A Parent’s Guide to Food Allergies Trends, Management, and Prevention by with Katie Marks-Cogan MD, Board-Certified Allergist 1 in 12 children develop a food allergy every year. Our mission is to provide parents with tools to prevent up to 80% of food allergies with expert-driven, evidence-based education about food allergies and prevention.
Making it Easy to Help Prevent 4 out of 5 Food Allergies
Our goal is to help parents protect their children from food allergies. Learn more about how we make it easy to follow the medical guidelines on food allergy prevention at readysetfood.com Evidence-Based Our gentle, guided system of food allergen introduction is based directly on the protein amounts used in the landmark studies Trusted Developed by an allergist-mom and recommended by leading pediatricians, our system introduces one food at a time, in accordance with pediatric guidelines Gentle Our system starts with a very small amount of each food before gradually increasing the dose, as recommended by allergists Easy Add a daily packet to your baby’s bottle or food: it’s now so easy to follow the new medical guidelines for food allergy prevention
Shortcuts to Your Most Common Questions: P10-11 What does an allergic reaction look like? P14 What’s a food allergy vs. an intolerance? P29 What’s my baby’s risk of developing a food allergy? P34 Is there a cure for food allergies? P44-45 How can I prevent food allergies before they start?
Table of Contents 09 About Food Allergies 17 Food Allergy Trends 27 Risk Factors 33 Management and Treatment 43 Food Allergy Prevention 53 FAQs, Glossary
All of the content in this book was developed in coordination with our Medical Advisory Board. Jonathan Spergel, M.D. Board-Certified Allergist • Chief of Allergy Section at Children’s Hospital of Philadelphia (CHOP) • Professor of Pediatrics at University of Pennsylvania School of Medicine • Member of the Clinical Advisory Board for Food Allergy Research & Education (FARE) Katie Marks-Cogan, M.D. Board-Certified Pediatric and Adult Allergist • Chief Allergist for Ready, Set, Food! “As a board-certified allergist, I’ve seen firsthand how families struggle with food allergies. Thankfully, findings from recent landmark studies have opened our eyes to new ways of thinking about allergy prevention in children. These studies have shown that introducing infants to common allergenic foods (peanut, egg, and milk) early and frequently can help reduce their risk of developing a food allergy by up to 80%. Because there is currently no cure for food allergies, prevention is our best defense. This is why I’m so passionate about Ready, Set, Food!: we focus on prevention of food allergies to give families the best head-start for an allergy-free future.” A Parent’s Guide to Food Allergies readysetfood.com
Gary Rachelefsky, M.D. Board-Certified Pediatric Allergist • Former President of the American Academy of Allergy, Asthma, and Immunology (AAAAI) • Former Professor of Allergy at UCLA Medical School Steven Czinn, M.D. Board-Certified Pediatric Gastroenterologist and Immunology Specialist • Chairman, Department of Pediatrics at University of Maryland School of Medicine • Chair of Pediatrics at the University of Maryland Medical Center (UMMC) Robert Hamilton, M.D. Board-Certified Pediatrician of 26 years • Known for his viral video “How to Calm a Crying Baby” • Founder of Lighthouse Medical Missions: led 22 medical mission teams to Africa in nearly 20 years. 7
About Food Allergies In this section, you’ll learn what food allergies are—and what they aren’t— in addition to how to recognize the symptoms and seek appropriate testing from a healthcare professional. 9
What Is A Food Allergy? A food allergy occurs when the body’s immune system mistakenly responds to certain foods that it thinks are harmful. Our immune systems defends and protects us from foreign invaders like certain viruses and bacteria. Food allergies occur when the immune system over-defends and treats certain proteins in foods as foreign invaders. These proteins are called allergens and our immune systems makes special allergy antibodies called IgE antibodies to these allergens to help fight them off. These antibodies trigger a reaction each time a person eats a food they are allergic to. Symptoms Of A Food Allergic Reaction A food allergic reaction can lead to symptoms like hives, swelling of lips/tongue, stomach upset, breathing problems, and other symptoms. In babies, hives and vomiting are the most common symptoms of a food allergic reaction. These symptoms usually occur within seconds to minutes and almost always within 2 hours. In addition, one reaction can vary widely from the next in the same person. Food allergies are most common in children, but a food allergy can occur at any age. A Parent’s Guide to Food Allergies readysetfood.com
