For many parents, one of the biggest concerns when introducing new foods is simple:
“How will I know if my child is having an allergic reaction?” We partnered with our friends at Latitude Food Allergy Care to raise awareness
Current guidelines recommend introducing the top 9 allergens between 4-6 months of age. Reactions are typically mild in infants and often consist of hives or vomiting if they occur. Severe reactions or anaphylaxis are rare; however, it's important to recognize the signs and symptoms and to be prepared.
What Is an Allergic Reaction and What Are the Signs?
Immediate-type (IgE-mediated) allergic reactions happen when the immune system mistakenly treats a food (called an allergen) as harmful and overreacts to it. Most of the time, IgE-mediated allergic reactions happen within 30 minutes of eating, and primarily those reactions happen within 2 hours after eating. That’s why we recommend introducing new allergens in the morning or right after a nap so that you can stay nearby and keep an eye on your baby for two hours after introducing a new allergen for the very first time. The 9 most common IgE-mediated allergens include: milk, peanut, egg, wheat, tree nuts (like cashew and walnut), fish, shellfish, soy, and sesame. Severe IgE-mediated reactions, called anaphylaxis, are rare, but it’s important to recognize them.
Here’s an overview of symptoms for mild to severe allergic reactions:
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Mild to Moderate Symptoms include: Itching, sneezing, hives, rashes, nausea, vomiting, diarrhea, or stomach pain. Zyrtec is often given for treatment.
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Severe Symptoms/Anaphylaxis include: If two or more body systems are affected (e.g. vomiting/stomach and hives/skin), it is considered a severe reaction or anaphylaxis. Other severe symptoms include trouble swallowing or breathing, loss of consciousness, and a weak pulse. In the case of severe symptoms/anaphylaxis, administer an epinephrine autoinjector if available and go to the nearest emergency room.
Another type of allergic reaction is called FPIES (Food Protein-Induced Enterocolitis Syndrome). FPIES is less common and is a non-IgE-mediated food allergy that primarily affects the gastrointestinal system, usually 1-4 hours after eating the trigger food. The most common symptom is severe, repetitive, projectile vomiting. Common triggers include: milk, soy, egg, oat, rice, banana, avocado and sweet potato.
If you see signs of an allergic reaction, stop feeding the food and consult your pediatrician. You may need to see an allergist for a complete diagnosis, prescriptions, and an emergency action plan for prevention, management, and even treatment — often most effective when started at a younger age.
Common Redness vs. Allergic Reactions?
Redness around the mouth is often just skin irritation, but it is commonly mistaken as a food allergy reaction. Many common foods can cause redness that are not due to allergies, some of which are highlighted below. In this scenario, babies are often not upset or even aware of these rashes, which tend to disappear after a few minutes on their own. If you are uncertain, or if the rash persists or worsens, it is best to consult a healthcare professional.
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Citrus fruits: Foods like oranges or grapefruits, or baby foods containing citric acid, can cause a rash around the mouth due to their acidity.
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Tomatoes: Tomatoes can similarly sometimes cause a rash around the mouth due to their acidity.
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Strawberries or other berries: Some infants may develop redness or rashes after consuming strawberries or other berries.
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Cinnamon or other high salicylate foods, such as paprika (and other spices), curry, fruit juices, or eggplant.
Top 5 Tips to Feel Prepared
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Know the signs and symptoms, and have Children’s Zyrtec (Cetirizine) on hand just in case
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If your child is high risk (e.g., severe eczema and/or another food allergy), talk to your pediatrician before introducing allergens.
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Plan to time the first food introduction when you can watch your child without distractions for two hours after consuming the allergen.
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For the first introduction, offer your child a small portion of the allergen, wait 15 minutes, and gradually increase to an age-appropriate serving size. Observe your child for 2 hours after introducing the allergen.
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Once you have successfully introduced a major allergen, be ready to be consistent!
How do We Maximize this Critical Window of Allergen Tolerance Learning?
Feeding these allergens the first time without reaction is a great start, but only the beginning. Once an allergen has been successfully introduced, it's important to continue regular exposure to build tolerance. Studies show that feeding 2 grams of an allergen, multiple times a week for the first 3-5 years of life, is ideal. Starting and stopping with gaps in between can potentially lead to sensitization and reactions, and that is why regular, consistent exposure is so important.
What's Next After We Discover a Food Allergy?
If your child has a known or suspected allergy to any food, he or she must avoid that food entirely while you seek care with a board-certified allergist who is experienced with food allergies. Allergy testing includes a detailed history — reaction history is the most important piece of the puzzle at such a young age — as well as, skin testing and often blood testing. It’s important to note that blanket testing in the absence of a reaction history, can lead to false positive results and unnecessarily avoiding foods.
When food allergies are confirmed, it’s important to be aware that proactive treatment options do exist. For instance, in our specialized clinics, treatment with oral immunotherapy (OIT) can allow patients of all ages to safely eat a wide variety of foods, and is especially life-changing for the youngest patients — and their families.
Latitude Food Allergy Care is the leading provider of life-changing testing and treatment, including oral immunotherapy (OIT), to help families with food allergies live more freely. Founded in 2018 by food allergy parents in partnership with world-renowned researchers, Latitude is led by board-certified allergists in 12 clinics in New York and California.
