When certain proteins in food trigger a response from the immune system, a food allergy occurs.

Typically, food allergies develop in children under the age of 3, with many outgrowing them by the time they reach school age.

Common symptoms of food allergies include hives, swelling, itching, difficulty breathing, and in severe cases, anaphylaxis.

It is important for individuals with food allergies to carefully read labels, ask about ingredients when dining out, and always carry an epinephrine auto-injector in case of emergency.

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Immediate and delayed food allergies exhibit different symptoms.

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Symptoms usually begin within minutes to 2 hours after consuming a specific food.

• Rapid rash
• Inflammation of the lips and face

If you suspect an immediate allergic reaction, consult your GP before reintroducing the food.

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Symptoms may appear within 2 to 24 hours after consumption.

This is common in babies allergic to cows’ milk or formula, and severe reactions like anaphylaxis are rare.

It’s important to keep a food diary and track any symptoms to help identify the specific trigger. If you suspect a delayed food allergy, eliminating the suspected food from your diet for a period of time may be advised to see if symptoms improve.

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The most common allergy triggers in children are egg, cow’s milk, and peanuts.

While eczema itself does not cause food allergies, there may be a connection.

It is important for parents and caregivers of children with eczema to be aware of the signs of food allergies and consult with a healthcare provider if they suspect their child may have an allergy. It’s also recommended to keep a food diary to track potential triggers and consider allergy testing if needed.

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If you suspect a food allergy in your child, seek advice from your GP.

• Referral to a pediatric clinic may be necessary
• Allergy testing might be recommended
• Keep a food diary to track any potential triggers
• Be prepared for a potential elimination diet to identify the allergen
• Always carry emergency medication, such as an EpiPen, if your child has a known food allergy

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Introduce common allergens early during weaning, such as dairy, eggs, nuts, and fish.

Offer new allergens approximately three times a week to help build tolerance.

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• Introduce allergens in puree form
• Gradually increase portion sizes

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Exclusive breastfeeding for the first 6 months is encouraged.

If not breastfeeding, special formula may be required for milk allergies.

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When introducing potential allergens, do so one at a time in small amounts to monitor for reactions.

Delaying the introduction of certain foods may heighten the risk of developing allergies.

It is important to consult with a healthcare provider or allergist before introducing potential allergens, especially if there is a family history of allergies or if the individual has a history of severe allergic reactions.

Keep an eye out for symptoms of an allergic reaction, such as hives, swelling, difficulty breathing, or nausea, and seek medical help immediately if any of these symptoms occur.

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Recognize allergy symptoms such as rash, runny nose, and breathing difficulties.

• Most reactions are mild
• Anaphylaxis is rare but demands immediate treatment

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Food additives undergo safety testing and must be clearly labeled.

Reactions to additives are uncommon compared to reactions from regular foods.

Learn to recognize symptoms and understand how to handle allergic reactions effectively.

For guidance on introducing solids, consider using the Solid Starts App.

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Allergic reactions to food generally occur within two hours of consuming the allergenic food, with many beginning within minutes. However, delayed allergic reactions, often due to FPIES, may affect a small percentage of babies.

Start with small amounts when introducing new foods, as the severity of the reaction is usually proportional to the amount consumed.

**If you suspect an allergic reaction, call emergency services immediately.**

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Allergic reaction symptoms in babies vary in severity, with the number and intensity of symptoms playing a crucial role. Familiarize yourself with the signs before introducing allergens.

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Mild symptoms can include:

• Itchy or runny nose, sneezing
• Isolated hives, mild itching
• Mild nausea, gastrointestinal discomfort, or vomiting

If your baby exhibits any of these symptoms, discontinue the allergen and seek medical advice.

More severe reactions may involve:

• Shortness of breath, wheezing, coughing
• Pale skin, facial swelling
• Extensive hives, vomiting, diarrhea
• Fatigue, appearing listless

In case of severe symptoms, contact emergency services immediately for epinephrine treatment.

