Introducing allergens

If you haven’t already, please watch the Introducing Allergens masterclass for a really good overview of introducing allergens. Below is a guide on each of the specific allergens and how best to introduce.

Does your little one have eczema?

If your little one has eczema, it can be really worthwhile purchasing a barrier cream to put on their face when testing allergens, to prevent food proteins entering the skin and causing a contact reaction (see below). I recommend purchasing an emulsifying ointment from the pharmacy – cheap, no preservatives and readily available in a big tub!!

Breastmilk

Food proteins, the part of the food that creates an allergic reaction, passes through breastmilk and to your baby. So, if your little one has been diagnosed with an allergy and you are still breastfeeding, you will need to avoid this allergen. Similarly, you may notice pre-solids, that your little one has eczema or digestive issues and this can be due to an underlying allergy or intolerance and proteins passing through breastmilk.

It is for this reason, that breastfeeding and eating allergen foods can be beneficial and research has shown it can be protective in preventing allergies from arising. However, this is an emerging area of research.

Family history

If you are your partner/another immediate caregiver have allergies, this can be really tricky to navigate when introducing to your little one. First, a family history of allergies can increase your little one’s risk. Second, it can be a logistical nightmare considering your safety when offering to your little one, particularly if you are allergic to touch. If this is you, I would recommend reaching out to your specialist for advice and/or asking another caregiver to offer the allergen to your little one.

Eggs

There has been information circulating that you should offer egg yolk before egg white to build a tolerance to the allergen. This is incorrect and not necessary – if your child is allergic to eggs, they will likely react to the yolk too. Yes, the allergic protein is technically in the egg white, but by virtue of sharing the same shell, there is inevitable contamination of the yolk.

Eggs commonly cause a contact reaction – a harmless localized reaction on the face, where the egg has touched. This is particularly common in little ones with eczema. It is due to the skin being immature and/or the barrier being impaired (eczema) allowing the food proteins in via the skin. It often results in redness and hives/welts/rash. As mentioned, it is typically harmless, but can cause a lot of confusion as to whether your little one is having an actual allergic reaction. So, where eggs are concerned, I recommend spoon feeding your little one when testing the allergen, particularly if they have eczema.

If your child does develop an egg allergy (it is one of the most common allergies), they have a really great chance they will grow out of it, as 80% of children outgrow an egg allergy by aged 3. Many children also have mild allergic reactions, rather than anaphylaxis, and can tolerate egg cooked into food.

How to offer

If offering via a spoon, as above, I recommend hard boiling an egg, mashing and adding to a previously tolerated food/puree – vegetable, fruit, porridge etc.

If you would prefer to offer as a finger food or for self-feeding, I would recommend offering omelet strips or scrambled eggs.

Peanuts

Peanuts are one of the top allergies that occur, often causing a more severe allergic reaction. Hence, it is one that causes a lot of anxiety. Interestingly, peanuts aren’t actually nuts – they are a legume. So, if your little one is allergic to peanuts, they (around 5%) can also be allergic or sensitive to other legumes like beans, chickpeas, lentils and peas. This is referred to as cross reactivity. Whilst peanuts aren’t actually nuts, around 35% of children are also allergic to one or more tree nuts.

Interestingly, around 20% of children grow out of peanut allergies, and if they don’t, peanut desensitization is an option with some care providers.

How to offer

The easiest way to offer peanuts to your little one is via peanut butter. Opt for a natural, no added sugar or salt variety, like Mayver’s. Alternatively, if you’re not a peanut butter eating family, you can purchase some peanuts, grind them up into a meal, mix with a puree or porridge/weetbix and offer to your little one.

Dairy

Dairy is another of the top allergies that occur (eggs, peanuts and dairy are the most common). If your little one is on a cow’s milk formula, they have already been introduced to, and presumably tolerating, dairy so there is no need to test the allergen like a breastfed family would. Much like eggs, if your little one does have a dairy allergy around 80% of children outgrow it by 5 years of age.

The protein in cow’s milk dairy is very similar to that of milk from other mammals (sheep and goat), with 90% of those allergic to cow’s milk, also allergic to another mammal milk. Similarly, the protein in soy, is also alike. As a result, many children allergic to dairy can also be allergic or sensitive to soy.

