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Introducing highly allergenic foods to infants and children

David M Fleischer, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


Studies support the existence of a critical time early in infancy during which the genetically predisposed atopic infant is at higher risk for developing allergic sensitization [1]. Thus, dietary interventions in the first years of life have been analyzed for their effects on the prevalence of allergic disease including food allergy [2]. Both American and European allergy expert committee guidelines recommend that solid foods be introduced between four to six months of age in all infants [3-6]. Other organizations have also concluded that complementary foods may be safely introduced between four and six months of age [7-9], although many still recommend or prefer exclusive breastfeeding for the first six months of life [8,10-13]. Recommendations regarding when to introduce highly allergenic foods, particularly in high-risk infants, have shifted over time.

Introduction of highly allergenic foods is discussed here. The general approach to introduction of solid foods during infancy is reviewed in greater detail separately, as is use of formula in high-risk infants. (See "Introducing solid foods and vitamin and mineral supplementation during infancy" and "Introducing formula to infants at risk for allergic disease".)

Other aspects of the primary prevention of allergic disease are also discussed in greater detail separately. (See "Primary prevention of allergic disease: Maternal diet in pregnancy and lactation" and "The impact of breastfeeding on the development of allergic disease".)


While any food has the potential to cause allergy, certain foods are more common triggers of significant acute allergic reactions due to various factors. The most common food allergens in children in the United States and many other countries include cow's milk (CM), hen's egg, soy, wheat, peanut, tree nuts, and seafood (shellfish and fish). (See "Pathogenesis of food allergy", section on 'Factors influencing sensitization or tolerance' and "History and physical examination in the patient with possible food allergy", section on 'Common culprit foods' and "Food allergy in children: Prevalence, natural history, and monitoring for resolution", section on 'Prevalence of childhood food allergy' and "Food allergens: Overview of clinical features and cross-reactivity".)


Infants and young children with a family history of atopy are at high risk for developing allergic disease, and those with a personal history of atopy, particularly those with moderate-to-severe eczema, are also at increased risk of developing other atopic diseases including food allergies. The American Academy of Pediatrics (AAP) had previously suggested in 2000 that the introduction of certain highly allergenic foods be delayed further in high-risk children: cow's milk (CM) until age one year; eggs until age two years; and peanuts, tree nuts, and fish until age three years [14]. This recommendation was based upon early studies that suggested that delayed introduction of solid foods might help prevent some allergic diseases, particularly atopic dermatitis (AD) [15-17]. (See "Introducing formula to infants at risk for allergic disease", section on 'Infants at high risk for developing allergy'.)


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Literature review current through: Dec 2016. | This topic last updated: Fri Jan 06 00:00:00 GMT+00:00 2017.
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