Does my Baby have a Food Allergy or a Food Intolerance?  Why is a Food Allergy different from a Food Intolerance or a Food Reaction?

The process of any allergic reaction occurs when the body mistakes something like a food or pollen as a harmful and dangerous invader.  The body reacts by releasing antibodies called immunoglobulin E(IgE).  The IgE in turn prompts the body to release chemicals known as histamines. 

When the histamines are released, the body reacts by producing symptoms such as runny nose, itchy eyes, a skin rash and in severe cases, anaphylaxis. 

In a food allergy, the body's immune system is involved.

Top 8 Allergenic Foods that account for 90% of all Food Allergies: (http://www.foodallergy.org/allergens.html)  Milk Egg Peanut Tree nut (walnut, cashew, etc.) Fish Shellfish Soy Wheat (visit our Wheat page) Children may  "outgrow" food allergies to milk, eggs, soybean products and wheat. Please note that a Wheat Allergy is different from Gluten Intolerance! Gluten Intolerance (Celiac's Disease) is never outgrown and must be managed!  Children (and Adults) rarely outgrow allergies to peanuts, tree nuts, fish and shellfish.

What is a Food Reaction or Intolerance?

A food reaction or intolerance does not involve the immune system and often, a food that caused a reaction is easily tolerated at another time.  A good example of this is citrus fruits. 

Citrus fruits may cause a reaction or an intolerance in infants due to the high acidity of the fruit.  The infant does not react with an immune response rather the infant reacts with either a gastrointestinal response or a dermatological response.  Often times infants who are fed oranges prior to the age of 1 year old will break out in rashes around the mouth or bottom and possibly have tummy cramps.

Another example of a food intolerance is a lactose intolerance.  People who are lactose intolerant lack a specific enzyme that helps to digest the sugar (lactose) in dairy products.  Infants are often able to digest the lactose in dairy products like yogurt and cheese as the culturing of these products has broken down the lactose.  

In contrast with primary lactose intolerance, cow’s milk protein allergy affects young infants and usually resolves during the first year.  Learn About Updated Lactose Intolerance Statements from the AAP.

How to Spot a Potential Allergic Reaction

Here are several things you might note that may indicate baby has a potential allergic reactionor intolerance to a food.

• Sudden loose, diarrhea stools and/or vomiting

• Sudden rashes on the skin and bottom

• Runny Nose

• Hives

• Irritability and/or gassiness after a new food/meal

• Breathing or other respiratory troubles after a new food/meal

• Swelling of the Face, Lips and/or Tongue

• Closure or tightening of the throat

Remember, an intolerance to a food is not the same as an allergy to a food and it's symptoms typically involve trouble within the intestines.

The "4 Day Wait Rule and Allergies:

It is very important to follow the "four day wait" rule when introducing your baby to new solid foods.  When you introduce a new food over the course of several days, you are better able to determine exactly how your baby is reacting to that food.  This is most important if you and/or your family members have a history of food allergies.

Following the four day wait rule and introducing new foods one at a time will also enable you to easily begin an "elimination diet".  If you suspect your infant has had an adverse reaction to a new food, you will have just a few foods to look to as the culprit.

Introduce new foods during the morning or early afternoon.  This will enable you to deal with any adverse reactions when your pediatrician is in office. Should an adverse reaction occur during the morning/early afternoon, it will cause the least amount of disruption in baby's fragile routine. 

Many commercial baby foods as well as foods targeted to babies and toddlers contain allergenic ingredients! If your baby has a food allergy or your family has a serious history of food allergies - read the labels when purchasing commercial baby food!   A few examples: Cheerios (wheat, soy protein) Instant Infant Cereals (soy) Stage "2", "3" and Toddler Meals (wheat, soy, casein (milk protein), albumin (egg) Gerber "Puffs" (wheat, soy)

Why is Honey on Your "Least Allergenic" List and the List of Forbidden Foods?

On 13 January 2007 Charlene wrote to us questioning the foods listed on our Allergy page. "I am wondering why you have honey on the list of least allergic foods? Honey can KILL babies"

We realize that many parents may skip over the paragraphs and head straight to the lists. So honey is included on the list because it is NOT an allergenic food and many parents come looking for honey on our Allergy page!

Please note that some of the foods that appear on the list of "Least Allergenic" should not be introduced until a certain age.  While these foods may not be allergy causing, there may be other issues that make that food item inappropriate to give to an infant prior to a specific age. 

An example of this is honey; honey is not a known allergen however it may contain spores that are botulism inducing.  Honey should not be given to an infant prior to one year of age.  To learn more about honey, visit our Honey and Botulism Tips section.

Introduce new foods during the morning or early afternoon.  This will enable you to deal with any adverse reactions when your pediatrician is in office. Should an adverse reaction occur during the morning/early afternoon, it will cause the least amount of disruption in baby's fragile routine.   