Food Allergy Reaction Symptoms Affected Body Part Symptoms Skin Redness, itching, hives, red bumps, swelling beneath skin Eyes Itching, tearing, redness, swelling Respiratory around eyes Mouth Nasal congestion, itching, runny nose, sneezing, swelling of voice box, hoarseness, cough, chest tightness, shortness of breath, wheezing Swelling of lips, tongue, or palate, itching in the mouth Gastrointestinal Nausea, colicky abdominal pain, reflux, vomiting, diarrhea Cardiovascular Rapid heartbeat, low blood pressure, dizziness, fainting, loss of consciousness What is anaphylaxis? ! When the symptoms are severe and involving more than one organ system, it’s classified as anaphylaxis, and this can be life-threatening. 11
IgE-mediated v. Non-IgE mediated food allergy IgE-mediated food allergy is different than non-IgE mediated (delayed-type) food allergy. • For instance, some infants have a delayed allergy to milk, which can cause blood and mucus in the stool hours to days after the ingestion of milk. • Another example is Food protein-induced enterocolitis syndrome (FPIES) which is a non-IgE mediated disorder that usually occurs in young infants. Symptoms include chronic vomiting, diarrhea, and failure to gain weight or height. When the allergenic food is removed from the infant’s diet, symptoms disappear. Milk and soy protein are the most common causes. Classification of food hypersensitivity Food Hypersensitivity Food Non-allergic food Allergy intolerances IgE-mediated Non-IgE mediated food allergy food allergy A Parent’s Guide to Food Allergies readysetfood.com
Food Allergy Testing Validated food allergy tests like skin prick tests or blood tests look for the presence of IgE antibody. If the tests are positive, they show that a person produces IgE antibodies to food allergens. But blood and skin tests alone cannot be used to diagnose food allergy. A person does not have a food allergy unless they also have clinical symptoms. There is also a chance that a person could have a “false positive” on their skin or blood test. The only way to definitively diagnose a food allergy is with an oral food challenge. This test exposes a person to their potential allergenic food in small doses, slowly increasing over time with careful observation in a medical facility to watch for signs of an allergic reaction. The only way to definitely diagnose a food allergy is with an oral food challenge. However, oral food challenges can be risky, thus many times they are avoided and a diagnosis is made based on the other tests above plus the person’s medical history. A patient’s medical history (their reported experiences after exposure to the specific food) is the most important part of the evaluation for a food allergy diagnosis. 13
What is a Food Intolerance? Food intolerances are adverse health effects caused by foods. They do not involve the immune system. The term food intolerance is often used interchangeably with the term food sensitivity. Reactions to food (from a food intolerance) can include: Metabolic (lactose intolerance) Inability to digest lactose, a prominent sugar found in milk, can lead to gas, bloating, and diarrhea Pharmacologic (caffeine) Jitteriness, etc. Toxic (scombroid poisoning) Ingestion of fish with high histamine levels due to improper handling Undefined mechanisms Gluten intolerance Food intolerances are rarely ever life-threatening, but IgE- mediated food allergic reactions can be life-threatening. Isolated respiratory (runny nose, asthma, chronic cough, etc.) or gastrointestinal symptoms (abdominal pain, bloating, gas) should lead to questioning of the diagnosis of food allergy, as these symptoms rarely occur alone in IgE-mediated food allergy. A Parent’s Guide to Food Allergies readysetfood.com
Food Intolerance Testing There is no validated test to diagnose a food intolerance or sensitivity. Eliminating the suspect food, monitoring for resolution of symptoms, and then reintroducing the food is the only way to determine sensitivity to a food. Food Intolerance Testing Tests marketed as “Food Sensitivity Tests” measure IgG antibody, which is a normal response to a food. However, consumers should note that: • These tests have never been validated by scientific evidence • In fact, higher levels of IgG4 to foods may actually be associated with tolerance • Many national/international allergy groups have recommended against their use Gluten-Related Disorders There is a spectrum of gluten-related disorders, ranging from intolerances to celiac disease. There is no such thing as a “gluten allergy.” Learn more about gluten-related disorders from our Chief Allergist here. 15
Food Allergy Trends In this section, you’ll learn about the rise in food allergies and the major food allergens involved. 17
