Managing Your Child’s Food Allergies on a Plant-Based Diet
When you’re a parent, dealing with food allergies can be stressful. How can you manage food allergies, while still providing a safe, nutritious plant-based diet for your family? It’s tough! That is a picture above of my oldest son, Christian, at his birthday party at school many years ago. Birthday parties were always fraught with anxiety, because you had to make sure you weren’t including any ingredients in the cupcakes that might set off someone’s food allergy. But perhaps dealing with food allergies is not as difficult as it once was, thanks to the latest science on how to introduce foods to babies in order to avoid food allergies. That’s why I invited food allergy expert Sherry Collins, MS, RD to stop by my blog to give some of her latest advice on the new science on food allergies.
Sherry Coleman Collins is a masters-level registered dietitian nutritionist who specializes in converting the science of nutrition into bite-size nuggets for consumers and professionals. Her experience includes clinical pediatrics, school foodservice, and working with individuals of all ages. She consults as the nutrition and food allergy expert for the National Peanut Board, providing education for experts across the country, including educators, school nutrition professionals, dietitians, nurses, and other health professionals.
Check out my interview with Sherry on what you can do about managing food allergies for your children, especially if you are eating a plant-based diet.
Sharon: What are some concerns regarding allergies in infants and children for plant-based families?
Sherry: I think that every family has concerns about the development of food allergies, if they think about it. This is especially true in families that are already impacted by someone else’s allergy–perhaps a family member or close friend. For those choosing to eat a plant-based diet – particularly those who are vegetarian or vegan, having to eliminate an important source of protein (e.g., milk, peanuts, tree nuts, or soy) could have significant nutritional implications, as well as make meal-planning much more challenging.
Sharon: The old thought was to avoid common food allergies from the start, but what is the new thought on this?
Sherry: We now know that avoiding allergens does not prevent food allergies from developing. Previous recommendations were an effort to prevent them, but there was never any actual research that showed avoidance reduced the risk for developing food allergies.
Sharon: Why has this changed? What is the new evidence?
Sherry: In 2015, the Learning Early About Peanut allergies (LEAP) study was published in the New England Journal of Medicine. In the study, researchers found that early introduction (between 4-11 months old) of peanut foods reduced the risk of developing peanut allergies by up to 86% in infants at high risk–those who had already developed egg allergy or those with severe eczema. The study was so impactful that every major allergy and pediatric organization worldwide now endorses early introduction of peanuts to prevent peanut allergies. In fact, in 2017 the National Institute of Allergy and Infectious Disease (NIAID) released guidelines encouraging the adoption of these recommendations.
Sharon: What should parents do about introducing potential food allergens?
Sherry: First, parents need to know their infant’s risk. Children with egg allergy or severe eczema should be evaluated by their pediatrician or by an allergist prior to introducing peanut foods. In some cases, a physician may want to test for peanut allergy first or perform a skin test to assess the risk. A small number of infants may need the first introduction of peanut foods in the physician’s office under supervision. Once cleared, this group of high risk infants should start eating peanut foods at around 4-6 months of age. Peanut foods should be kept in the diet of these infants in the amount of 2g (e.g. 2 teaspoons of peanut butter), three times per week (6g/week total). Infant with mild-moderate eczema should begin eating peanut foods at around 6 months and can do so without pre-screening, but parents can certainly discuss with their doctor first if they prefer. Finally, children without eczema or existing allergy should begin eating peanut foods in an age-appropriate way in accordance with family preferences and cultural practices. Peanut foods should be eaten early and often to help reduce the risk of developing peanut allergy.
Sharon: What guidelines should they use to introduce foods safely?
Sherry: It is important to be sure that an infant is ready to begin solid foods. They should be sitting up with a little support and have good head and neck control. Showing an interest in food (e.g., watching intently when you eat in front of them, leaning in for a bite, and mimicking chewing) is a good sign of readiness. Start slowly with just a ¼-½ teaspoon of peanut butter mixed into applesauce the first time. Feed the baby early in the day when you can watch for signs of an allergic reaction. Try again later in the day if there’s no reaction. After that, move up to a full infant serving. Don’t introduce new foods when the baby is fussy or ill, because you don’t want to mistake a virus or teething with a food allergy reaction. Be sure that the servings are always infant-safe in form. Infants should not be given whole peanuts or large dollops of peanut butter. Instead, feed babies thinned peanut butter (2 teaspoons of peanut butter + 2 Tbs warm water or breastmilk), or 2 tsp powdered peanut butter in puree or cereal, or try a peanut teething puff (e.g. Bamba). Always stay nearby and observe when babies are eating.
Sharon: What should parents do if they have a history of allergies or if their children are at high risk?
Sherry: Parents of children at high risk (as previously described) should discuss introducing peanut foods to their infants before they begin.
Check out some of Sherry’s favorite resources for understanding allergies:
- preventpeanutallergies.org
- How to introduce https://preventpeanutallergies.org/how-to-introduce/ (has step by step, videos, and recipes)
- peanutallergyfacts.org
- Infographic with 5 easy ideas for early intro https://peanutallergyfacts.org/wp-content/uploads/2017/05/EarlyIntro_April18.jpg
- NIAID Addendum Guidelines for the Prevention of Peanut Allergy in the United States https://www.niaid.nih.gov/diseases-conditions/guidelines-clinicians-and-patients-food-allergy