Foods that may cause allergic reactions Dermatological or Anaphylactic	Foods least likely to cause allergic reactions
berries (not blueberries or cranberries!) chocolate cinnamon (may cause rashes) citrus fruits (acidic) coconut corn dairy products egg whites mustard nuts peas peanut butter pork shellfish soy strawberries wheat yeast	apples apricots avocados barley beets broccoli carrots cauliflower chicken cranberries dates grapes honey lamb lettuce mangoes oats papayas peaches pears poi raisins rice rye safflower oil salmon squash sunflower oil sweet potatoes turkey veal

PLEASE Note the Following When Reading the Above List:

On our Allergy page we list foods by their common “highest” and “lowest” allergen risk.  We also have a nice table at the bottom of the page that was developed by Janice M. Joneja, Ph.D., RD. 

Elizabeth had written to ask us why the lists on the Allergy page weren’t consistent.  

All lists vary by the numbers of food items as well as the scale of the allergy risk. 

The chart that we have above is a list of typical food allergens,  broken down by the generic “high” and “low”.  

These food allergens are not broken down with any specificity regarding high-higher-highest allergens for example.  

You will see that on the “high” list, peas share the space with peanuts yet peas do not pose as great a concern as peanuts. This list is more of a “generic” list in that foods are in the same categories yet,  they are not distinguished by allergenic levels.

Dr. Joneja compiled her more indepth and specific scale from research and experience in food allergies.  The foods on the scale are listed from the highest to the lowest allergenicity and are broken down into specific categories of allergenicity.

The nice table that is at the bottom of our allergy page was developed by Janice M. Joneja, Ph.D., RD.  In speaking to the different levels of allergenicity in foods, she says, “Nevertheless, we can make some generalizations about the degree of allergic potential (usually referred to as the allergenicity) of foods. I have developed an allergen scale (often referred to as the Joneja Food Allergen Scale), that has proved to be useful as a sort of comparative measure of the allergenicity of foods, based on the frequency of reactions in people eating a typical Western Diet.”   You may visit her site here http://www.allergynutrition.com to learn more about her and her publications.

Always keep in mind that your doctor or consulting allergist should be able to tell you the appropriateness of foods for your baby.

 

FREQUENTLY ASKED ABOUT FOODS:

Read About Egg Allergies

Wheat & Gluten

Wheat, Oats and Barley all contain Gluten.  Gluten in wheat is essentially the "allergen" culprit however a gluten intolerance is NOT the same as a wheat allergy! It is best to wait to introduce wheat until you are certain that your infant has no reactions to rice, oats or barley.

As Gluten is found in Rye, Oat, and Barley amongst other grains, if your infant has not had any reactions to the other grains you should be ok to introduce wheat between 8-10 months old; depending on your baby's allergy history. Always consult your pediatrician when introducing foods that may be an allergy risk!! Read more at  The Confusion Over Wheat

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Strawberries

Please note that the current recommendation for introducing strawberries is after a baby has reached 12 months of age. Many infants are introduced to strawberries earlier than 12 months old; most often when they have been eating Stage 2 commercial baby foods.

So why do many commercial baby foods marketed as "Stage 2" contain strawberries? Beech Nut commercial baby food states:

"Fresh strawberries can sometimes cause food reactions in babies. Cooked strawberries, on the other hand, usually do not. That's because heat pasteurization destroys the substance responsible for reactions. So Beech-Nut includes strawberries – pasteurized for safety and good tolerance"

Most pediatric resources will tell you to hold off on introducing strawberries until a baby is between 10-12 months of age. The early end of this age range takes into account the non-food sensitive and non-allergic baby. We urge you consult your personal pediatrician when it comes to introducing potential allergenic foods. As mentioned, there are some infants who are clearly not food-sensitive and your pediatrician might give the go-ahead for foods at an age earlier than the commonly recommended age.

The book Managing Food Allergy and Intolerance, (published for Health Care Professionals and The General Public) indicates introducing strawberries between 12 months and 24 months of age for the allergic/allergy prone infant. If you have any concerns regarding the introduction of strawberries (or other potentially allergenic foods) please consult your pediatrician!

Strawberries are acidic and may prompt rashes even in the infant who is not food-sensitive. When you do introduce strawberries, we would recommend introduction of a very small amount to begin with. Strawberries need only be mashed and served or cut into tiny pieces and served as finger food.

Visit our Strawbery Baby Food page to learn more about strawberries & allergies

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 Could my baby be allergic to Rice/Rice cereal It seems like she had a reaction to it!

Rice in particular is not a known "high" allergen in the US and most Western Countries and this is why it is typically recommended as an infant's first food (in the US that is).  If there is a rice allergy, studies show that the allergy is most often to the pollen of the rice and a reaction is triggered by the inhalation of the pollen - rice is a grass and may produce hay fever like symptoms.  Rice pollen has been know to cause allergies in those that live around rice fields.  Typically, if one is allergic to rice, then there will be sensitivities shown to other grains such as oats, barley, wheat and rye to name a few!  Rice may cause diarrhea in those that are sensitive to it however it is rare.

