Written by Dr. Alice Hoyt, board certified allergist
If you don’t have a little one with a food allergy, chances are you know someone who does. In recent decades, food allergies in children have risen by 50%, while nut allergies have tripled!1 What many new parents don’t realize is that babies aren’t born with food allergies. They actually appear over time, and thanks to recent research, we know there is a critical window during which some food allergies can actually be prevented. The concept is referred to as Early Exposure or Early Allergen Introduction, and we’re going to break it down for you!
The evolving science behind food allergies has shown that the early and regular consumption of allergenic foods, especially peanuts, starting in infancy can help prevent allergies to those foods from developing later on. That’s great news for everyone!
Our friend and board-certified pediatric allergist Dr. Alice Hoyt, founder of the Hoyt Institute of Food Allergy, host of the “Food Allergy and Your Kiddo” podcast, and Mission MightyMe advisor, breaks down the research and shares tips for introducing common food allergens in the starting-solids phase. So, you can feed more confidently. We believe feeding babies should be fun and stress-free!
What Is Early Allergen Exposure?
It means getting an early start on exposing your little one to nuts, eggs, and other common food allergens before allergies have a chance to develop. Begin introduction around 4-6 months of age as your little one is starting solid foods.
Why Do Parents Need to Introduce Peanuts and Other Common Allergens?
Many experts believe that the now outdated feeding recommendations of avoiding peanuts, egg, dairy, and other common food allergens in infancy contributed to the increase in food allergies we see today.
There have been several studies in the last decade that have shown the protective benefit of early exposure. Two studies are the LEAP2 and EAT3 Studies, led by world-renowned pediatric allergist and Mission MightyMe co-founder, Dr. Gideon Lack. The LEAP Study4 and its follow-up LEAP On Study proved that most peanut allergies are preventable if peanut foods are introduced to high-risk infants in their first year of life and eaten regularly until five years of age. The EAT Study showed protective benefits in a low-risk population when sufficient quantities of milk, peanut, sesame, fish, egg, and wheat were consumed.
What is the Latest Guidance for Parents?
Based on the LEAP Studies, the National Institutes of Health (NIH)5 and the American Academy of Pediatrics (AAP)6 recommend that most babies start infant-safe peanut foods around 6 months, and that high-risk babies (with severe eczema and/or egg allergy) start earlier around 4 months after evaluation by a doctor. If your baby is high-risk, the AAP does recommend evaluation by a doctor and possible allergy testing before beginning allergen introduction.
The USDA Dietary Guidelines for Americans, 2020-2025, also specifically encourages early and regular consumption of peanut and common allergens in the first year of life.7
Do All Babies Need Early Exposure to Peanut?
New studies8 9, overwhelmingly say “yes!”, finding that to maximize peanut allergy prevention in the general population, all infants should start eating age-appropriate peanut products by 6 months of life. Infants with eczema, especially severe eczema, should start from 4 months of age.
Even though peanut allergy occurs more frequently in high-risk infants, infants without risk factors make up the majority of the population and make up a significant number of the children who have peanut allergies. If we only focus on high-risk infants, it simply won’t bring down the population burden of peanut allergies to where we want it: at zero!
“To maximize the prevention of peanut allergy in the population, infants should start eating age-appropriate peanut products by 6 months of life; infants with eczema, especially severe eczema, should start from 4 months of age.”
What parents need to know is this: the earlier the better! Research suggests that each month allergen introduction is delayed, the greater chance your baby has of developing an allergy. The estimated reduction in peanut allergy diminishes with every month of delayed introduction. Overall, the data finds that introducing peanut products into all babies’ diets by 6 months of age could reduce peanut allergy by up to 77%, while waiting until 12 months would only lead to a 33% reduction.10
How Do I Start Early Exposure to Nuts with My Child?
