None under One: Honey versus Food Allergens

“None under One” No Longer Applies for the Top 9 Allergens but Always will for Honey. Here’s the Difference.

Alrighty. So, I know I said I was doing a three-part series on honey but while I was writing my last post, I realized that there really should be another one. I could have squeezed the info in this post into the last one but it really just made better sense to flesh it out more and give it its own post. So, here we are. A “No Honey Under One” series addendum. 😉

In my last post (None under One: Honey versus Dairy), I broached the concept of introducing allergens in infancy as a way to lessen their ability to cause allergic reactions down the road. In this post, we’ll learn more about allergens and why this recommendation is in place. We’ll also explore why this recommendation doesn’t apply to honey.

A brief history of food allergen recommendations for children

Until fairly recently, the general advise from doctors and other food and drug professionals was to hold off feeding these major allergen foods to children until they were out of infancy, sometimes even out of the toddler years. This avoidance was an effort to reduce allergic reactions in children.

However, an important study (LEAP: Learning Early About Peanut Allergy) in 2015 showed that this strategy wasn’t working. The authors stated that the “prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia.” Their study broke infants into two groups: the peanut avoidant group and the peanut consumption group with the hypothesis “that the early introduction of peanuts to the diet may offer protection from the development of peanut allergy.” They then tested those same infants for peanut allergies when they were school-aged and found that “peanut avoidance was associated with a greater frequency of clinical peanut allergy than was peanut consumption, which raises questions about the usefulness of deliberate avoidance of peanuts as a strategy to prevent allergy” (du Toit et al., 2015). In other words, their hypothesis seemed correct. Introducing these peanuts earlier in life seems to protect the individual from developing allergic reactions to peanuts later in life.

The LEAP study tested this hypothesis only with peanuts but the principle has been applied to other common food allergens and a radical shift in recommendations has swept through the pediatric world. These foods went from the recommended ages of “12 months old for dairy, 24 months old for eggs, and 36 months for peanuts, tree nuts, and fish” (Barnes, 2020) to being served as some of baby’s first foods at roughly 6 months of age. [!!!] That’s quite the shift!

This, and other, new research has led to this huge shift in the recommended age for the introduction of food allergens, specifically the Top 9 allergens, to children. Always consult with your pediatrician before serving these foods to your child if you have a family history of food allergies. Otherwise, it is now recommended to feed your infant these common allergy producing foods beginning at 6 months of age. This helps your child’s body acclimatize to the allergens and resist the creation of potentially life-threatening and lifelong allergic reactions to those same foods. There is no promise that feeding your child these allergens and following these recommendations will prevent this from occurring but it drastically reduces the probability.

It should be noted that while serving these foods to younger children is now seen as a positive move, there is such a thing as too young. No solid foods (of any variety, allergens or not) should be given to infants younger than four months of age. They simply aren’t developmentally ready for solid foods yet. Breastmilk or formula should be their only source of nutrition unless their pediatrician states otherwise.

If you’re really gung-ho about getting them exposure to allergens at an early age, the best way to do so is by eating these foods yourself and then breastfeeding your infant. “Studies have shown that babies at high risk of having allergies who are exclusively breastfed for the first three to four months of life are less likely to develop food allergies and eczema during the first two years of life” (The Australasian Society of Clinical Immunology and Allergy (ASCIA), 2020). 

How to introduce the Top 9 allergens to your infant

As noted above, if your family has a history of food allergies, consult with your doctor before serving any of allergens to your child.

Introducing the Top 9 allergens to your infant may seem intimidating and you might not know where to start. That’s understandable! But, please know that while these foods represent 90% of the allergic reactions to food, they also only occur in 8-9% of the population. Be alert when introducing these foods but please don’t be over-anxious. And, other than being more alert for signs of allergic reaction, there isn’t any difference between how you would introduce your child to allergens than to any other food you choose to feed them.

Generally, you should begin introducing solid foods to your child between the ages of 4-6 months or when your baby is able to sit up with minimal assistance and is showing curiosity about your food. You want your baby to be sitting upright while eat solids, typically in a high chair or on a caregiver’s lap. Baby’s first solid foods should be pureed or so soft that it can be mashed with little to no pressure applied.