You will find that the early commercial Rice products offered to baby are fortified with iron and typically contain further additives. Commercial baby cereals that contain rice are typically of the "mixed" ingredient nature and may contain items such as soy and starch.  Infant jar foods that contain rice may contain items such as soy, modified corn starch, tapioca etc..  It may be that in the beginning, your baby had a sensitivity to something contained within the cereal or the jar that was not directly related to the rice.

EGG FREE DIET

Avoid foods that contain any of the following: albumin egg (white, yolk, dried, powdered, solids) egg substitutes eggnog globulin lysozyme (used in Europe) mayonnaise meringue ovalbumin ovomucin ovomucoid ovovitellin Simpleese Note: A shiny glaze or yellow glaze on  baked goods usually indicates the presence of egg.

SOY FREE DIET

Avoid foods that contain any of the following ingredients: miso shoyu sauce soy (flour, grits, nuts, milk, tofu soy bean sprouts) soybean (granules, curd) soy protein (concentrate, isolate) soy sauce textured vegetable protein (TVP) tofu Ingredients that MAY indicate the presence of soy protein: flavorings hydrolyzed plant protein hydrolyzed soy protein hydrolyzed vegetable protein natural flavoring vegetable broth vegetable gum vegetable starch Studies show that most soy allergic individuals may safely eat products containing soy lecithin and soy oil.

WHEAT/GLUTEN FREE DIET

Avoid foods that contain any of the following: Please note that this list is a compilation of the most common but not ALL the possible wheat/gluten foods and ingredients! bread crumbs bran cereal extract acker meal enriched flour farina semolina durham gluten high gluten flour high protein flour vital gluten wheat bran wheat gluten wheat starch whole wheat flour oats barley Ingredients that MAY indicate the presence of wheat protein: gelatinized starch hydrolyzed vegetable protein modified food starch modified starch natural flavoring soy sauce starch vegetable gum vegetable starch

MILK FREE DIET

Food completely without diary products will say "Parve" on the package. You will usually find these foods in the kosher section amongst your other favorite sections in your local grocers.   A "D" on a product label next to a "K" or circled "U" may indicate the presence of milk protein. Avoid foods that contain any of the following: artificial butter flavor butter, butter fat, buttermilk casein caseinates (ammonia, calcium, magnesium, potassium, sodium) cheese cottage cheese curds custard half and half hydrolysates (casein, milk protein, protein, whey, whey protein) lactalbumin, lactalbumin phosphate lactoglobulin lactose milk (derivative, protein, solids, malted, condensed, evaporated, dry, whole, low fat, non fat, skim) nougat pudding rennet casein sour cream, sour cream solids sour milk solids whey (delactosed, demineralized, protein concentrate) yogurt Ingredients that MAY indicate the presence of milk protein: brown sugar flavoring caramel flavoring chocolate high protein flour margarine natural flavoring Simplesse

TREE NUT FREE DIET

Avoid foods that contain nuts or any of these ingredients: almonds brazil nuts cashews chestnuts filberts / hazelnuts gianduja (a creamy mixture of chocolate and chopped toasted nuts found in premium or imported chocolates) hickory nuts macadamia nuts marzipan / almond paste nougat Nu-Nuts artificial nuts nut butters, i.e. cashew butter nut oil nut paste, i.e. almond paste pecans pine nuts (pinyon nuts) pistachios walnuts Nu-Nuts are artificial nuts that really are peanuts that have been deflavored and reflavored with a nut like pecan or walnut. Filberts are hazelnuts. Avoid natural extracts such as pure almond extracts, and natural wintergreen extract (for filbert/hazelnut sensitive). Use imitation or artificial flavored extracts.

PEANUT FREE DIET

Avoid foods that contain any of these ingredients: cold pressed peanut oil ground nuts mixed nut Nu-Nuts artificial nuts peanut peanut butter peanut flour Foods and ingredients that MAY indicate presence of peanut protein: African, Chinese, Thai and other ethnic dishes baked goods (pastries, cookies, etc..) candy chili chocolate (candy, candy bars) egg rolls hydrolyzed plant protein hydrolyzed vegetable protein marzipan nougat Peanuts are very allergenic and can cause a life threatening anaphylactic (general body) reaction.

 

The Joneja Food Allergen Scale

Thiis table is based on the typical North American diet and compiled from a wide variety of sources. Foods are listed from the highest to the lowest allergenicity. People vary in their reactivity to foods and show a different pattern of reactivity depending on their individual characteristics. Persons following ethnic diets tend to show a different order of allergenicity. Allergenicity depends on a variety of factors including frequency of exposure to the food. Visit Dr. Jonja's site to learn more.

 

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Fresh Start - So Easy Baby Food Kit