Everything You Need to Know About Early Allergen Introduction with Malina Malkani, MS, RDN, CDN

“Wow, early allergen introduction is just sooo easy!” -No mom ever

That’s why we started Mission MightyMe: to make it deliciously simple to include nuts and other common food allergens in little diets with less stress and less mess. We’ve got you covered with delicious science-backed snacks containing peanuts and tree nuts – but did you know that the USDA now recommends introducing the top nine common allergens early and often? In this blog, we’re sharing additional insights shared by Malina Malkani, MS, RDN, CDN on an amazing Nurture by NAPS webinar about what you need to know about early allergen introduction (sponsored by Mission MightyMe!).

Food Allergies 101: let’s get on the same page.

• An allergic reaction to food is the triggering of a release of chemicals in the body that can produce an immune response or adverse reaction, usually within about a few minutes to two hours of when the food is eaten. 

• A true food allergy is reproducible, meaning a reaction will happen every single time a food is eaten. A “sensitivity” or “intolerance” is not potentially life-threatening in the same way as a food allergy. 

• Theoretically, it is possible to be allergic to any food, but there are 9 in particular –milk, eggs, peanuts, tree nuts, fish, crustacean shellfish, wheat, soy and sesame – that are responsible for over 90% of all food allergies.

• Babies are not born with food allergies. Although many food allergies can be outgrown (particularly allergies to milk, egg, soy and meat), a smaller percentage of kids outgrow allergies to peanuts, nuts, fish and shellfish. There is no cure.

• Risk factors for food allergies include severe eczema in infancy, an existing food allergy, and family history (in that order!). Interestingly, studies show that those high-risk babies stand to benefit the most from early introduction of foods like peanuts and egg between 4-6 months.

• Introduction of the top common allergens can cause a lot of stress among parents, but   it might help to know that severe allergic reactions to foods are extremely rare in the first year of life. [The FARE website is a great resource for food allergy signs and symptoms.]

For these reasons and more, anything we can do now to prevent food allergies from developing later is worth exploring! Only recently do we have a food allergy prevention tool that is effective – but only during a critical and short window of time. Which brings us to….

The latest pediatric guidelines. They’ve changed a lot – but that’s because we know a lot more now than we did before, and that’s a good thing!

• In the year 2000, the American Academy of Pediatrics (AAP) recommended avoiding top allergenic foods for the first 1-3 years of life. Between 1997-2011, there was a 50% increase in the prevalence of food allergies in children.

• Even though the avoidance guidelines were rescinded in 2008 due to lack of evidence, avoidance remained the norm.

• Today, there’s been a total 180-degree shift in pediatric feeding recommendations. Thanks to an amazing new body of research – including The LEAP Study, led by Mission MightyMe co-founder Dr. Gideon Lack – we know so much more now about the how, what and when of feeding babies during their first year of life. 

• The LEAP Study found that early introduction and regular feeding of peanut in the diets of high-risk babies could prevent development of peanut allergy by up to 86%. That’s mind-blowing!

• Based on the LEAP Study, leading health organizations around the globe now recommend starting common food allergens - especially peanut - once a baby has started solids, and keeping them in the diet regularly. It is recommended that high-risk babies (with severe eczema and/or egg allergy) seek a doctor’s evaluation and possible allergy testing first.

“The best thing you can do as a parent to make this whole process easier is to start the conversations with your pediatrician about your baby’s level of risk for food allergies early, when your baby is around 2-3 months old. The level of risk will affect the timing and method for introduction of these foods.” - Malina Malkani, MS, RDN, CDN

We’ve covered what food allergies are, what the latest guidelines say, and how to know if your baby may be considered “high-risk.” Next up, the fun part: introducing new and exciting foods to your little ones! If you’re feeling stressed on this journey, you’re not alone. So keep reading and take a deep breath, because…

Feeding your baby can – and should – be fun! Here are some top takeaways for early feeding how-tos and beginning early allergen introduction.

• Establish Feeding First: There’s no perfect first food, and don’t let anyone tell you otherwise! Some great first food options include avocado, sticks of steamed sweet potato, or a little bit of ripe banana. These can be served as finger foods, or mashed and pureed and served on a spoon. The goal of early establishing meals is for your baby to explore the food and play with it and have a positive experience. If they take a little bit or even more, that’s fantastic – but don’t get worried if they don’t.

• Texture and Food Sizing: A common misconception is that food sizing for finger foods depends on a baby’s age and how many teeth they have, but that’s irrelevant. How we size food should depend on the type of grasps a baby is using. Around 6 months, it’s a palmar grasp, so offer food the size of an adult pinky finger or larger. Every baby is different, but most have transitioned to a pincher grasp around 9 months – that’s your cue that it’s time to offer smaller food, cut to the size of a chickpea or cheerio! Regardless of food size, food should always be squishy (easily smashed between the thumb and forefinger) and soft to reduce choking risks.

