Updated guidance for families regarding food introduction and allergy prevention in infants has been published in a new review in the Canadian Medical Association Journal.

The new guidelines from Elissa Abrams, MD, and Allan Becker, MD, both of the Department of Pediatric Allergy and Clinical Immunology at the University of Manitoba in Winnipeg, suggest introducing allergenic foods between 4 and 6 months of age.

“It has been well documented that avoidance of allergenic foods is not preventative of food allergy,” wrote Drs. Abrams and Becker.

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Their recommendations are supplemented by evidence from the Learning About Early Peanut (LEAP) study. The randomized, controlled trial found that introducing high-risk children to peanuts earlier in life reduced the risk of food allergy by as much as 80%. Both the American Academy of Pediatrics and the Canadian Society of Allergy and Clinical Immunology support these findings.

The incidence of food allergies has increased over time, with research showing an 18% increase in the United States between 1997 and 2007. Recent surveys of Canadian households found that 8% reported at least one food allergy. According to the study, the most commonly reported allergens are cow’s milk, soy, peanuts, tree nuts, eggs, wheat, fish, shellfish, and sesame.

To introduce new foods, the American Academy of Allergy, Asthma, and Immunology recommends the following: introduce a new food every 3 to 5 days in an age-appropriate manner (to avoid choking); start with grains, fruit, and yellow and orange vegetables; introduce one of the potentially allergenic foods, if well tolerated, in small amounts; introduce highly allergenic foods at home; and increase the quantity of food over several days.

Previous recommendations suggested avoiding potentially allergenic foods in high-risk infants until 12 to 36 months of age, with mothers avoiding potentially allergenic foods during pregnancy and breastfeeding. Current guidelines do not support these avoidance diets.

“Once highly allergenic foods are introduced, regular exposure is important for maintenance of tolerance,” the researchers wrote. “Children should eat these foods on a regular basis.”


  1. Abrams EM and Becker AB. CMAJ. 2015; doi: 10.1503/cmaj.150364