Food Allergies Are On the Rise Food allergies are on the rise and have reached epidemic proportions, with 32 million, or more than 1 in 10 in the US, now suffering from a food allergy. Not only are food allergies inconvenient for families to manage, but one accidental exposure can have potentially life-threatening consequences. In fact, more than 40% of food allergic children have experienced a severe reaction. Major Food Allergens Although more than 170 foods have been identified as triggers of food allergy, the FDA classifies 8 foods/food groups as the major food allergens in the US: milk, egg, peanut, tree nuts, shellfish, fish, wheat, and soy. Sesame is becoming an emerging concern and the FDA is considering including it as the 9th major food allergen in the US (Canada, Australia, New Zealand, and the EU already list sesame as a major food allergen). In young children, milk, egg, and peanut comprise > 80% of food allergies. Not only do these represent the most common childhood food allergies, but studies indicate that with early introduction, there can be a significant reduction in the development of an allergy to these foods. See our chapter on Prevention to learn more. A Parent’s Guide to Food Allergies readysetfood.com
32 million Americans have food allergies > 1/10 1/12 Children > 80% of childhood food allergies are Egg Milk Peanut 19
A Parent’s Guide to Food Allergies readysetfood.com
Top Allergens Affecting Children Egg • Affects 2% of children • Usually presents in the 1st year of life • ~ 50% of children do not “outgrow” (or become tolerant to) their egg allergy, which often happens as late as teenage years. Milk and egg are Milk the hardest to avoid, • Most common food allergy in infants causing a significant impact on a child’s and young children • Affects 2-3% of children, < 3 years old quality of life. • Usually presents in 1st year of life • Though most children “outgrow” (or become tolerant to) their milk allergy, it remains the most common cause of reactions in school Peanut allergy Peanut is most often • Affects up to 2% of children associated with severe or fatal • Peanut allergy is more likely to be lifelong; only 20% outgrow a reactions peanut allergy • Although peanut is the allergen most often associated with severe or fatal reactions, any food allergen has the potential to cause anaphylaxis. 21
Top Allergens (cont.) Shellfish • Affects 1-1.5% of children • Includes shrimp, lobster, squid, crab, scallops • Often caused by a protein called tropomyosin • Even the steam from cooking can trigger an allergy Fish • Affects 0.5% of children • Up to 40% of fish allergies develop in adulthood • May be allergic to finned fish and not shellfish or vice versa Soy • Affects 0.4% of children, normally under the age of 3; Affects 0.3% of the general population • 70% outgrow it by age 10 • Found in many food products, so it’s important to read the labels A Parent’s Guide to Food Allergies readysetfood.com
Wheat • Affects 0.4% of children • Often outgrown by 10 years of age • Not to be confused with celiac disease. People with a wheat allergy can often have other grains that are not wheat. • Wheat is sometimes found in cosmetic products. People with wheat allergies should avoid using these products on their body. Tree Nuts • Affects 1% of the general population • Many people with tree nut allergies are only allergic to 1 or 2 types of tree nuts. Therefore, it’s worth working with an allergist to determine if they can safely eat other types of tree nuts. • Includes brazil nuts, cashews, pistachios, almonds, macadamia nuts, walnuts, pine nuts (as well as foods made with these nuts) Any food allergen has the potential to cause anaphylaxis. 23
The Economic Impact of Food Allergies Parents of food allergic children can face costs of up to $4,200 every year per child according to a 2013 study, accounting for direct medical care; out of pocket cost for special foods, lost labor productivity and opportunity costs (reduced labor productivity of caregivers). The Impact on A Child’s Quality of Life 1. Social Exclusion & Activity Avoidance Children with food allergies, particularly milk and egg, can find many social events (e.g. birthday parties) difficult and isolating. 2. Bullying About 1 in 3 children with food allergies has been bullied at least once, according to a 2014 study. Roughly a third of those children were reported to be bullied at least twice a month. 1 in 3 children with food allergies has been bullied A Parent’s Guide to Food Allergies readysetfood.com
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Risk Factors Food allergies develop from a combination of genetic and environmental factors (such as changes in lifestyle and diet). With many things to consider, in this section you’ll learn about the latest research on risk factors and food allergy development. 27
All Babies Are At Risk Babies aren’t born with food allergies; they develop over time. In fact, over 50% of children diagnosed with a food allergy do not have a direct family member with a food allergy. That’s why, according to the new medical guidelines on food allergy prevention, early allergen introduction is recommended for all babies. See our chapter on Prevention to learn more. While there are some factors that increase the risk, it’s important to note that all babies are at risk for developing food allergies. General Population: Everyone is at risk for developing a food allergy, with 1 in 12 children suffering from a food allergy today. A Parent’s Guide to Food Allergies readysetfood.com
