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Welcome to the Fortified Family! I’m Katie Ferraro, Registered Dietitian Nutritionist and mom of 7 and I specialize in baby-led weaning. I’m passionate about feeding strong families and making food fun.

"Eat the 8" Allergenic Foods for Babies

"Eat the 8" Allergenic Foods for Babies

Disclaimer: This is not a sponsored post. I did receive a complementary copy of the “Eat the Eight” book that I review in the post. The author of the book Dr. Ron Sunog is an advisor to PUFFWORKS, a company I have worked with in the past; however, I received no financial compensation for this post. All of the ideas and thoughts contained within this post (with the exception of Dr. Sunog’s quotes) are my own. This post does contain affiliate links.

Have you heard about the “Big 8”? They’re the 8 foods that account for about 90% of food allergy in North America.

Despite emerging research, updated guidelines and lots of buzz about earlier introduction of allergenic foods, many parents don’t realize that incorporating the Big 8 early on can help prevent food allergy down the road.

So why aren’t parents feeding babies The Big 8 “early and often”?

Well…I was wondering JUST the same thing, which is why I sat down with Ron Sunog, MD, author of “EAT THE EIGHT: Preventing Food Allergy with Food and the Imperfect Art of Medicine” to learn more.

 

Eat the 8 Movement

In case you’re curious, the 8 foods that cause most food allergy are milk, egg, peanut, tree nuts, wheat, soy, fish and crustacean shellfish. (Food Allergy Research & Education, FARE points out that allergy to sesame is an emerging concern too.)

Dr. Ron Sunog is a Boston-based pediatrician and advocate for food allergy awareness. He has made it his mission to get other pediatricians and parents to start recommending and implementing an “Eat the Eight” approach starting in infancy.

Much like the public health campaign “Back to Sleep” for infant sleep safety that started in 1994 (now called Safe to Sleep), Dr. Sunog is trying to help bring evidence based recommendations into the world of infant feeding advice, with the catchy, easy-to-remember and informative title: “Eat the Eight”.

Don’t be surprised if you hear more “Eat the Eight” advice soon - and you’ll have Dr. Sunog to thank for bringing this info to the forefront of pediatrician offices everywhere!

 

One Giant LEAP Forward

The medical community’s understanding of preventing food allergy has changed dramatically in a short period of time.

When I was studying nutrition as an undergraduate (only) 20 years ago, we learned the American Academy of Pediatrics (AAP) recommendation to “delay introduction of peanut in high-risk children until age 3”.

Fast-forward to 2015 when the Learning Early About Peanut Allergy (LEAP) trial results were published in the New England Journal of Medicine. LEAP showed us that “feeding peanut to high-risk infants early and often could prevent them from developing a peanut allergy.”

In fact, in the LEAP trial, early introduction reduced risk by 81% compared to control groups who avoided peanuts completely for 5 years. (For more interesting facts about the LEAP studies, check out this article from FARE.)

As a result of the LEAP study outcomes, by early 2017 the National Institute of Allergy and Infectious Diseases (NIAID) officially changed their addendum guidelines to support early introduction of peanuts as a recommended way to reduce risk for peanut allergy.

Although we have the strongest evidence to support early introduction for peanut allergy prevention, other emerging research appears to also support early introduction of other “Big 8” allergenic foods, as Dr. Sunog outlines in his book “Eat the Eight”.

 

First, Do No Harm

But as you know…just because the info is out there, it doesn’t mean people are using it!

One study published in the Annals of Allergy, Asthma & Immunology found that almost 70 percent of parents were unwilling to incorporate peanuts into a baby’s diet at or before 6 months…and nearly one third of them didn’t know anything about the new peanut guidelines.

So…if research supports early introduction…and updated guidelines recommend early introduction…why aren’t parents actually introducing allergenic foods to their babies early and often?

As Dr. Sunog points out - it’s because they aren’t hearing this advice from the very place they go to seek health information: the pediatrician’s office.

By October 2017, 10 months after the addendum guidelines were published, only 11% of pediatricians had put this into practice. As Dr. Sunog states in the book, “Physicians are not immune to the inclination to cling to obsolete information.”

 

The “3-5 Days Between Foods” Farce

I couldn’t agree with that last quote more! And from interactions with my students, clients, peers and social media community, I know firsthand that parents are routinely STILL being told by their pediatrician to “wait 3-5 days before trying new foods”.

In my opinion, this whole 3-5 day “waiting game” is an outdated, unnecessary, and unsupported recommendation that only instills fear in parents about trying new foods with baby.