An extra note – most of us have seen a particular “dairy ladder” circulating and being recommended by a few questionably qualified individuals. This is a non-evidence based “recommendation” on the basis of gut immaturity. Your baby doesn’t hit a certain age and magically be able to tolerate a different type of dairy. Dairy is dairy, and all proteins are received by the body in the same way, irrespective of their individual source. The only dairy ladder you need to be concerned with is if your little one is diagnosed with an allergy and you discuss reintroduction with your Doctor.

How to offer

My favorite way to test the dairy allergen is to use Greek yoghurt – its super easy to offer in increasing increments and you can purchase a variety of sized tubs. Of course, I prefer (and use) a plain Greek yoghurt as I like that Franklin is use to a non-sweet yoghurt, however, if you opt for a flavored yoghurt, I like the Tamar Valley Greek yoghurts.

Soy

Soy is an allergen many people naturally avoid it in its most obvious forms – soy yoghurt, soy milk, tofu, tempeh etc. However, it is one of the allergens that is often hidden in packaged foods like bread, muesli bars and cereals. It is also a less common allergy, with many outgrowing it, much like dairy and egg.

How to offer

The easiest way to offer is via soy yoghurt or milk, much like you would dairy. However, for those that are familiar with, or eat tofu, scrambling soft tofu or pan-frying sticks of tofu is a great option too.

Wheat

I have seen some questionable advice regarding avoiding gluten and wheat until your little one is closer to 12 months old as it is “bad for their gut”. Again, this is incorrect – gluten and/or wheat is only problematic for those with Coeliac Disease or a non-coeliac gluten intolerance.

How to offer

The easiest way to introduce wheat is Weetbix. Alternatively, you can try toast or grains like couscous.

Sesame

Sesame is a less prevalent ingredient and allergy, however can be hidden in packaged goods. 

How to serve

The easiest way to offer sesame is through hummus or tahini – both are a paste like consistency and easy to mix with other foods.

Fish

Interestingly, fish is typically an allergy that presents itself later in life, with few children being allergic to fish. There appears to be no relationship between fish and shellfish, so those allergic to one, can generally eat the other. Once you have introduce one fish, your little one can tolerate all fish.

How to offer

My favorite types of fish are sardines and salmon as they are oily and particularly rich in omega 3 fats. If you’re not a fish-eating family, offering sardines or tuna can be a really easy and convenient way to introduce and offer fish to your little one.

Tree Nuts

There are nine tree nuts, all of which should be introduced individually. However, I don’t think I have ever eaten or seen a chest nut in Australia, so you shouldn’t need to introduce these. The tree nuts include: cashew, almond, pistachio, pine nut, walnut, brazil nut, macadamia, chest nut, hazelnut.

There is some cross-reactivity between tree nuts – many children allergic to one tree nut, will be allergic to others. In particular, cashew and pistachio are part of the same family and walnut and pecan are also part of the same family. As a result, there is a really high chance that those allergic to walnuts, will be allergic to pecan and those allergic to cashew will be allergic to pistachio. The other nuts aren’t part of the same families, but there are associations.

How to offer

You can purchase nut butters; however, few are individual, and this can become quite expensive. So, instead, I recommend purchasing a small bag/portion of each nut, grinding up into a meal, and mixing into other foods. Once successfully introduced, I then recommend combining all nuts into a jar and adding the mixed nut meal to breakfasts a few times a week.

Shellfish

Shellfish are actually split into two groups and to fully test the allergen, your little one will need to be exposed to both.

·      Crustaceans: prawns, crayfish, crabs, lobster

·      Molluscs: mussels, oyster, scallops

Shellfish is a less common food – many families don’t eat shellfish. If this is you, you can opt not to offer, given it will be tricky to keep in your little one’s diet. For example, we eat prawns regularly, but never eat mussels/oysters/scallops unless out, so we haven’t introduced the latter to Franklin.

How to offer

Crustaceans: I recommend blitzing or finely dicing prawn, cooking and adding to a puree or making prawn patties/burgers.

Molluscs: The easiest way to introduce is using smoked oysters or mussels from the supermarket, in a tin like sardines. Again, I would recommend blending and mixing into a puree.