Weaning with food allergy: a practical guide

Starting solids when allergy is a concern

For most children, current guidance supports introducing allergenic foods (including peanut, egg, milk, and tree nuts) during weaning, typically from around 4-6 months. Early introduction, where safe to do so, appears to reduce (not increase) the risk of developing food allergy.

For families already managing a confirmed food allergy, or where there is a strong family history of allergy, weaning requires a more tailored approach.

Which children need a supervised introduction?

A paediatric allergy assessment before weaning is advisable if your child:

• Has moderate to severe eczema that has not responded well to treatment
• Has already reacted to a food
• Has a sibling with a confirmed food allergy
• Has known sensitisation (from a previous blood test or skin prick test) to a food they have not yet eaten

In these situations, introducing certain foods under medical supervision rather than at home is often safer and far less stressful for the family.

Introducing peanut

The landmark LEAP trial showed that early peanut introduction in high-risk infants significantly reduced peanut allergy development. Current NHS guidance recommends introducing smooth peanut butter (never whole peanuts in children under 5) from around 6 months in most children.

If your infant has had a previous reaction to peanut or has a strong sensitisation on allergy testing, the first introduction should be supervised in a clinical setting.

Practical tips

• Introduce one new food at a time and wait 2–3 days before introducing the next, so any reaction can be attributed to a specific food
• Start with a small amount and, if tolerated, increase gradually
• If your child is on a milk-free diet, introduce other allergens (egg, peanut, wheat) as usual; milk exclusion does not protect against other allergies
• Keep a simple food diary during weaning to track what has been introduced and tolerated

When to seek advice

If your child reacts to a food during weaning (hives, swelling, vomiting, or any breathing difficulty), give antihistamine for mild symptoms or call 999 for anything severe, and arrange a review with Dr Sood before reintroducing that food.