Instead, parents and caregivers should be ENCOURAGED to introduce the wide variety of foods, flavors, tastes and textures that we know babies need to become independent eaters, prevent picky eating AND prevent food allergies.

And, if you want to bring common sense into the conversation - as Dr. Sunog points out in his book and during our interview, if a reaction is going to occur, it will be within hours and not days following the ingestion of the offending food.

Five days after your baby has a strawberry, if his diaper looks different or there’s a new rash around his mouth - do you really think it was the strawberry that caused the “reaction”?

That’s not how reactions or the anaphylactic responses work, and I stand by Dr. Sunog’s efforts to help shift pediatricians away from this outdated practice of recommending to wait 3-5 days between new foods.

(For more information on how you can get your baby to try 100 Foods Before Turning One check out my free online workshop “Baby-Led Weaning for Beginners” here.)

 

Turning the Tide

In his book, “Eat the Eight” Dr. Sunog does an excellent job outlining the current environment of food allergy advice at a typical pediatrician’s office…it’s generally a conversation that isn’t happening, unless mom or dad asks about it.

And given all the OTHER things there are to worry about as a new parent, the conversation about food allergies often falls to the wayside.

Besides outlining all of the relevant research, historical recommendations, new guidelines and suggestions for introducing allergenic foods, Dr. Sunog’s “Eat the Eight” book includes some very important commentary about why parents aren’t hearing this advice and how a concerted campaign or effort called “Eat the Eight” may help turn the tide.

 

Allergenic Food Answers from Dr. Sunog

Because I work as a dietitian specializing in infant feeding, I am in constant contact with parents of babies approaching, at, or just after the 6 month mark - that magical age when babies start the weaning process through initial introduction of solid foods.

And in this line of work I get a TON of questions about food allergies. So why not ask the expert to help answer them?

I surveyed my audience and curated some of the most popular questions about food allergies, and brought them to my interview with Dr. Sunog.

Basically I asked him every allergy question in the book, and his straightforward, evidence-based answers were a breath of fresh air in what can be a confusing space to try to sort things out on your own.

Below are some selected questions from you - with answers from Dr. Sunog - all about starting allergenic foods with your babies in an attempt to help prevent food allergy down the road:

 

“If my baby doesn’t have an allergic reaction to a food on first exposure, could he have it on second or subsequent exposures?”

Dr. Sunog’s response: Your first exposure to anything that you’re going to react to essentially “primes the pump”. On the second exposure you actually react. It should be a second or later exposure…it can happen on the first time baby is “eating” that food - but “eating” it might not be the actual true first exposure.

He went on to explain that testing dust samples from a baby’s crib almost always yields trace amounts of peanut and other food proteins - so baby may be exposed outside of traditional food “tasting” before first bite of that food.

 

“What are the signs and symptoms of a reaction that parents should be on the lookout for when trialing new foods with babies?”

Dr. Sunog’s answer: For an infant, look for things like a rash around the mouth or elsewhere, fussiness, vomiting, any kind of respiratory distress.

We also discussed how other things happening concurrently can cause reactions too, like teething, or baby having a cold and being immunocompromised. So it’s not always the food’s fault if a reaction happens!

 

“If mom had to remove dairy while breastfeeding because of skin and gut problems in baby, should she avoid introducing solid dairy foods and milk protein to baby at 6 months of age and onward?”

Dr. Sunog’s response: if baby’s symptoms resolved during breastfeeding when mom removed dairy, it does not necessarily mean baby is “allergic” to dairy foods. Over the ensuing months, baby’s gut has developed to the point where baby may be able to tolerate these food proteins more efficiently, so after checking with your own doctor, it’s likely safe to trial these foods.

He went on to point out the importance of understanding the difference between food allergy and intolerance - they’re not the same thing: an allergy is a potentially life-threatening allergic reaction to what is usually the protein component of a food.

An intolerance - while it’s an inconvenience and may be uncomfortable for mom or baby - is not life-threatening.

Knowing the difference between allergy and intolerance - and using those terms correctly - is important when relaying your baby’s medical situation to the healthcare provider.

 

“LEAP and new guidelines have redefined ‘high-risk’ for peanut allergy as being baby with severe eczema and/or established egg allergy…how do you know if your baby has severe eczema and therefore falls in this high risk category?”

Dr. Sunog’s answer: Consider these statistics:

  • 12.97% of children have eczema

  • 7% of these children with eczema have severe eczema, therefore

  • 0.9% of children have severe eczema, and

  • 2% (at most) of children have egg allergy

(…and those statistics are for all “children”, they’re probably smaller for infants.)