Food Allergies What is your baby’s risk? Baseline 1 in 12 Risk Family 1 in 7 History Delayed up 1 in 4 Allergen to Exposure Eczema 1 in 3 29
Risk Factors that cannot be changed 1. Family History: One study suggests that if you have a sibling with a food allergy, your risk of developing one is 13% -- compared to more than 10% in the general population. 2. Eczema (Atopic Dermatitis): While the above risk factors do play a role in determining your child’s risk, eczema (atopic dermatitis), is the most important risk factor to consider. That’s because research shows that infants with eczema are at the highest risk for developing food allergies. Food allergy does not cause eczema, although it can worsen the symptoms. Moreover, up to 67% of infants with severe eczema, and 25% of infants with mild eczema, will develop a food allergy. That’s why new guidelines from the AAP and NIH on infant food allergy prevention are specifically focused on infants with eczema: these infants need food allergy prevention, and in turn, early allergen introduction, the most. However, parents of infants with severe eczema are recommended to consult with their pediatrician before introducing allergenic foods. A Parent’s Guide to Food Allergies readysetfood.com
Risk Factors that can be changed 1. Timing of Allergen Introduction: Delaying the introduction of allergenic foods into an infant’s diet can increase their risk of food allergies. Multiple studies have shown that feeding infants allergenic foods, like egg and peanut, early and often can decrease their risk of developing a food allergy by up to 80%. 2. Hygiene Theory: Improved hygiene, and therefore, decreased exposure to certain germs, has made it harder to “train” the immune system to be able to tell the difference between good and bad germs. This has caused the immune system to overreact to even harmless substances (like food proteins) and cause allergies in certain people. Scientists are also actively exploring the role of hygiene and the microbiome in the development of food allergies. 3. Vitamin D: Studies suggest Vitamin D deficiency may increase a baby’s risk of developing food allergies. Some of these studies show that children exposed to less sunlight (e.g., living further from the equator) are more likely to develop a food allergy. Delaying food allergen exposure puts your child at a greater risk for developing food allergies. 31
Management and Treatment In this section, you’ll learn about important steps families can take to manage a food allergy, in addition to new research and exciting possibilities for food allergy desensitization treatments. 33
Avoidance and Nutritional Counseling Currently, there is no cure for food allergy. The cornerstone of treatment for an IgE-mediated food allergy is strict avoidance and nutritional counseling. (Exception: some people with milk or egg allergies can tolerate baked versions of these foods.) A high level of education is needed for everyone involved in order to maintain safety, including: • Label-reading (Learn more here) • Identifying hidden ingredients • Preventing cross-contact • Recognizing early signs of anaphylaxis and when to use epinephrine Common Sources of Hidden Ingredients Allergens are easily hidden in common foods. For example, EGGS are found in the following: Mayonnaise, meringue, egg substitutes, cake mixes, frosting, pasta, salad dressing, meatballs, sauces, ice cream, glaze on soft pretzels… A Parent’s Guide to Food Allergies readysetfood.com
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Severe Allergic Reactions If a person with food allergies is exposed to a food allergen, they can experience anaphylaxis, a severe, life-threatening allergic reaction. What is anaphylaxis? Anaphylaxis occurs when more than one organ system is involved in the reaction. See page 11 for the list of organ systems that can be involved. Each year in the U.S., it is estimated that anaphylaxis to food results in: 30,000 emergency room visits 2,000 hospitalizations 150 deaths Prompt administration of epinephrine by autoinjector (e.g., EpiPen) during early symptoms of anaphylaxis may help prevent these serious consequences. A Parent’s Guide to Food Allergies readysetfood.com
Treating Severe Allergic Reactions: Epinephrine Epinephrine is the only medication that can stop anaphylaxis and is life-saving. • Three different doses: 0.1mg, 0.15mg, and 0.3mg based on the person’s weight • Immediate evaluation in the ER for monitoring after use • Biphasic reactions (a secondary reaction): can occur 4 to 24 hours after the initial reaction in 10-15% of people and therefore two epi auto-injectors are required at all times • Antihistamines (Benadryl, Zyrtec, Xyzal, Allegra, Claritin), steroids (Prednisone) and inhalers (Albuterol) are not used for first-line treatment in anaphylaxis - They are additional medications that can improve symptoms, but they will not stop anaphylaxis Action Plan: Every patient/family should have a personalized action plan. (FARE offers resources for these here.) In addition, creating a 504 plan for school-aged children with food allergies can be very helpful. 37