Always ask your pediatrician any questions about whether your child is ready for allergen introduction. Once you get the greenlight, remember these tips:
Use age-appropriate food forms: Whole nuts and nut butters are a choking hazard for babies! My go-to recommendations are:
Peanut or tree nut butter diluted with bottled water or breastmilk
Peanut or tree nut butter powder mixed into a puree
Keep in the diet regularly: Allergists recommend “early, often, ongoing” when it comes to introduction and consistency. My rules of thumb are:
Start at 4-6 months of age, depending on your baby’s risk factors
Include nut proteins in the diet about 3 days per week (that’s about 2 tbsp of nut butters per week or 1 bag of MightyMe peanut puffs per week)
Keep nuts in the diet regularly at least through age 5
Try not to stress! You’ll drive yourself crazy if you try to meet a certain amount of allergens in your little one’s food every week. Just aim to keep nuts and other common allergens in their diet regularly as a normal part of your family’s overall routine.
Ready to introduce and regularly include peanuts and tree nuts in your little one’s diet? Check out Mission MightyMe Nut Butter Puffs, and use code LALO15 for 15% off your first purchase!
Meet the Expert
About Dr. Alice Hoyt
Dr. Alice Hoyt is a board-certified allergist and the chief allergist at the Hoyt Institute of Food Allergy. She is the founder and chair of the national non-profit Code Ana, host of the top-ranked food allergy podcast Food Allergy and Your Kiddo, and mom of two.
1Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up, J Allergy Clin Immunol. 2010
2George Du Toit, M.B., B.Ch., Graham Roberts, D.M., Peter H. Sayre, M.D., Ph.D.,Henry T. Bahnson, M.P.H.,Suzana Radulovic, M.D., Alexandra F. Santos, M.D., Helen A. Brough, M.B., B.S., Deborah Phippard, Ph.D., Monica Basting, M.A.,Mary Feeney, M.Sc., R.D., Victor Turcanu, M.D., Ph.D., Michelle L. Sever, M.S.P.H., Ph.D., et al., for the LEAP Study Team, Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy, New England Journal of Medicine
3Michael R. Perkin, Ph.D., Kirsty Logan, Ph.D., Anna Tseng, R.D., Bunmi Raji, R.D., Salma Ayis, Ph.D.,Janet Peacock, Ph.D., Helen Brough, Ph.D., Tom Marrs, B.M., B.S., Suzana Radulovic, M.D., Joanna Craven, M.P.H., Carsten Flohr, Ph.D., and Gideon Lack, M.B., B.Ch., for the EAT Study Team*, Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants, New England Journal of Medicine
4DuToit et al. Effect of Avoidance on Peanut Allergy after Early Peanut Consumption, New England Journal of Medicine
5Addendum Guidelines for the Prevention of Peanut Allergy in the United States, National Institute of Health
6Frank R. Greer, MD; Scott H. Sicherer, MD; A. Wesley Burks, MD; COMMITTEE ON NUTRITION; SECTION ON ALLERGY AND IMMUNOLOGY; Steven A. Abrams, MD; George J. Fuchs, III, MD; Jae H. Kim, MD; C. Wesley Lindsey, MD; Sheela N. Magge, MD; Ellen S. Rome, MD; Sarah Jane Schwarzenberg, MD; Elizabeth C. Matsui, MD; John Andrew Bird, MD; Carla McGuire Davis, MD; Vivian Pilar Hernandez-Trujillo, MD; Todd A. Mahr, MD; Jordan S. Orange, MD; Michael Pistiner, MD; Julie Wang, MD; Paul V. Williams, The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods, American Academy of Pediatrics
7Dietary Guidelines for Americans, 2020-2025, USDA
8Roberts G., Bahnson H., Du Toit G., O’Rourke C. Sever M., Brittain E., Plaut M., Lack G., Defining the window of opportunity and target populations to prevent peanut allergy, Journal of Allergy and Clinical Immunology, 2022
9Kirsty Logan, Henry T. Bahnson, Alyssa Ylescupidez, Kirsten Beyer, Johanna Bellach, Dianne E. Campbell, Joanna Craven, George Du Toit, E. N. Clare Mills, Michael R. Perkin, Graham Roberts, et al., Early introduction of peanut reduces peanut allergy across risk groups in pooled and causal inference analyses, European Journal of Allergy and Clinical Immunology
10Roberts G., Bahnson H., Du Toit G., O’Rourke C. Sever M., Brittain E., Plaut M., Lack G., Defining the window of opportunity and target populations to prevent peanut allergy, Journal of Allergy and Clinical Immunology, 2022