Allergy prevention in infants

Main message

• Do not exclude common allergenic foods from:
  • the mother’s diet during pregnancy
  • the mother’s diet while breastfeeding
  • the infant’s diet in the first 12 months
• Food avoidance to prevent allergy is outdated and not supported by current evidence.

Key clinical principle

• Early introduction, not avoidance, is recommended.
• Common allergenic foods should be introduced when the infant is developmentally ready for solids, usually around 4–6 months, and before 12 months.
• Once tolerated, these foods should be continued regularly, for example at least twice weekly, to help maintain tolerance.

Common allergenic foods

Common allergenic foods include:

• Egg
• Peanut
• Cow’s milk/dairy
• Tree nuts, such as cashew or almond paste
• Soy
• Sesame
• Wheat
• Fish
• Shellfish/other seafood

Maternal diet: pregnancy and breastfeeding

Do

• Encourage a healthy balanced diet.
• Include common allergenic foods unless the mother herself has an allergy or intolerance.
• Do not restrict maternal diet purely to prevent allergy in the baby.

Do not

• Do not advise pregnant or breastfeeding women to avoid egg, peanut, milk, wheat or other allergens to prevent infant allergy.
• Avoidance diets may increase nutritional risk and are not effective for allergy prevention.

Infant feeding

Do

• Introduce common allergenic foods in the first year of life.
• Introduce one allergenic food at a time, preferably at a meal, so the trigger can be identified if a reaction occurs.
• Use age-appropriate forms:
  • smooth peanut butter or peanut paste, not whole nuts
  • fully cooked egg
  • dairy/wheat/soy/sesame/fish in safe texture forms
• Continue tolerated foods regularly.

Do not

• Do not delay allergenic foods beyond 12 months.
• Do not use hydrolysed formula, soy formula or goat’s milk formula for allergy prevention.
• Do not use PPIs or H2 blockers for simple infant reflux, due to poor efficacy and possible increased food allergy risk.

Peanut allergy prevention

• Infants with severe eczema or egg allergy are at higher risk of peanut allergy.
• These infants should have peanut introduced in the first 12 months, following an appropriate structured approach.
• Regular peanut intake before 12 months in high-risk infants reduces the risk of developing peanut allergy.

Egg allergy prevention

• Introducing cooked egg before 8 months may reduce the risk of egg allergy.
• This is especially relevant if there is a family history of egg allergy.

Cow’s milk allergy prevention

• Hydrolysed cow’s milk formula is not recommended for allergy prevention.
• If breastfeeding is not possible, use standard cow’s milk-based infant formula as first-line.

Simple infant reflux

• Do not use acid suppression for uncomplicated reflux.
• PPIs and H2 blockers have poor efficacy in simple reflux and are associated with increased risk of food allergy.

Harms of avoidance

Avoiding allergenic foods may cause:

• Increased risk of food allergy, especially peanut and egg allergy
• Nutritional deficiency
• Poor growth
• Low birth weight or intrauterine growth concerns if maternal restriction is excessive
• Reduced motivation to breastfeed
• Feeding difficulties
• Fussy eating

Parent counselling script

“Current evidence shows that avoiding common allergenic foods does not prevent food allergy.

In fact, delaying foods like egg and peanut may increase the risk of allergy.

When your baby is ready for solids, usually around 4–6 months, we recommend introducing common allergenic foods one at a time, in safe forms such as smooth peanut paste and well-cooked egg.

Once tolerated, keep giving them regularly, about twice a week.