THE ABC OF FOOD ALLERGIES IN CHILDHOOD

 

 

There’s generally one aspect to starting solids that could be stressful and cause a lot of anxiety for parents: the introduction of allergenic foods. As a registered dietitian with a special interest in allergies, I aim to provide practical tips and advice in-line with the most current guidelines. Nutritional management is key in the overall management of food allergies. This blog post will provide you with a greater insight into food allergies but for individualized advice, always consult a registered healthcare practitioner such as a dietitian. 


Allergens

There are eight food groups that are considered major allergens. These are:

  1. Cows Milk
  2. Egg
  3. Peanut
  4. Tree nuts ( i.e. almond, cashews, pistachios, walnuts) 
  5. Fish
  6. Shellfish
  7. Soy
  8.  Wheat

Food allergies tend to start in early infancy/ childhood, particularly cow's milk protein allergy. The first 1000 days of life is a critical window period for growth, oral motor and cognitive development, and a period when feeding patterns are established.  Many of the more common allergens contribute essential nutrients during this vulnerable time, such a protein, iron, calcium, vitamin B12, Vitamin D, zinc and essential fatty acids such as omega 3. A registered dietitian, together with an allergist, plays an integral role in the nutritional and medical management of food allergies, ensuring suitable replacements to prevent micronutrient and macronutrient deficiencies.

Food allergies can be outgrown in childhood, especially cow’s milk, egg, soy and wheat. Fish, shellfish, peanut and tree nut allergies are less commonly outgrown.  Children who are allergic to milk and egg may tolerate them in the baked form, as heat changes the shape of the proteins which makes them less “recognizable” by the immune system, decreasing the chances of a reaction taking place. A healthcare professional will guide you through this.

 

Be aware- Check Food Labels!

It is always recommended to check the food labels to see whether the product contains any allergens. If there is any uncertainty about the allergen content of a food, it is best to call the manufacturer. Only major allergens are required to be present on food labels. With regards to minor allergens, caution is warranted with foods that list  colourings, natural flavours and additives. Precautionary Allergen Labeling (PAL) includes statements such as “May contain” or “Manufactured/ Produced in the same facility as..” These precautions are generally noted under ingredient lists and should also be taken note of.  

Complementary Feeding: Introduction of Allergens 

 

The research has shifted from previous guidelines which recommended to delay food allergen introduction beyond 1 year of age to current guidelines stating that introduction of all allergens should take place before 1 year of age, specifically starting from 4-6 months of age. There is a considerable amount of research around the early introduction of egg and peanut. Below are practical examples of how to introduce allergens (always consult with your healthcare practitioner before commencing if your child is allergic):  

Milk—Yoghurt/ cheese can be introduced from 6-7 months. Avoid giving full cream milk to drink before 1 year of age as it is too concentrated for your baby’s kidneys 

Egg—Give fully cooked/baked egg to start with (ie in a pancake/ cupcake)rather than soft boiled egg/poached egg/raw egg powder/pasteurized egg. Under-cooked egg is also not recommended for children younger than 1 year.

Soy—Offer you baby soy milk, soy yogurt, or tofu (there is not much protein left in soy sauce, and the salt content is very high— best to avoid these).

 Fish/Shellfish—Give your baby a few portions of the fish/shellfish species that you tend to eat as a family and continue with regular intake. (Don’t give more than 2 portions of fatty fish per week according to the Food and Drug Administration [USA]) and Food Standards Agency [UK] guidance.)

Sesame—Try mixing some hummus and tahini in foods, i.e. in porridge/ mashed vegetables.

Wheat—Softly cooked pasta (which also makes a great finger food), porridges containing wheat or bread fingers.