Finally! Canada has taken a position on food allergens during pregnancy, breastfeeding and introducing solids. As of December 2013, Canada has put out a joint statement from the Canadian Paediatric Society & the Canadian Society of Allergy and Clinical Immunology. It’s entitled “Dietary exposures and allergy prevention in high-risk infants".
In summary, when pregnant and nursing you do not need to avoid any foods. And there’s no benefit (may in fact be harmful) to delaying introduction of even the most allergenic proteins after 6 months of age. This applies to both low risk and high risk (a parent or sibling has an allergy), but not to infants that already have food allergies. More on that later…
While old guidelines suggested delaying nuts, eggs and seafood to 1-3 years, this was not based on evidence and rather just expert opinion. Newer observational studies now show that delaying of allergen introduction has actually caused an increase in allergies! For example, in the UK, prevalence of peanut allergy tripled when the recommendations were to delay introduction. There is currently better research underway, such as the LEAP study in the UK. In the LEAP study, high-risk infants are being introduced to peanuts for the first time at either 4-10 months or 3 years, with exposure 3 times per week. Once the babies are 5 years old, they will look at the prevalence of peanut allergy in each group. The hypothesis is prevalence will be lower in the group that was introduced to peanuts earlier.
So this position paper applies to high-risk infants, but not to babies that already have food allergies? So what if your baby already has food allergies or you are especially concerned about introducing more allergenic foods? The position paper discourages allergy testing in young children, as the results are so inaccurate. However an allergist can help decide if an oral food test is a good idea. While it is true that delaying introduction of a food does not prevent, and may increase incidence of an allergy, the parents comfort level also needs to be taken into consideration. While a 3 year old can likely tell you if they are experiencing an itchy throat for example, a 6 month old cannot. I like to recommend using Dr. Janice Joneja’s (RD) process for introducing allergenic foods to at-risk babies. You can read about her process here: Feeding the Allergenic Infant: Introducing Solid Foods.
So I can feed my baby peanuts and nuts at 6 months? Egg yolk and whites? Fish and shellfish? Wheat? Yes, please do! While it’s still beneficial to introduce one food (especially these more allergenic foods) a few days apart and watch for any signs of allergy, it’s good to introduce them early in your baby’s starting-solids career. And then continue to feed them regularly (at least 3 times per week) to help retain this tolerance. This whole starting solids process just became a lot easier. Have fun and bon appetit to baby!