The Key to Allergy Prevention? Early Exposure -- Not Avoidance

Danelle M. Fisher, MD

As healthcare providers, we know that our patients often look to us for equal parts medical advice and moral support. This is especially true in pediatric care. New parents are flooded with a mix of joy, exhaustion, and anxiety, and every decision they make about their newborn is a big one. Feeding practices alone can raise dozens of questions, and understandably so; nutrition is a critical part of a baby's healthy growth and development. How and when foods are introduced can even have lasting impacts on their eating behaviors, dietary preferences, and their immunologic response to food allergens. In fact, early and frequent exposure, not avoidance, is the key to food allergy prevention.

Updating Our Approach to Food Allergy Prevention

The prevalence of food allergies continues to rise in the United States, now affecting 1 in 12 children and more than 1 in 10 adults. According to the US Food and Drug Administration, the top offenders include milk, eggs, peanuts, tree nuts, shellfish, fish, wheat, and soy.

When I first began my medical training in 2001, standard practice was to counsel parents against introducing these potentially problematic foods for the first few years of life. But today, we know that avoidance is not the answer. On the basis of landmark clinical trials investigating food allergy prevention (LEAP, 2015; EAT, 2016; PETIT, 2017), leading health organizations from around the world have issued new guidelines recommending early and sustained allergen introduction to help prevent severe food allergies in babies.

Current pediatric guidelines make these recommendations:

Begin introducing allergens within the first year of life. Research supports exposing infants to allergenic foods as early as 4-6 months of age.
Introduce allergens in isolation. It's important to incorporate allergens into the diet one at a time every few days to determine how the baby is reacting to each new food.
Take a stepwise approach. Leading pediatric organizations recommend starting with small doses and gradually increasing the dosage over time to help promote tolerance.
Maintain the feeding regimen for several months. Clinical trials found that exposing infants to allergenic foods two to seven times per week for 3-6 months resulted in reduced food allergy risk, while families who exposed their baby less frequently or for a shorter period saw no benefit.

Yet, recent studies find that only 8% of parents are following these guidelines. As healthcare providers, we need to do more to bridge this enormous gap between evidence and practice.

Empowering Families to Lean Into Early Introduction

The latest allergen introduction guidance may be backed by science, but that doesn't make the process any less nerve-wracking for caregivers. I've had more than one family say they'd be more comfortable feeding their baby peanut butter for the first time if they could do it in my clinic parking lot, just to know that rescue was within reach. That's why compassionate and consistent "surround-sound" education from the whole healthcare team is so important. Yet, national surveys show that only about 30% of pediatricians teach parents about food allergy prevention.

Providing families with approachable, evidence-based education is step one. At Providence St. John's Health Center in Los Angeles, where I am a pediatrician, our partnership with the nationally recognized food allergy experts Ready, Set, Food! has been transformational. By integrating their educational content into electronic medical record after-visit summaries, the advice that parents and caregivers hear in the physician's office is then reinforced with actionable information in their electronic medical records.

Resources like preventallergies.org are also available at families' fingertips through the Circle mobile app, which provides easy-to-access education as well as automated reminders and feeding guidance at 2, 4, 6, and 9 months of age. By making these messages part of our regular communication with families, we can help assuage common feelings of anxiety and self-doubt, and help parents feel confident in their feeding decision-making.

I've also found that a big part of empowering parents is providing them with real-world tools. At a time in their lives when they're stressed, tired, and often overwhelmed, anything to help take the guesswork out of childcare is a win. Because Ready, Set, Food! has a comprehensive, three-stage guided system that allows families to introduce the top food allergens to their babies safely and easily in preportioned amounts, it addresses multiple barriers that new parents face and has helped so many families I've worked with.

Introducing your baby to new foods should be exciting, not daunting. To help parents feel comfortable and confident introducing food allergens in a safe way, we as healthcare providers need to familiarize ourselves with the latest research and guidelines first. I encourage everyone to explore preventallergies.org, a nonprofit affiliate of Ready, Set, Food!, as well as guidelines provided in the current 2020-2025 USDA Dietary Guidelines and from the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the American Academy of Pediatrics, among other leading organizations, to learn more.

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