Emergency Care Food Allergy & Anaphylaxis Emergency Care Plan Here are common symptoms and treatment information in case of an allergic reaction. Please always consult with your physician to discuss recommended treatment. For any of the following mild symptoms For mild symptoms from more than one system area, give epinephrine. For mild symptoms from a single system area, follow the FARE directions. Nose Mouth Itchy or runny nose, Itchy mouth sneezing Gut Skin Stomach upset A few hives, mild itch A Parent’s Guide to Food Allergies readysetfood.com
For any of the following severe symptoms INJEC T EPINEPHRINE IMMEDIATELY. Call 911. Tell emergency dispatcher the person is having anaphylaxis and may need epinephrine when emergency responders arrive. Lung Heart Shortness of breath, wheezing, Pale or bluish skin, faintness, repetitive cough weak pulse, dizziness Throat Mouth Tight or hoarse throat, trouble Significant swelling of the breathing or swallowing tongue or lips Skin Gut Many hives over body, Repetitive vomiting, widespread redness severe diarrhea Other / Emotions Any Combination Feeling something bad is about to of symptoms from different happen, anxiety, confusion body areas 39
Immunotherapy: Food Desensitization Treatments While there is a lot of new research and exciting possibilities for food desensitization treatments, all of the below treatments have risks and benefits. Additionally, it is currently unknown if these treatments can successfully achieve tolerance, which is the ability to permanently tolerate ingesting the food. There is still no true “cure” for food allergies. There is still no true “cure” for food allergies. Current research focused on food desensitization includes: • Oral Immunotherapy (OIT): Small doses of the allergenic food are given to the patient and the amounts are slowly increased over time until a target dose is reached. • Sublingual Immunotherapy (SLIT): Similar to OIT, liquid form of food allergen given under the tongue. SLIT may not work as well as OIT but is associated with fewer side effects. • Epicutaneous Immunotherapy (EPIT): A patch that contains the food allergen is applied to the skin and releases tiny amounts of the food allergen into the skin. A Parent’s Guide to Food Allergies readysetfood.com
Allergic When the body’s immune system mistakenly responds to certain foods that it thinks are harmful. Desensitized An increase in reaction threshold to a food allergen while receiving months of continued, active therapy that may equal protection from accidental ingestion. Sustained Unresponsiveness After several years of therapy, a lack of clinical reaction to a food allergen after active therapy has been discontinued for a period of time. Has been seen in only subsets of treated subjects. Requires some level of continued allergen exposure. Tolerance A complete lack of clinical reactivity to an ingested food allergen, not depending on continued food allergen exposure. 41
Food Allergy Prevention In this section, you’ll learn about how we now can prevent up to 4 out of 5 food allergies before they start, according to recent clinical trials and new medical guidelines from the AAP and NIH. 43
What is Early and Sustained Allergen Introduction? Thanks to recent clinical trials and new medical guidelines, we now know we can prevent up to 4 out of 5 food allergies before they start! 1. Starting Early: Based on the research, health organizations from around the world are recommending allergen introduction as early as 4 months of age. 2. Continuing for Several Months: Feeding your baby allergenic foods once or twice has not been shown to reduce the risk of developing a food allergy. Therefore, even more important than starting early is continuing to frequently feed your baby these allergenic foods multiple times a week over many months. A Parent’s Guide to Food Allergies readysetfood.com
Early and Frequent Feeding is Difficult… • Many infants are not developmentally ready to regularly eat solid foods at 4-6 months. • Infants are picky eaters, so maintaining exposure to specific foods can be challenging. • In the largest clinical trial, more than 50% of parents were unable to sustain exposure, and therefore did not see food allergy reduction. Learn more about how Ready, Set, Food! makes it easy here. 45
International Medical Guidelines for Food Allergy Prevention International medical societies have issued guidelines for early and sustained allergen introduction for food allergy prevention. ! Australasian Society of Clinical Immunology and Allergy (ASCIA) 2016 “All infants should be given allergenic solid foods including peanut butter, cooked egg, dairy and wheat products in the first year of life. This ! includes infants at high risk of allergy.” 2017 National Institutes of Health (NIH) “Recent scientific research has demonstrated that introducing peanut-containing foods into the diet during infancy can prevent the development of peanut allergy.” ! American Academy of Allergy, Asthma, and Immunology (AAAAI) “The guidelines now recommend that children at high risk should be introduced to peanuts early in life, instead of avoiding all peanut-containing foods.” ! National Institute of Allergy and Infectious Diseases (NIAID) “Early introduction of peanut will result in the prevention of peanut allergy in a large number of infants.” A Parent’s Guide to Food Allergies readysetfood.com
