts, fish or shellfish tend to persist into adulthood.
13. Q: Is honey an allergen? Can I give it to my baby?
A: It is extremely rare to be allergic to honey but there is advice to avoid honey during infancy, because of a small risk of infantile botulism.
14. Q: My toddler has a severe peanut allergy. Is it likely that my baby daughter will also get it?
A: There is a 7% risk of peanut allergy in the sibling of a child with peanut allergy. It may be worth considering getting tested just before weaning so that if the test is negative, peanut can be introduced into the diet, to reduce the risk of allergy to it developing.
15. Q: My two year old has a peanut allergy. Should I avoid every product that says it contains traces of nuts?
A: This will depend on numerous factors and many children are advised that they can have some foods with advisory labels on, in certain circumstances. This should be discussed with your allergy specialist to ensure the advice is tailored to your individual circumstances.
16. Q: Should you avoid nuts when you are pregnant?
A: There is no need to avoid nuts during pregnancy or breastfeeding as these won’t influence the chances of your baby having a nut allergy.
17. Q: What are the links between asthma, eczema and allergies?
A: These are all atopic diseases, meaning that they are all related to allergies. Children who are atopic (the inherited tendency to get allergies) often go through the ‘allergic march’ – a progression of conditions. This usually starts with eczema in infancy, which predisposes to getting food allergies. Both these conditions often improved but give way to respiratory allergy including asthma and hayfever.
18. Q: My one year old daughter is allergic to all dairy – when can I start to re-introduce things like cow’s milk back in to her diet?
A: This depends on the type of allergy. With immediate type allergies, the allergy test will be repeated over time to see if the allergy has gone before trying it again but with delayed allergies, then often milk may be tried again from 1 year of age.
19. Q: My 11 month old son tends to get really blocked up after mealtimes.
I’m thinking of cutting out dairy for a short period so see if that makes a difference? What would you recommend?
A: It is very unlikely that food is responsible for isolated respiratory symptoms so I would suggest you discuss this with your GP. You may want to refer to the NICE food allergy parent’s guide which is a useful source of information. https://www.nice.org.uk/guidance/cg116/ifp/chapter/Food-allergy
20. Q: I gave my toddler (aged 2) prawns for the first time, and he was really sick.
Does this mean that he has a seafood allergy and should I be avoiding all shellfish?
A: This is one possible explanation – there are others and this really needs allergy testing to better understand if allergy was the cause of the vomiting.
21. Q: If my child has a particular food allergy, do I need to cut that food out of my diet when breastfeeding?
A: If your baby is allergic to certain foods such as milk, egg, soy or wheat, what you eat will probably be passing via your breastmilk into your child’s diet. In infants with an immediate type allergy to milk or egg for example, rather than having an immediate reaction sometimes there is a delayed reaction effecting the gut or worsening of eczema for example. You should discuss with your doctor before trying to cut any foods out of your own diet. For example, without milk you will need to include an alternative source of calcium to make sure that your breast milk is providing enough calcium for your baby.
22. Q: What is a food challenge?
A: Apart from a skin prick tests or blood test, one of the best ways to diagnose a food allergy is a ‘food challenge’. First of all your child is put on an elimination diet where the suspected food or foods are removed from your child’s diet. The suspected food or foods are then reintroduced into your child’s diet under medical supervision and your child is watched for signs and symptoms of an allergic reaction.
23. Q: What are the best milk substitute formulas?
A: For the first year, ideally breast milk is given to infants but where this isn’t possible, formula milk is given as ordinary cow’s milk does not provide adequate iron and other nutrients. However infant formula is made from cow’s milk so if your baby has a cow’s milk allergy this means they will need a special formula.
Cow’s milk substitute formulas for babies are:
– Extensively hydrolysed formulas and amino acid based formulas which need to be prescribed by your GP.
– Partially hydrolysed formulas are available not on prescription where proteins are broken down to make them less allergenic but these are not suitable for children with cow’s milk allergy.
– Soya based infant formula, which is not recommended to babies under 6 months
In the first year, babies will need up to 600ml of hypoallergenic formula a day to meet their nutritional requirements. The Department of Health recommends giving a supplement of vitamin D and A to all children over 6 months who are given breast milk as their main milk source. Early diagnosis is important as these types of formulas don’t taste good but the earlier you introduce them the more likely they are to be tolerated.
Alternative milks for older children:
– Non formula alternative milks like Oatly made from oats or Alpro milks made from foods like almonds, soya or coconut will not provide adequate nutrients under one year but can be used for older children, although calcium fortification is advised.
– Rice milk is not recommended for children under 4 ½ years old.
– Sheep or goat’s milk is not recommended for cow’s milk allergy as the proteins are very similar and are likely to cause the same reaction
24. Q: If my child is allergic to peanuts should I avoid all nuts?
A: It used to be advised that if your child was allergic to peanuts that they should avoid nuts completely. However, there is concern that many children who do this will develop an allergy to nuts they were not allergic to as a result of avoiding them. Tree nuts e.g. cashew, pecan, walnuts, pistachio, almonds etc. are not related to peanuts but can cause reactions. Consult your doctor if your child is allergic to peanuts but he may well advise that you do give other nuts to your child. Remember that whole nuts should be avoided until 5 years of age.