As baby grows, the size, shape, texture, and hardness of their food will gradually change as their skills develop. Please ensure that you’re providing your infant with foods that are developmentally appropriate for their age and skill set in order to prevent choking.

When introducing solids, start by feeding your child non-allergen foods for the first several weeks. Let them grow accustom to eating solid foods and you grow accustom to how their body reacts to solids (such as changes in alertness level, bowel movements, contact dermatitis -a slight rash around the mouth, not a sign an allergic reaction but is a sign of skin being irritated with new stimulation) before you start introducing these common allergens.

When you introduce any new food to your infant, allergen or not, it is wise to only introduce one new food at a time, allowing several days to pass without adding a new food to their diet. This allows you to more easily isolate which food might be causing your child any problems (allergies, bowels, or otherwise). This advice is even more vital when dealing with allergens. Make sure the only new food to your child’s diet is the allergen, waiting several days before adding a new element to your child’s menu.

If your child shows no signs of a reaction, continue providing your child exposure to that food as they grow, preferably feeding it to your child twice a week. This will help them to develop their resistance to future food allergies associated with those particular foods and it will also help them learn to enjoy the food and have a balanced diet.

After feeding your child a new allergen, pay close attention to them, looking for any signs of allergic reaction. The Australasian Society of Clinical Immunology and Allergy (ASCIA) states that if “you notice any swelling of the lips, eyes or face, hives or welts, vomiting, or any change in your baby’s behaviour (becoming very unsettled), soon after giving a new food [generally within minutes but also up to hours later], your baby could be having an allergic reaction. You should stop feeding your baby that food and seek medical advice. Call an ambulance immediately if there are signs of a severe allergic reaction (anaphylaxis), such as difficult/noisy breathing or your baby becomes pale and floppy, or if there is tongue swelling. Information about the signs and symptoms of mild to moderate and severe allergic reactions (anaphylaxis), is on the following website https://preventallergies.org.au/identifying-allergic-reactions/” (The Australasian Society of Clinical Immunology and Allergy (ASCIA), 2020). 

All of those signs and symptoms of allergic reaction can sound scary! And they are. But, please remember that they only occur in 8-9% of the population and the goal of early exposure to these foods is to prevent your child from developing allergies that will include a lifetime of worries about these reactions due to accidental exposure to known allergens. You got this! Just be alert and vigilant for these signs and symptoms.

The confusion with honey

In our parents’ generation, and even up to a few years ago, there was a generally understood consensus that certain food wasn’t to be given to young children and babies. Among this list of no-no foods (the “None under One” foods) were the allergens listed above and honey. When the guidance for the allergens changed so dramatically, honey was suddenly left mostly alone in the None under One list. Most of the other foods that formerly were part of this list were now encouraged to be fed to infants instead.

Without fully understanding the reasoning behind the change for the allergens, one can easily make the mistake of thinking that all of the former “None under One” are now fair game foods for infants. It’s easy to see how and why this mistake occurs and why there is confusion about it.

So, to be clear, DO NOT SERVE HONEY TO INFANTS UNDER A YEAR OF AGE.

As a brief recap of the first article in this series, the concern with serving honey to infants involves botulism, a bacteria that can colonize the gut producing paralysis and in undetected/severe cases, death. Honey is a common host food to spores containing botulism and infants, it is speculated, do not yet have robust enough defenses in their guts for staving off the colonization of botulism.

While both honey and the Top 9 allergens can make a child sick, honey is not an allergen. Unlike providing allergens to infants, there is no potential reward (developing tolerance to the foods and hopefully preventing future allergies) to outweigh the potential risk (botulism) of feeding honey to infants. Just don’t do it.

If you were among those who thought the change in allergen recommendations included honey, please don’t fret. If your child is healthy, then no harm no foul. Just start today-nix honey from their diet until they’re a year of age.

Good luck to all of you in your adventures in parenting! It really is a wild ride! xoxoxo

Hello! I’m Briana!