Dr. Leah Alexander, M.D., F.A.A.P. began practicing pediatrics at Elizabeth Pediatric Group of New Jersey in 2000. She has been an independently contracted pediatrician with Medical Doctors Associates at Pediatricare Associates of New Jersey since 2005. After graduating from Kalamazoo College and Michigan State University College of Human Medicine, she completed her pediatric residency at Overlook and Morristown Memorial Hospitals. She is board certified in General Pediatrics. Outside of the field of medicine, she has an interest in culinary arts.
The introduction of first foods can be a joyful experience for parents and infants. Parents often worry, however, about possible allergic reactions to a new food. While other types of infant food allergies are rare, food allergies in babies are more common. According to Dr. Silverstein of Asthma and Allergy Specialists of New Jersey, “Food allergy has become one of the more common allergic disorders. [They] typically present in early childhood, usually after the first exposure to the offending food. Cow's milk, peanuts, tree nuts, eggs, wheat, soybean and shellfish are the most common foods implicated after an allergic reaction occurs” (source). The thought of this can be overwhelming for parents. Certain foods are more likely to cause allergic reactions in infants than in toddlers and children. The scope of this article is to discuss possible food allergies in babies, and in what situations would ELSE be beneficial.
What Does It Mean to Have an Allergy?
An allergic reaction is an adverse immune response to a food, irritant, or something in the environment to which a person has a sensitivity. The immune system treats this exposure as if it is something that could harm the body. IgE antibodies cause the release of histamine from blood cells called eosinophils. This histamine is responsible for the symptoms typically seen in such reactions (source). It is common for the first exposure to elicit little to no reaction. With subsequent exposures, the immune system becomes “sensitized.’ Each time, symptoms become increasingly severe, and potentially life threatening.
How Common Are Food Allergies in Babies?
More infants and children develop food allergies each year. In the U.S., studies have shown that approximately eight percent of children have at least one type of food allergy (source). Peanuts appear to be the primary culprit in children, followed by cow’s milk, shellfish, and tree nuts. The risk of anaphylaxis appears to be higher when the child has asthma or an allergy to environmental allergens, insects, or medications. In contrast, a French study found cow’s milk to be the most common food allergies in babies, followed by eggs, wheat, and peanuts (source). Of those infants studied, one third experienced atopic dermatitis. In those infants at risk for anaphylactic reactions, hives, hypotension, and an altered neurological status were noted. The prevalence of food allergies in babies varies globally. While peanut allergies predominate in Australia and the United Kingdom, wheat, egg and milk allergies are more common in Asia (source).
There has been much debate as to why the numbers of infants and children with are food allergies are increasing. One theory is the “hygiene hypothesis.” Current cleaning and sanitization practices, both in homes and commercially, have altered the human microbiome. This causes the immune system to adversely react to normal things in our environment (source). There is growing evidence that infants who are exposed to pets or a farm environment are less likely to develop allergies. It is felt that these “less clean” living environments are protective. Low levels of vitamin D have been shown to play a role as well as family history (source).
What to Expect When an Infant Has a Food Allergy
Infants who are exclusively breastfed for the first 6 months rarely exhibit food allergies. When they do, it is primarily due to breastmilk transmission of the allergens a mother consumes in her diet (source). Formula fed infants develop reactions much earlier due to consuming cow’s milk-based or soy-based infant formulas. Symptoms can range from simply a mild rash to moderate symptoms such as hives, vomiting, and blood-tinged stools. Anaphylactic reactions are characterized by facial swelling, lethargy, and loss of consciousness, and require emergency medical intervention (source).
Most infant food allergies are detected during the introduction of new foods. When a food is offered, most medical professionals suggest starting with a very small portion. If no allergy symptoms in babies occur, a larger portion may be offered. It is generally recommended to introduce a single new food for three to five consecutive days. In this way, the problematic food is easy to distinguish from foods that are tolerated. An allergic reaction may not be evident during the first trial, but may develop with continued exposure and sensitization to this new food. Once it clear that there is no allergic reaction, the food is safe to include in the infant’s usual diet.
Management of Food Allergies
As a preventative measure, many pediatricians discuss the possibility of food allergies during the four month old well visit. If an allergic reaction occurs, a weight appropriate dose of this medication would be administered at the first sign of a reaction. If symptoms progress despite this intervention, a medical professional should be contacted.
In general, infants do not undergo allergy testing. Both radioallergosorbent tests (RAST) and skin prick tests give inconsistent results under the age of two (source). Serum IgE levels may be more indicative but not specific. Therefore, allergic reactions in this age group are primarily diagnosed based on symptoms.
Once a food allergy had been identified, an injectable, low dose of epinephrine is prescribed for use as a “rescue” medication in case of an accidental exposure (source). In the event of a rapidly progressing allergic reaction or anaphylaxis, epinephrine should be administered immediately. While symptoms may resolve initially, they may return hours later depending on how much of the offending food was ingested. For this reason, an emergency services evaluation is recommended for any allergic reaction where rescue medication has been administered.
Prevention of Common Food Allergies in Babies
For many years, some medical authorities suggested that avoiding common food allergens protected children from developing food allergies. This was particularly the rationale for peanut allergies. However, in 2019, the American Academy of Pediatrics revised their avoidance policy, finding that no benefit to withholding peanuts, tree nuts, fish, and eggs after six months of age (source). Israeli studies have consistently shown that early introduction of common food allergens is protective against developing these allergies later in life (source). Since then, most health authorities agree that there is no reason to delay the introduction of these foods.
What Is Unique About Almonds
Almonds are a member of the tree nut family which also includes walnuts, hazelnuts, pecans, and cashews. While pistachios, macadamia nuts, Brazil nuts, and coconut are technically classified as tree nuts, they are structurally different and less associated with allergic reactions (source). The tree nut protein components that cause reactions are often associated with that tree’s pollen. The oily outer layer of nuts can also be allergenic. Compared to other types of tree nuts, almonds have fewer allergenic proteins. One study found that less than 1% of children in the U.S. have tree nut allergies (source). Another found that in the U.S., Australia, Europe, and Latin America, the incidence of almond allergies is less than eight percent (source). Exceptions are higher rates are seen in Costa Rica and among specific populations in Germany, Spain, Sweden, and Switzerland. The allergenicity of almonds may be more related to how they are processed rather than to the nut itself. Wet heat processing increases reactions to almonds in those who are also allergic to birch trees (source). Dry roasting methods are more likely to produce anaphylactic reactions to almonds in those who are sensitive.
ELSE: An Almond-based Nutritional Product for Infants and Children
Because common food allergies in babies are increasing, an effort has been made to develop “allergy free” products for infants and children. The creators of ELSE formula and nutritional supplements offer a unique concept. Instead of cow’s milk or soy, ELSE is made with almonds and buckwheat, and can be ideal for those looking to avoid dairy and soy. Almonds provide an added benefit of a natural source of linolenic acid, an essential fatty acid important for growth and development. In addition, the processing techniques that increase the allergenicity of almonds are not used in its production. There are a variety of milk “alternatives on the market made from such ingredients as rice, oat, hemp, and peas. Unfortunately, they are often low in protein and high in sugar. ELSE has significantly less sugar than most of the current options on the market. It is also fortified with a variety of vitamins and minerals. ELSE is an ideal nutritional product for a variety of infants and children.
The content and advice provided in this article is for informational purposes only and is not a substitute for medical diagnosis, treatment, advice for specific medical conditions. Always consult a pediatrician to understand the individual needs of your child.
Disclaimer: Any infant or child with a known allergy, or potential allergy risk to nuts, should consult with an allergist before consuming ELSE.