Eczema is a break in the skin’s barrier. The worse the eczema, the higher your risk is for food allergy. There’s no blood test for diagnosing severe eczema, it’s not a quantitative thing, but if you look at the statistics, very few infants actually are “high risk” for peanut allergy.

Yes, there are high risk criteria for peanut allergy, but determining severe eczema is essentially a judgement call on the part of the pediatrician…the pediatrician who may make that call or refer baby to a dermatologist to do the same.

 

“What should I do if I think my baby is at high risk for food allergy?”

Dr. Sunog’s response: babies with severe eczema, egg allergy, or both should strongly consider evaluation with peanut-specific IgE and/or skin prick tests, and, if necessary, an oral food challenge. Then based on these test results, introduce peanut-containing foods at four to six months of age, per the guidelines.

For the mild to moderate eczema categories, introduce peanut containing foods at around 6 months of age.

And for your babies with no eczema or any food allergy, introduce peanut containing foods at an appropriate age and in accordance with family preferences and cultural practices (…from the NIAID addendum guidelines).

Dr. Suno recommends peanut containing food and all the Big 8 for low risk children as it is likely to reduce the risk of developing food allergy and these are nutritious foods for baby.

 

“Should I park my car outside the pediatrician’s office or emergency room to try a new allergenic food with my baby?”

Dr. Sunog’s answer: No. Allergic reactions are scary…I liken it to a febrile seizure - any seizure is terrible to look at - even as a professional. But febrile seizure is utterly safe, results in no harm…although yes, you’re still super scared.

With food reactions, parents are assuming the worst. But the good news is that a first time reaction is rarely life threatening…fatality is all but unheard of, especially in young infants like the ones who are trying these foods for the first time at or around the 6 month mark.

Most reactions don’t require anything more than at-home administration of Benadryl. And Dr. Sunog reminds you to still check with your pediatrician, explain the symptoms and get confirmation about preferred Benadryl dosing for baby.

 

“How many grams of potential allergy food is considered an effective dose? We see 2 grams 3 times per week from LEAP of peanut protein, but what about other foods?”

Dr. Sunog’s response: there are no established guidelines about dose. We don’t know anything about that. Even with peanut, for better or worse, that was just the “dose” that was tested…nobody could say less wouldn’t work. If my child was high risk I would push harder to do it early and often.

 

‘What are some safe ways to introduce peanut protein to a baby at 6 months of age if intact peanuts are a choking hazard and peanut butter in globs may be too challenging for babies this young?”

Dr. Sunog’s answer: I have done a lot of research helping to develop a peanut puff that is appropriate for babies. As an advisor to PUFFWORKS, I helped bring their PUFFWORKS Baby line of peanut puffs to market. These are an improvement on existing puff products for a number of reasons.

PUFFWORKS Baby puffs are:

  • Softer than other peanut puffs on the market, so they’re easier for early eaters to eat even without teeth

  • Lower in salt with no added sugar; other commercial products have added salt and sugar that babies don’t need

  • Comprised of non-GMO ingredients and include whole gain ingredients that are less processed than other baby puff products.

 

“What about this trend of ‘medicalizing’ introduction of allergenic foods? If a baby can eat food at 6 months of age or more, why should parents be told they have to buy fancy, high-priced products that have arbitrary amounts of the allergen in them?”

(Full disclosure: this was my question - and it’s one of my biggest pet peeves. Six month old babies can eat real food, I just wanted to see if Dr. Sunog agrees!)

Dr. Sunog’s response: I agree that certain brands and products are fear-mongering when they “educate” parents about needing elaborate and expensive regimens for introducing allergenic foods. For the high risk peanut allergy population who may need to start peanut allergy at 4-6 months of age - before baby can safely tolerate solid food products - yes, there may be a market for those products that you mix into formula or breastmilk and feed from a bottle.

But once baby is 6 months of age, there are a number of safe ways to introduce every Big 8 food to babies and I support a food first approach to introducing allergenic foods for babies at this age. I’m hopeful that through my work with pediatricians, parents and other healthcare providers, we can get more parents and caregivers and their infants to “Eat the Eight” and help prevent food allergies later in life.

 

Thank you to Dr. Sunog for taking the time to sit down and answer all of these allergenic food questions. For more information about allergen introduction for your baby, please check out his book on Amazon, “EAT THE EIGHT: Preventing Food Allergy with Food and the Imperfect Art of Medicine”.

To try out some PUFFWORKS Baby for your baby, you can get 15% off on Amazon with code 15BABYLED - click here to order.

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