“Give your child an allergy-free future.”
“Stop peanut allergies before they start.”
“The only baby food designed to introduce eight common allergens.”
These are just a few examples of claims being made by companies that are marketing products to anxious parents as a way of reducing the risk of future food allergy in babies.
With names like Lil Mixins, MyPeanut, Ready, Set, Food! (which earned an investment from Mark Cuban on Shark Tank earlier this year), Inspired Start and SpoonfulOne, these supplements come in a variety of forms, but they all centre on the same concept: introducing common allergenic foods starting around four to six months in the hope of fending off later food allergies, particularly those who are at high risk, thanks to eczema, or a family history of allergies. But how useful are they, really?
At one time, doctors commonly counselled parents to delay feeding their babies common food allergens, and those most likely to cause a severe reaction: a list that includes cow’s milk, egg, peanut, tree nuts, fish, shellfish, wheat and soy.
Within the last half-dozen years, however, a number of studies began casting doubt on this strategy. The most famous was a groundbreaking trial called the LEAP (Learning Early About Peanut Allergy) study. Published in 2015, it showed that, compared to babies who avoided peanut, those who began eating it early (between four and 11 months) and who ate it consistently were up to 80 percent less likely to have developed an allergy to it by age five. Similarly, there is now emerging evidence that introducing egg early may reduce the risk of that allergy, too.
In light of the latest evidence, the Canadian Paediatric Society and the American Academy of Pediatrics currently recommend starting allergenic foods at around six months and no earlier than four months.
These new products are designed to make that process easier for parents by reducing the amount of planning and preparation involved. All contain pre-measured doses of one or more common food allergens, depending on the brand. Most are powders that can be added to formula, or an already-tried and tolerated food like cereal; one or two others come already mixed (for instance, in squeezable pouches of fruit puree), or in the form of finger-food (such as puffed snacks and crackers) for slightly older children.
While, “the concept behind these products is based on sound evidence,” says Edmond Chan, head of the division of allergy and immunology at Vancouver’s BC Children’s Hospital, “there are a lot of nuances, and devil-in-the-details issues,” that make the field of options confusing for the average parent. This is one reason that even experts are divided over whether to support the use of such supplements.
For starters, “some of my colleagues are quite against these commercial products,” Chan notes, because, “they feel it over-medicalizes the act of introducing new foods.” This could lead to unnecessary stress over this milestone. Another concern is cost, with the price of a one-month supply ranging from around $20 to $90 US (roughly $28 to $120 Canadian). “It’s a lot more expensive than buying a jar of peanut butter,” Chan observes.
Elissa Abrams, an assistant professor in the section of allergy and clinical immunology in the department of paediatrics at the University of Manitoba in Winnipeg, also worries about how healthy they actually are: A few contain ingredients such as added sugar (which the CPS recommends avoiding during baby's first year) and palm oil, which some parents prefer to avoid due to environmental concerns.
And finally, some doctors worry consumers might confuse these early introduction products with a peanut allergy treatment called Palforzia, and use them for reducing an already-present allergy, which could be quite dangerous.
Even though the products are based on science, some doctors also have concerns about their effectiveness and worry about the mix of ingredients offered. For example, a few brands contain allergens such as tree nut and shrimp, and some specialists argue there’s not yet enough evidence to support early introduction of allergenic foods other than peanut and egg. Other product lines omit either milk or egg, which are two of the top three allergenic foods for infants. And while most health professionals recommend introducing one potentially allergenic food at a time, and waiting for a few days before starting another, a couple of the commercial offerings contain a mixture of multiple allergens.
Another potential issue with certain brands is the dose. For instance, with SpoonfulOne, whose products contain a long list of allergens, the dose may be very low: while it’s difficult to ascertain exact amounts even after reading the nutrition facts panel, the label reads, ‘not a significant source of protein.’ Why might that be a problem? Since kids in the LEAP study consumed six grams of peanut per week, “some allergists who are familiar with the research feel that when you start getting below three or four grams of protein a week, you’re not dealing with a ton of evidence,” Chan explains. “We still don’t know exactly what children need to be eating on an ongoing basis to prevent allergy,” Abrams adds. “We only have a few studies that looked specifically at that.”
All in all, “there’s a lot of detective work that the parent, or the physician has to do to be able to choose, or give advice,” Chan says. That said, provided parents do the homework, some products may have, “utility for certain families in that there’s an ease of use—a convenience factor,” says Abrams.
If that’s not your number one priority, however, the alternative is simply starting to introduce age-appropriate servings of allergenic foods one at a time, around six months, and continuing to include them in your child’s diet at least a few times a week. For peanut, that might be two teaspoons of peanut butter thinned with hot water, then cooled before it’s mixed with pureed veggies. In the case of egg, it might be a bit of scrambled egg, or pureed boiled egg stirred into another, already tolerated food.
At the end of the day, there's no guarantee whether or not your kid will get an allergy. It's always best to talk to your baby's doctor about the best course of action when it comes to introducing foods.