Early introduction of allergenic foods: is it good for my baby?

A couple of weeks ago, the topic of food allergies in babies came up in a discussion from a mama group. At a certain moment, the following question was asked: when should parents start giving babies allergenic foods such as peanuts and eggs? Some mamas remembered being told a couple of years ago to wait until the child was older to give these foods. Other mamas mentioned that they had been told to start as soon as possible with the introduction of allergenic foods. After a long discussion, the question that remained was "who was right?".

Short answer...the mamas from the second group were correct. However, this topic deserves the long answer....so here it goes: The mamas that said to start as soon as possible with the introduction of allergenic foods were following the current recommendation. The mamas that said to wait until the child was older were giving an outdated recommendation. Not long ago, waiting was the recommendation...but things changed.

The changes in the recommendations started thanks to a study done in 2008, where researchers discovered that peanut allergy was higher among Jewish children from the UK than it was among Jewish children from Israel (they also found similar results for sesame and tree nuts allergies). The only difference between these children was that children in Israel were given peanuts during their first year of life while in the UK they were introduced way later. After this study, other studies followed. Researchers looked at the effect of introducing at an early age foods such as eggs, peanuts, etc on the risk of developing allergies later in life and found that, for all, early introduction reduced the risk of being allergic to these foods.

So when should you start giving allergenic foods? The current recommendation is that, once you start giving solid foods to your baby, you should also start introducing allergenic foods. Depending on your baby, this could be any time between 4-6 months. Delaying the introduction of allergenic foods is not recommended (it is preferable if babies have already been given these foods before they reach 8 months of age).

In the Netherlands, the introduction of these foods can be done in hospitals when babies are at high risk of food allergies. When babies have a low risk of food allergies, the introduction can be done at home. For some foods, such as peanuts and eggs, it may be difficult to determine how to give said food/which is the best preparation. In the case of peanuts, you can give a little peanut butter (100% pindakaas) to your baby. In the case of egg, you can give a little scrambled egg or hardboiled egg. For the quantities, you can follow the table below:

I will conclude this post by saying that science is constantly changing and nutrition science is no exception. New, substantiated discoveries lead to changes in guidelines and recommendations that improve our quality of life. The recommendations of today are not the same ones that were given a couple of years ago. For some this may be annoying but it is better to see it this way...every time that science advances we learn more and more!

Luz

PS: If you are interested in the studies that started it all, here is a short list of them:

Du Toit G, Katz Y, Sasieni P, et al. Lack early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122(5):984-991

Koplin JJ, Osborne NJ, Wake M, Martin PE, Gurrin LC, Robinson MN, Tey D, Slaa M, Thiele L, Miles L, Anderson D, Tan T, Dang TD, Hill DJ, Lowe AJ, Matheson MC, Ponsonby AL, Tang ML, Dharmage SC, Allen KJ. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010;126(4):807–13.

Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G, LEAP study team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803–13.

Du Toit G, Sayre PH, Roberts G, Sever ML, Lawson K, Bahnson HT, Brough HA, Santos AF, Harris KM, Radulovic S, Basting M, Turcanu V, Plaut M, Plaut M, Lack G, Immune Tolerance Network LEAP-On Study Team. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med. 2016;374(15):1435–43.

Natsume O, Kabashima S, Nakazato J, Yamamoto-Hanada K, Narita M, Kondo M, Saito M, Kishino A, Takimoto T, Inoue E, Tang J, Kido H, Wong GW, Matsumoto K, Saito H, Ohya Y, PETIT Study Team. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomized, double-blind, placebo-controlled trial. Lancet. 2017;389(10066):276–86

Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Reeves T, Tagiyeva-Milne N, Nurmatov U, Trivella M, Leonardi-Bee J, Boyle RJ. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis. JAMA. 2016;316(11):1181–92.