Food allergy baby hives

Babies and Food Allergies | Children’s Hospital Los Angeles

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Health and Safety Tips

Experts agree: Feeding infants peanuts, eggs and other common allergens makes them less likely to develop sensitivities to these foods.

By Stephanie Cajigal

A lot has changed when it comes to caring for babies, including how to feed them. It used to be that parents were told to wait until their child was 3 to give him or her foods many people are allergic to, like peanuts. Not anymore.

Experts now recommend feeding babies common allergens before they turn 1 to reduce their chances of developing allergies to these foods.

Jill Madison, MS, RD, a Clinical Dietitian at Children’s Hospital Los Angeles, and Jonathan Tam, MD, Medical Director of the Gores Family Allergy Center at Children’s Hospital Los Angeles, offer these tips for feeding your little one.

Feed solids at around 4 months

Your baby is likely ready to start eating food when he or she has good head control, can sit up unassisted, and shows interest in foods, Madison says. At the baby’s 4-month checkup, your pediatrician will tell you whether it’s time to introduce solids. This means giving your baby a single-item food, like steamed carrots, not a combination of foods, like steamed carrots blended with potatoes.

“Historically, we started with purees. Now we know you can give a baby a whole food as long as it’s soft enough to chew, like a slice of ripe peach,” Madison says. To prevent choking, make sure that chunks of food are not round and hard, and can be mashed with a fork.

The first foods babies typically eat are single-grain cereals, vegetables, fruits and meat. Once your baby has gotten comfortable with these foods, you can start feeding him or her common allergens, introducing them one by one.

Safely introduce allergens

The most common allergens are eggs, milk, wheat, soy, sesame, tree nuts, peanuts, fish and shellfish. It’s a good idea to feed these foods to your baby before he or she turns 1, with the exception of milk in liquid form. That’s because cow’s milk has more calcium than breast milk and could interfere with the way your baby absorbs iron. Give your baby cottage cheese, yogurt or other forms of dairy, but wait until 12 months to give a cup of milk, Madison says.

As for nuts, babies can choke on these when they’re whole, so opt instead for nut butters that are creamy and smooth as opposed to chunky. You can make the nut butter less sticky by mixing it with water or breast milk or even blending it with apple sauce, Madison says. Another option is to stir a nut flour such as almond flour into a food your baby has already eaten many times before.

Pay attention to texture when feeding your baby, making sure food is soft enough to chew. Dip whole wheat bread in breast milk or water, for example, and mush shellfish and fish with a fork. You can mash a hardboiled egg and serve it as is or blend it with breast milk. Yogurt is an easy one to introduce since you don’t need to do anything to it. Start with plain yogurt made with whole milk, Madison says. You can also stir the yogurt into a fruit puree to change things up.

Ask your doctor about your baby’s allergy risk

Talk to your pediatrician if your baby has eczema, because this can put your baby at higher risk for developing a food allergy. And children with one food allergy may develop other food allergies. Children with an egg allergy, for example, are at higher risk of developing a peanut allergy, Dr. Tam says. If your child already has a food allergy, your pediatrician can give you advice on when to introduce other potential allergens.

Keep in mind that you should not avoid giving your baby a food just because someone in your family has an allergy to it.

“Since we know that in some context giving food early can prevent food allergy, then it would be even more important for an at-risk child to have it introduced early and purposefully,” Dr. Tams says.

Follow the 3-day rule

Your pediatrician may have told you to give your child a new food for three days in a row before introducing another new food. The same goes for common allergens.

“We want to give the child enough time to actually ingest the food and see how their body does with it,” Madison says.

While you’re doing this, remember to keep offering your baby foods you’ve already introduced.

Prepare foods at home

With all the jars, pouches and puffs available at stores, the options for feeding your baby may seem endless—and overwhelming. But Madison says making meals for your infant can be really simple.

As you’re cooking foods for the rest of your family, you can set aside a portion that doesn’t have salt or other seasoning. Say you’re cooking cod and asparagus, for example. You can cook the cod on the stove with some olive oil and mush it up with a fork for your baby. You can also cook the asparagus with olive oil on the stove top or in the oven and then puree or slice into half-moon pieces for your little one.

Madison says that while store-bought baby foods can be a good option for parents in a pinch, it’s best not to depend on them too much since studies show they can have unsafe levels of lead, mercury and other metals.

Looks for signs of a food allergy

How do you know if your baby is having an allergic reaction? Look for changes that begin within minutes to two hours after he or she ate the food. Hives and vomiting are the most common symptoms in infants, Dr. Tam says. Shortness of breath, coughing or wheezing can also happen, but are more common reactions in older children. If your baby develops a rash, take photos to track whether it’s getting worse, he says.

Seek medical attention for serious symptoms

If your baby is acting normally but has a mild rash or some hives, you could give your baby an antihistamine. Diphenhydramine (Benadryl) can provide comfort, but second-generation antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) last longer and are less likely to make your baby sleepy, Dr. Tam says.

If your baby is vomiting, coughing, having difficulty swallowing (pay attention to new, suspicious drooling), or acting very sleepy, seek immediate medical attention. Try to get a doctor on the phone or go to the emergency department, Dr. Tam says.

Focus on variety over the long term

As your baby grows up, remember to keep feeding your child a variety of flavors and textures to help him or her develop a taste for different types of foods.

“Children eat what their parents eat,” says Madison. “If parents eat vegetables and try new foods readily, babies and kids will too.”

Click here to learn more about raising a happy, healthy baby.

Food Allergy

Is this your child's symptom?

Allergic reactions to foods
The most common symptom is hives
Questions about food allergies
Oral Allergy Syndrome is also covered. The main symptom is mouth itching and swelling. The main triggers are raw fruits and veggies.

