What to Look for in an Allergic Food Response
Many parents are worried about introducing foods that may potentially result in an allergic response to babies.
This worry is understandable. No parent wants to see their baby in distress of any kind. Moreover, like many aspects of starting solids there is a lot of conflicting advice and guidance on allergens – from what foods can be associated with an allergic response to diagnosis and management of food allergies.
This blog, with extracts from my best-selling book – The Nourished Baby - will give some simple tips on what you are looking for in an allergic response as well as some general guidance on what food allergies are and the latest guidelines on their introduction for babies.
While our understanding of the immune system has increased significantly over the past few decades, the physiological reason for why allergy exists remains largely unknown. An allergic reaction is defined as a response of the autoimmune system to the protein in a food. This means the immune system creates IgE antibodies to protein (IgE-mediated).
There is a distinct difference between a food allergy, food intolerance and food sensitivity and these are commonly confused. It is a food allergy (IgE-mediated) that we are primarily concerned with as this has the greatest association with more severe responses and requires careful management.
There are eight foods, though, that are classified as ‘high-allergenic foods’. As you can see from the list these are all significant sources of protein. It is highly unlikely for a response to occur to foods that contain next little-to-no protein (for example fruits, grains or spices).
4 Tree nuts
There is now a significant body of peer reviewed, scientific research to show the importance of early introduction of these top 8 allergens in decreasing the risk of an allergen presenting itself and maximising time for careful re-introduction while the gut is in the first two years of maturation.
The current Australasian Society of Clinical Immunology and Allergy (ASCIA) feeding guidelines are for all infants to be given allergenic solid foods in the first year of life (including those at high risk of allergy).
All babies must be given these foods orally (not on the skin) and this oral introduction is essential for diagnosing an allergy. In line with best practice diagnosing a food allergy should not be diagnosed without an oral introduction (through breastmilk is not sufficient).
These are the foods which should be given in isolation i.e. on their own. Other foods do not need to be as they do not present a high risk of a response. I step you through how to do this both in The Nourished Baby (and my subsequent starting solids introduction guide) and have many videos on Tiktok and Instagram reels on how to do this. I also cover the wheat allergen here – as one of my key guidelines is to without grain or gluten-based foods up to 10-12 months (blog here too).
A reaction of the auto-immune system will be immediate. Normally this is straight away (within seconds or minutes) as a maximum it will be within two hours. There maybe delayed responses but this is rare (for an IgE-mediated response) and will be more likely non-IgE-mediated (often digestive).
The following responses are what to look for:
*Swelling especially of the lips, face or eyes
*Redness of the face overall
*Hives (swollen, itchy pink/red bumps) or welts on the skin
*Rash (including front and back of the torso)
*Shortness of breath or trouble breathing (anaphylaxis)
Just as a note on anaphylaxis as this is what parents are most worried about. Anaphylaxis is less than 5% of all allergic reactions. While it is the most severe it is also the least likely. Early introduction of the allergens remains the best chance to decrease the risk of an allergic response presenting and, if it does, the greatest amount of time for careful reintroduction.
If a response occurs or you are worried at any point do seek immediate medical attention. After this initial response has settled I also highly recommend ensuring you have a management plan. Unfortunately I see many parents who have not been given a management plan other than complete avoidance. This does not provide support for introducing other allergens (if you have not done so) and there is now significant research to show that with careful re-introduction under the care of a health professional in a laddered approach we can support the auto-immune system to not react. This is especially the case for egg and dairy responses.
This is something that I can help with in a 1:1 consultation (I do not give generalised ladder introductions and no health professional should, as every allergenic reaction is unique). However more than anything I would just strongly encourage you seek a second opinion if you are not happy with the support you have been given even if it is not with me.
Further recipes, books and blogs you might find helpful are:
* Introducing eggs to a baby (blog) - link here
* Allergy-free pancakes - recipe in my brand new Fruit Spread Cookbook so bubs can join in on pancake Sunday!
* To book a 1:1 consultation for individualised allergy advice - online booking system here.
x Dr Julie