! U.S. Food and Drug Administration (FDA) “Introducing foods containing ground peanuts between 4 and 10 months of age and continuing consumption may reduce the risk of ! developing peanut allergy by 5 years of age.” The British Society for Allergy and Clinical 2018 Immunology (BSACI) “In babies at higher risk of food allergy, studies have shown that starting egg and peanut earlier - from 4 months of age - can help prevent food ! allergy to egg and peanut.” 2019 American Academy of Pediatrics (AAP) “There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond 4 to 6 months prevents atopic disease. There is now evidence that early introduction of peanuts may prevent ! peanut allergy.” Canadian Paediatric Society (CPS) “There is emerging evidence that early food introduction, between 4 to 6 months of age, may have a role in preventing food allergy...” “I recommend early and sustained allergen introduction for all babies.” Jonathan Spergel, M.D., Board-certified Pediatric Allergist, Head of Allergy at Children’s Hospital of Philadelphia 47
Landmark Clinical Trials Learning Early About Peanut Allergy (LEAP) Key Outcomes: An 81% reduction of peanut allergy in high- risk infants who consumed the study-recommended amount of peanut protein per week for the suggested time period. Preferred peanut source was Bamba, a snack food manufactured from peanut butter and puffed maize. Smooth peanut butter was provided to infants who did not like Bamba. Takeaways: LEAP established that sustained introduction of peanut beginning in the first 11 months was highly effective in preventing the development of peanut allergy. A follow-up study (LEAP-ON) later demonstrated that the same infants remained allergy-free through their 4th year of avoiding peanuts. LEAP Study EAT Study PETIT Study 81% 67% 79% Reduction Reduction Reduction in peanut allergies in multiple food in egg allergies allerges A Parent’s Guide to Food Allergies readysetfood.com
Enquiring About Tolerance (EAT) Key Outcomes: A 67% reduction in the prevalence of overall food allergy, 100% reduction in peanut allergy, and 75% reduction in egg allergy in the early introduction group Takeaways: Early introduction of allergenic foods starting at 3 months compared to starting after 6 months was both safe and demonstrated a significant reduction in food allergy prevalence, suggesting that there are more benefits to introducing allergens earlier rather than later and as early as 3 months. One of the key findings from the study established that early allergen introduction did not negatively impact breastfeeding practices. However, study participants could only achieve 50% compliance with protocol, indicating that early and sustained introduction was difficult to achieve at such a young age. Prevention of Egg Allergy with Tiny Amount Intake (PETIT) Key Outcomes: A 79% reduction in egg allergy prevalence among infants with eczema who consumed the study- recommended amount of cooked egg protein per week Takeaways: Stepwise introduction of egg safely and effectively prevents the development of egg allergies in children. Delaying introduction of egg may actually increase the incidence of food allergies. 49
5 Key Rules For Early Allergen Introduction To Prevent 4 out of 5 Food Allergies: 1. Start Early: Studies recommend starting as early as 4-6 months, to align with a critical immune window, giving your infant the best opportunity to develop a positive response to new foods. 2. Introduce One Food At A Time: Following pediatric guidelines, only introduce allergenic foods one at a time every few days, to determine how the baby is reacting to each new food. Ready, Set, Food! introduces one new food at a time, in accordance with these guidelines. 3. Start with a Low Dose, Then Gradually Ramp Up Dosage: The PETIT study and leading pediatricians recommend this dosing as it maximizes safety and efficacy. Ready, Set, Food! aligns with this guidance, as it starts with a low dose and gradually increases to the full dose. 4. Continue Multiple Times A Week For Several Months: Clinical trials exposed infants to allergenic foods 2-7 times a week for 3-6+ months. Families unable to maintain this frequent feeding did not see any benefit of food allergy prevention. 5. Keep Going, Despite Difficulties: Many 4-6-month-olds are not ready to eat solid foods regularly and can be picky eaters. Despite these difficulties, continuing allergen introduction is crucial. For long-lasting immunity, research shows that “educating” an infant’s immune system over time is vital to creating tolerance. A Parent’s Guide to Food Allergies readysetfood.com
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