The Best Time to Introduce Eggs and Peanuts to Avoid Allergies in Children

Australia’s food allergy rates are among the highest in the world – but there are some early preventative steps you can take to reduce the risk for your baby.

Introduce egg and peanut before 12 months

Children should be introduced to peanut and egg before they turn one (but not before they reach four months old), according to updated guidelines from the Australasian Society of Clinical Immunology and Allergy.

This recommendation was largely based on results from the “Learning Early About Peanut Allergy” (LEAP) trial, which found “regular peanut intake before 12 months of age can reduce the risk of developing peanut allergy”.

Research also shows babies with an egg allergy or severe eczema are at high risk of peanut allergy.

Dr Chris Toumpas, paediatrician, says the evidence around introducing peanut (as peanut butter) into the diet has changed completely over the past few years.

“The introduction of peanut butter into the diet should not be delayed,” says Dr Toumpas.

“Regular peanut intake before 12 months of age can reduce the development of peanut allergies in infants with severe eczema and/or egg allergy.”

Is your child ready for solids?

Dr Toumpas says infants should start solids at around four to six months – once he or she is ready.

“Signs of readiness include showing interest in foods, watching family members eating, mouthing, tongue thrusting and good head control.”

How should you introduce egg and peanut into your child’s diet?

Dr Toumpas says peanut can first be introduced at home – as long as your child has not had any significant prior allergic reactions to food.

“Please see your doctor if there is a family history of allergic reactions for further evaluation. A medically supervised introduction may be required in some cases (e.g. moderate or severe eczema and further allergy testing). This can be in a clinic.”

Dr Toumpas said peanut should not be introduced for the first time at a day care centre or restaurant.

Egg can be incorporated in the diet once other more typical foods such as cereals, vegetables and fruits have been started.

“Infants should start with cooked egg (raw egg is not recommended),” says Dr Toumpas.

“If there is a family history of allergies, there is some evidence that introducing cooked egg into an infant's diet before eight months of age can reduce the risk of developing an egg allergy.”

Preparing for an allergic reaction

“Food allergies in children can present in a variety of ways from a rash or diarrhoea (intolerance) to life threatening severe reactions including lip or tongue swelling or breathing problems (anaphylaxis),” says Dr Toumpas.

They can also be unpredictable.

“If your child suffers a reaction, you should seek medical advice. If there are any breathing problems or other similar concerns you should seek treatment urgently.”

“Further investigations such as skin prick tests, blood tests or elimination diets or doctor-supervised oral food challenges may be required.”

It is important to be informed about the risk factors as allergies in children are on the rise.

Dr Toumpas says risk factors include:

• A family history of food allergies
• Conditions like eczema which can increase the risk of developing allergies
• Reactions in high risk foods such as eggs and peanuts

The Medical Journal of Australia has published the following suggested procedure for the introduction of peanut before 12 months (but after four months) under medical supervision or at home:

• Rub a small amount of smooth peanut butter/paste on the inside of the infant’s lip (not on skin).*
• If there is no allergic reaction after a few minutes, feed the infant ¼ teaspoon of smooth peanut butter/paste (as a spread or mixed into other food that the infant is already eating or mixed with a few drops of warm water) and observe for 30 minutes.
• If there is no allergic reaction, give ½ teaspoon of smooth peanut butter/ paste and observe for a further 30 minutes.
• If there is no allergic reaction, parents should continue to include peanut in their infant’s diet in gradually increasing amounts at least weekly, as it is important to continue to feed peanut to the infant as a part of a varied diet.
• If there is an allergic reaction at any step, stop feeding peanut to the infant and seek medical advice (if at home).
• An allergic reaction should be treated by following the ASCIA action plan: www.allergy.org.au/anaphylaxis.

* This is to exclude a contact reaction to the skin, which is not a test for food allergy. Many infants will have erythema to many different foods on direct skin contact. Mucosal contact will give a low dose exposure of the allergen to the infant. Additional reference: Savage J, Sicherer S, Wood R. The natural history of food allergy. J Allergy Clin Immunol Pract 2016; 4: 196-203;quiz 204.

Dr Chris Toumpas is a founding director of Paeds in a Pod which has several clinics and a large group of paediatricians and other specialists and allied health professionals in Brisbane.

Editor’s note: This article is of a general nature only and is not intended as personal advice. Ramsay Health Care recommends seeking medical advice specific to your individual circumstances.