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Severe reactions may present as:

• Shortness of breath, wheezing, coughing
• Pale or bluish skin
• Swelling of the face, lips, or tongue
• Extensive hives, repetitive vomiting, diarrhea
• Fatigue, limpness

If severe symptoms are evident, seek immediate assistance from emergency services for treatment.

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Instructions on administering epinephrine to babies

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FPIES is a severe, life-threatening food allergy that leads to delayed reactions. Common triggers include cow’s milk, soy, oats, and rice. Symptoms may comprise vomiting, diarrhea, low blood pressure, and pallor. Medical attention is crucial for cases of FPIES.

Hives may occur during an FPIES reaction.

It is important for caregivers of babies with FPIES to always have an epinephrine auto-injector on hand in case of an emergency. Administering epinephrine promptly is crucial in treating severe allergic reactions in babies. Make sure to follow the instructions provided with the auto-injector and seek immediate medical help after giving the injection.

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While babies with severe eczema have a higher risk of food allergies, most babies with eczema do not develop a food allergy. Food allergens can trigger immediate or delayed eczema flare-ups.

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Extensive rashes may be a sign of an allergic reaction. Contact rashes resulting from acidic foods tend to appear in specific areas and fade quickly. Contact a doctor for persistent rashes.

A toddler showcasing a contact rash from consuming tomatoes.

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Be prepared with essential information for emergency services in the event of an allergic reaction.

• Insurance card
• Nearest hospital details
• Specific health information

Access the Solid Starts App for guidance on introducing allergens to your baby.

Hives present as common welts characterized by itching and swelling, typically short-lived in infants.

Treatment: If your baby develops hives, try to identify and eliminate the trigger. You can give your baby an antihistamine as recommended by your pediatrician to help relieve the itching and swelling. It’s important to monitor your baby closely and seek medical attention if the hives persist or if your baby shows signs of a severe allergic reaction.

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Baby hives, also known as urticaria, are usually mistaken for mosquito bites due to their blotchy appearance. These raised, red welts can appear anywhere on the body and may come and go or persist for several weeks.

In addition to being itchy and irritating, hives can sometimes lead to more severe symptoms such as swelling of the throat, difficulty breathing, and in rare cases, anaphylactic shock. It is important to seek medical attention if you or your child experience these symptoms.

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Common triggers of baby hives include food allergens like Cows’ Milk Allergy. Other factors such as insect bites, medication, or environmental changes may also provoke hives.

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CMA may induce hives in around 30% of cases, often accompanied by other symptoms throughout the body.

If hives or CMA are suspected, monitor for additional symptoms and seek medical advice.

Explore whether your baby’s eczema is linked to food allergies by evaluating symptoms and consulting healthcare professionals.

For additional support, contact your health visiting team or doctor, and listen to the LLLGB podcast episode with Dr. Robert Boyle.

It is important to note that food allergies, including CMA, can manifest in various ways, such as eczema and hives. Keeping a food diary and working closely with healthcare professionals can help identify triggers and manage symptoms effectively.

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Babies may be unsettled due to various reasons, some of which may become clearer with time and effort, while others remain mysteries until the babies outgrow them. This article may be beneficial if your baby is under two months old and requires frequent soothing at specific times each day.

Discover more potential causes for unsettled babies.

If these strategies do not alleviate your exclusively breastfed baby’s discomfort or other symptoms, it is important to seek advice from a healthcare provider. They can help investigate potential issues such as food sensitivities, reflux, or other medical conditions that may be causing your baby’s discomfort. Keeping a detailed log of your baby’s symptoms, feeding patterns, and behaviors can be helpful for your healthcare provider in making an accurate diagnosis and developing a treatment plan. Additionally, seeking support from a lactation consultant or pediatrician specializing in breastfeeding medicine can provide additional guidance and support in addressing any breastfeeding issues that may be contributing to your baby’s discomfort. Remember, it’s crucial to prioritize your baby’s health and well-being, so don’t hesitate to seek help if you have concerns.

