Ask the Allergist
Should Babies Get Allergy Tested Before Starting Solid Foods?
Should all babies get allergy tested before they start solid foods?
Absolutely not. There are several reasons for this. I really think we need to move away from the medicalized approach towards feeding babies. The guidelines changed in regards to how we introduce solid foods and allergenic foods to babies several years ago, as evidence accumulated and demonstrated that it's actually preferred to try to introduce allergenic foods such as cow’s milk, egg, wheat, soy, peanuts, tree nuts, and seafood to babies around 4 to 6 months of age, when they show an interest in eating other solids. So, start with the typical, you know, purees and cereals and things like that. And then we want to introduce these allergenic foods in age-appropriate forms and most importantly, continue to give it to them on a regular basis. The evidence supports that that’s likely the best path towards trying to prevent food allergies from developing.
If we started testing all babies before we introduced these foods, that would create a whole host of problems. First and foremost, just having access to medical professionals and doctors and the testing to be able to do that would create a logjam and delay the introduction of these allergenic foods. But more importantly, the allergy tests that we use are not screening tests. They were never designed to be used as screening tests because we get a lot of high false positive rates, which leads to unnecessary avoidance, misdiagnosis, and actually can cause food allergies to develop in susceptible babies if we avoid giving them foods that are sensitized, but not allergic towards.
So bottom line, we want to let the babies eat. It's very safe to introduce these foods. If there's ever any concern, please discuss with your own personal pediatrician or allergist. And if you really have concerns, do what we do as allergists in the office setting. Just give a small amount at first. Give a few bites. Monitor for 5 to 10 minutes. If you don't observe any signs of an allergic reaction such as rash or hives or fussiness, then you can give a little bit more and a little bit more, and a little bit more. And you can watch your babies expand their palate and also start to love a wide variety of foods. Have fun.
David Stukus, MD, is a Professor of Clinical Pediatrics in the Division of Allergy and Immunology, Director of the Food Allergy Treatment Center, and Associate Director of the Pediatric Allergy and Immunology Fellowship Program at Nationwide Children’s Hospital and The Ohio State University College of Medicine. He is board certified in allergy/immunology and pediatrics.
Dr. Stukus has devoted his career to communicating evidence-based medicine and best clinical practice to colleagues, medical professionals of all backgrounds, patients, and the general public. In addition to providing clinical care for children with all types of allergic conditions, he participates in clinical research, quality improvement, patient advocacy, and medical education.