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Ask the Expert: Allergy Partners of Fredericksburg

Mar 28, 2022 06:00AM ● By Emily Freehling

Food allergies affect 1 in 13 U.S. children, according to the Centers for Disease Control and Prevention. But while some parents may remember being told to delay the introduction of hyper allergenic foods such as peanuts to infants, research increasingly shows that early introduction of these foods to children between 4 and 6 months is key to preventing the onset of food allergies. Allergy Partners of Fredericksburg is one of the only practices in Virginia where patients can receive oral immunotherapy, or OIT, a treatment that has been proven to reduce the severity of the most common food allergies. As our March Expert, Dr. Nicholas Klaiber, M.D., a double-board-certified, fellowship-trained physician who is part of the Allergy Partners team, discusses the latest advice for parents on identifying and seeking treatment for food allergies.


How prevalent are food allergies in American youth, and what are the most common foods that cause allergic reactions?

Food allergies have dramatically increased in prevalence over the last 20-30 years. Egg and milk allergies are the most common, but the good news is that 90% of children are going to outgrow an egg or milk allergy. That is not the case with peanut or tree nut allergies, which typically do not go away once they develop. Today there are approximately 1.5 million kids with peanut allergy in the United States.

The most hyperallergenic foods are:

  • Peanuts
  • Tree nuts
  • Shellfish
  • fish
  • Eggs
  • Milk
  • Soy
  • Sesame
The molecular characteristics of these foods make them very good at causing allergic reactions. Over 90% of anaphylactic food reactions are caused by these items.

You don’t have to worry so much about fruits and vegetables causing allergic reactions. Although those foods can cause skin irritation and oral discomfort, they are much less likely to cause the kind of catastrophic anaphylactic reaction that we use an EpiPen for.


When should parents introduce these foods to infants?

We now recommend 4-6 months as the age to start introducing these foods. Early introduction is key to decreasing the rate of food allergies as demonstrated by the LEAP study. Delayed introduction of hyper allergenic foods is one of the primary reasons we’ve seen such an increase in food allergy over the last 15 years. If parents can introduce those high-risk foods we mentioned earlier, when their child is between 4 and 6-months old the chances of developing a food allergy are significantly decreased.


What are some tips for introducing hyper allergenic foods safely at this age?

When introducing new foods to infants, you want to make sure first that it is not a choking hazard. A smooth, non-chunky peanut butter diluted with breast milk or infant formula is a good starting point. We still recommend strict avoidance of honey in infants under 12 months due to the presence of botulism spores in honey, which can pose a severe health risk to infants, so do not use peanut butter which contains honey. We also suggest introducing just one potentially allergenic food per day. That way if there is any sort of reaction it will be easier to determine the cause. Give a small amount of the food and watch the child over the next thirty minutes for any signs of allergic reaction. The most prevalent symptoms of allergy that you are looking for are hives and vomiting. These almost always occur within 15 to 30 minutes of consuming the food. If you notice these, seek medical attention immediately.  After the initial reaction is treated, it is essential to follow up with a board-certified allergist.

Once introduced, the food should remain regularly in the child’s diet. So for peanuts, that might look like a little bit of peanut butter on the finger, or mixed with formula or breast milk, and then as long as there is no allergic reaction, you continue to give it at least three times a week. That is what the data supports for preventing food allergy.


Is it important to have any potential allergic reaction examined by a doctor?

Getting an official evaluation of the condition is very important. I see a lot of cases where a patient had an initial reaction and they just avoid the food for several years. That can be very dangerous. If you don’t have an EpiPen and you develop a true food allergy, it is hard to predict how severe the next reaction is going to be. Even though you only had a mild reaction, your next reaction may be much more severe. If you don’t have those rescue medications ready to go it can be deadly. In addition, children who are allergic to one food are very often allergic to other foods, they also are at higher risk for eczema, asthma and allergic rhinitis, all of which we are trained to diagnose and treat.

It’s important to remember that food allergies are not static. You may have a true allergy right now that may go away in a few years, so reevaluation is very important, not just taking the diagnosis and letting it sit for 10 to 20 years. You really want to follow up as recommended to make sure that if you are outgrowing the allergy, you can reintroduce the food at the appropriate time, or if the allergy is getting more severe, you can think about other treatment options.


What is oral immunotherapy (OIT)?

OIT is a new FDA-approved treatment for food allergies. Before OIT, we used to just have to tell patients to strictly avoid all contact with their food allergen.  OIT involves feeding an allergic individual an increasing amount of an allergen under the supervision of a physician with the goal of increasing the threshold that causes a reaction. Just last month, the results of a large placebo-controlled trial showed that OIT is effective and safe in young children. The trial also showed that the chances for eliminating peanut allergy through OIT was directly related to the age desensitization was started. The younger the patient the better they tended to do. We think this is because at a young age the immune system is more malleable.

Allergy Partners of Fredericksburg is one of only a few practices in Virginia that offers OIT, and our physicians work hard to stay up to date on the latest developments regarding this treatment.


What makes Allergy Partners of Fredericksburg a good fit for families?

We are part of the largest physician-owned national allergy and immunology specialty group. This allows us to tap into a large number of experts in the field. This network is also beneficial for patients in a number of ways. If a patient is moving to a different geographic area, we often can seamlessly transition their care from one Allergy Partners location to another. It just makes things a lot easier to have that kind of national backing when you are dealing with these complex conditions.

To learn more or to schedule an appointment for an evaluation for allergy or immune problems, visit

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