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Considering food allergies as a potential cause is a common suggestion for parents of unsettled babies. However, most unsettled babies do not have food allergies. While allergy clinic referrals are increasing, studies indicate that food allergy rates among young children have not significantly risen. Prevalence varies by region, with urban and high-income areas having higher rates than rural and low-income regions.

Parents introducing solid foods to older babies may accurately identify food allergies. Common allergens include egg, nuts, milk, fish, shellfish, and sesame. Despite this, cow’s milk allergy in young babies may be overdiagnosed, with reports suggesting that most babies treated for milk allergy can tolerate cow’s milk without issues.

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An allergic reaction is the immune system’s response to a specific trigger, with symptoms consistently appearing within two hours of consuming the allergen. Consulting with a medical professional for allergy testing may be necessary if your baby displays food allergy symptoms.

Allergic reactions are infrequent in exclusively breastfed babies due to minimal allergenic proteins in breastmilk. Reactions usually occur when babies directly consume allergenic foods. IgE food allergies may be managed by avoiding triggers and undergoing desensitization therapy under medical supervision.

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Food allergies fall into the categories of IgE (immediate) or non-IgE (delayed), with symptoms like hives, swelling, vomiting, coughing, or wheezing typically appearing within two hours of consuming the problematic food. IgE allergies usually develop when allergenic foods are ingested and rapidly absorbed, triggering an immune response.

Non-IgE allergies, less common, manifest through different syndromes such as FPIES, Food Protein Induced Enteropathy, and proctocolitis. Distinguishing non-IgE allergies from other conditions requires careful monitoring and elimination of suspected trigger foods.

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There are situations where mothers of allergic infants may be advised to switch to specialized formulas, even though this may not be necessary and could hinder breastfeeding. Despite allergies, human milk remains the healthiest option for babies.
Sometimes, a breastfed baby could have an allergy, leading doctors to suggest a break from breastfeeding while the mother eliminates certain foods from her diet. In such cases, it is possible to question the advice to pause breastfeeding and instead continue expressing milk to maintain a strong supply.
The most common allergy problem among young children is eczema, which causes an itchy rash that can last for months or years. Approximately 1 in 16 children worldwide suffer from eczema, with a higher prevalence in babies and preschoolers, including formula-fed babies.
Babies who experience challenging eczema in early life are more prone to developing food allergies due to a compromised skin barrier. Eczema is mainly caused by a genetic predisposition.
If eczema is the only symptom, then a food allergy is unlikely. However, if certain foods trigger increased skin inflammation consistently, then excluding them for a trial period may be necessary. It is crucial to exclude foods only if a specific reaction occurs consistently, rather than unnecessarily removing items from a baby’s diet to prevent allergies.
Allergic reactions in exclusively breastfed babies are uncommon, but some babies may show sensitivity or intolerance to specific foods consumed by the mother. It is essential to observe your baby’s reactions and, if needed, exclude certain foods temporarily, with the possibility of reintroducing them later.
Introducing common allergy foods early can reduce the risk of allergies, so guidelines suggest incorporating family allergens into a baby’s diet when introducing solid foods. Homemade, culturally appropriate foods are preferred by the WHO.
Overall, it is important to seek medical attention if a baby shows allergic reactions and to be cautious about unnecessary exclusions of foods from a mother’s diet. Connecting with other breastfeeding mothers can provide valuable support and insight into managing allergies and sensitivities effectively.
Acknowledgments:
We would like to thank Dr. Robert Boyle for his valuable input on this article. Special thanks also go out to the mothers who reviewed the text: Anna Barnes, Rachel Cruddas, Lucy Ling, and Laura Mould.
(Authored by Joanna Godden, Jayne Joyce, and Charlotte Allam, March 2025)