• Balanced Baby Meals: Once feeding is underway and you’ve introduced a few first different foods and had positive experiences, begin balancing your baby meals to ensure he’s getting enough nutrients to grow. A balanced meal includes an iron-rich protein food, a fruit or a veggie high in vitamin C (helps with absorption) and an energy rich food (healthy fats support brain development and overall growth). Don’t stress too much about portion sizes: babies are amazing at self regulating and meeting their nutritional needs when we offer them a variety of healthy foods and let them decide whether and how much to eat – in other words, when we feed responsibly. For baby-led weaning, you can start with three pieces of food. With spoon feeding, it’s reasonable to expect a baby will consume 1 tbsp of each food offered, and you can always offer more if they finish.

• How to Begin Offering Allergens: Once your baby has had a few first foods, most are ready to start trying the top allergens. An approach that makes it easy to determine the responsible food, if there is a reaction, is to pick a weekday morning – so a pediatrician can be easily contacted – on a day you can be attentive for at least two hours. Start with a healthy, happy baby so in the event of a reaction, you’re not mistaking a teething issue or stomach bug for something it’s not. Offer that food either alone or as part of a meal your baby has tolerated a lot before – just a tiny bit on the tip of the tongue! Wait 10 minutes; if there is no reaction, you can offer the rest of the portion and then feed it again the next two days. This is usually enough to establish a food is well-tolerated. After that, keep the food in your baby’s diet 2-3 times a week. Congrats…you can now move on to the next allergen!

• Diet Diversity is Key: As a general rule, offer a variety of foods, textures, flavors, eat with your baby as often as possible, and introduce those top allergens early and often starting at around 6 months, then keep in diets consistently.

Remember: meals are not going to go perfectly – and that’s OK! There’s almost no such thing, and there are so many goals to early infant feeding that no matter what happens during a meal, your baby is going to benefit in some way. 

Looking for easy ways to incorporate the top nine allergens in baby diets? Check out our Early Allergen Introduction Guide, available to parents as a free resource! Here are a few additional ideas from Malina:

The “Big 9” allergens are all common, minimally processed foods that contain a lot of the important nutrients for babies that they need to thrive and grow, so we want to try to keep those in the diet long-term.

• Cow’s milk – Plain full-fat yogurt, cheeses (choose softer, lower sodium options like mozzarella or goat cheese)

• Eggs – Include both egg white and yolk early and often (be sure to cook eggs in full!)

• Peanuts – Mission MightyMe’s Proactive Peanut Puffs, or 2 tsp of smooth PB thinned out with breast milk, formula or water

• Tree nuts – Mission MightyMe’s Proactive Nut Butter Puffs (containing peanuts, walnuts, cashews, almonds and hazelnuts) or 2 tsp of smooth nut butters thinned with breast milk, formula or water  

• Fish – Sardines, wild caught Alaskan salmon, arctic char and steelhead trout (all options high in omega 3s, low in mercury - remember to remove all bones and cook thoroughly)

• Wheat – Infant wheat cereal, wheat germ mixed with familiar puree, tender pasta cooked well

• Soy – Sticks of raw or cooked tofu, boiled and mashed edamame (mash and slip skins off for easier swallowing)

• Sesame – Tahini spread in a thin layer on a toast strip or teething cracker, or mixed into a familiar puree 

• Crustacean shellfish – Don’t stress too much about this one! If shellfish is already a part of your family’s diet and you eat it regularly, by all means work it into your baby’s diet in a safe, modified form. Shellfish can be high in sodium, so just be mindful of levels in other foods served to your baby that week.

If introducing nine foods feels too overwhelming, focus on peanut, egg and dairy first, starting around 6 months or even earlier. These are the most common food allergies in kids, and we know the most about these foods from research, so it’s key to get them into diets early and often to prevent food allergies. Tackle these first and aim to get the rest in before your baby’s first birthday!

"As parents, we need to be strong advocates for our children. If your pediatrician is more old school and recommends holding off on introducing allergens during infancy – and doesn't have a compelling clinical reason as to why – I really would encourage you to press them on why, and possibly get a second opinion. Because this is important stuff." -Malina Malkani, MS, RDN, CDN

With proactive, early and often allergen introduction, parents have an amazing, tangible opportunity to reduce the number of kids who grow up dealing with the burden of food allergies. Give yourself grace along the way in your feeding journey. You can do this, mama!

The moms at Mission MightyMe are big fans of Malina’s evidence-based yet realistic feeding tips for families! Her goal is to help parents feel empowered, confident and excited about starting solids, including early allergen introduction. Follow Malina on Instagram @healthy.moms.healthy.kids for more educational materials, advice and meal ideas.