Symptoms of Food Allergies

Hives all over and swelling of the face are the most common symptoms. Hives are raised pink bumps with pale centers (welts). They look like bug bites.
Mouth itching and swelling
Runny nose and coughing
Vomiting and diarrhea
Life-threatening allergic reactions also must have trouble breathing and/or swallowing. The medical name for this is anaphylaxis. Most of these reactions have a sudden onset within 10 to 20 minutes. All occur within 2 hours of eating a certain food. People who have had this carry an emergency kit like an Epi-Pen.

Causes of Food Allergies

8 foods cause 90&percnt; of food allergies
In the first year of life: cow's milk, soy milk and egg
Older children: peanuts, tree nuts, fish, shellfish and wheat
Shellfish include shrimp, crab, lobster, clams, oysters and scallops
Tree nuts include all the nuts (such as almonds and cashews) except peanuts.
Of children with a proven food allergy, 40% have severe reactions. The other 60% have mild reactions.
Peanuts and tree nuts are the most common triggers for severe reactions.

Cross Reactions with Other Foods

Children with allergies listed below can react to other foods:

Cow's milk allergy: 90% also react with goat's milk and 40% with soy milk
Egg: 5% react with chicken
Peanut: 5% react with other legumes (like peas or beans). About 30% also react to tree nuts.
Tree nut: 40% react with other tree nuts
Fish: 50% react with other fish. Only 10% also react to shellfish.
Shellfish: 70% react with other shellfish
Melon: 90% react with banana and avocado

How Long do Food Allergies Last?

Cow's milk: 80% outgrown by age 16
Soy milk: 80% by age 16
Egg: 70% by age 16
Peanut: 20% by age 16
Tree nut: 10% by age 16

Allergic Disease - Can You Prevent with Diet?

Most allergic diseases (food allergies, eczema and asthma) cannot be prevented.
Helpful: Feeding only breastmilk for 6 months or longer
Not helpful: Avoiding high-risk foods for pregnant or breastfeeding women
Not helpful: Soy formulas instead of cow's milk formula
Not helpful: A delay in starting baby foods past 6 months
Not helpful: A delay in starting high-risk foods like peanut butter or eggs
Source: AAP

Oral Allergy Syndrome (OAS)

A minor reaction to some raw fruits and veggies
Causes itching and swelling only to the lips and tongue
Also called Pollen-Food Syndrome

Symptoms of OAS

Rapid onset of itching (or tingling) and swelling of the mouth.
This can involve the lips, tongue, throat, and roof of the mouth.
The uvula (tag of tissue hanging down in back) can become very swollen.
These symptoms follow eating a high-risk raw fruit or veggie.
OAS can start by age 5.
Serious symptoms or very bad reactions rarely happen.

Causes of OAS

A contact allergy. It only involves the parts of the mouth that touch the raw food.
Trigger foods for OAS are always raw (not cooked.)
Fresh Fruits. These include apple, apricot, banana, cherry, melons, orange, peach and pear.
Raw Veggies. These include carrot, celery, parsley, potato and tomato. Carrots and celery have the highest risk for also causing serious symptoms.
Certain Seeds. These include sunflower seeds and fennel seeds.

OAS and Nose Allergies Can Be Linked

Over 50% of people who are allergic to pollen also have OAS. This means 10% of all people.
Ragweed pollen allergy can cross-react with all melons. Also, sometimes with bananas and tomatoes.
Birch pollen allergy can cross-react with raw potatoes, carrots, celery and apples.
Grass pollen allergy can cross-react with tomato and kiwi.

When to Call for Food Allergy

Call 911 Now

Life-threatening allergic reaction to similar food in the past. Food eaten less than 2 hours ago.
Trouble breathing or wheezing
Hoarse voice or cough start all of a sudden
Trouble swallowing, drooling or slurred speech start all of a sudden
You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Hives all over start 2 to 4 hours after eating high-risk food. High-risk foods include nuts, fish, shellfish, or eggs.
Major face swelling (not just lips) starts 2 to 4 hours after eating high-risk food
Vomiting or stomach cramps starts 2 to 4 hours after eating high-risk food
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Other symptoms that might be from a food allergy and present now
You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

Recurrent symptoms that might be from a food allergy but not present now
Oral Allergy Syndrome suspected but never confirmed by a doctor
Food allergy diagnosed and you want to restart that food
You have other questions or concerns

Self Care at Home

Food allergy: mild reaction
Oral allergy syndrome

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Care Advice

Treatment of a Food Allergy

What You Should Know About Food Allergies:
- About 5&percnt; of children have food allergies.
- Most children with a new food reaction need to be seen.
- If your child is stable, hives often can be treated at home.
- Hives as the only symptom can have many causes.
- Your child can be seen later to decide future risks and best treatment.
- Here is some care advice that should help.
Allergy Medicine for Hives:
- Give Benadryl 4 times per day for hives all over. Age limit: 1 and older.
- Use the allergy medicine until the hives are gone for 12 hours.
- If the hives last more than a few days, switch to a long-acting antihistamine, such as Zyrtec. No prescription is needed. Age limit: 2 and older.
- Caution: if your child is less than 1 year, call your doctor for advice.
Cool Bath for Itching:
- To help with any itching, can also give a cool bath. Do this for 10 minutes.
- Caution: Do not cause a chill.
How to Prevent Future Reactions:
- Help your child avoid the food that caused the symptoms.
- Read labels on all food products fully.
- Tell other people who care for your child of your child's food allergy. Also, inform the staff at your child's school.
- Learn more at Food Allergy Research and Education.
What to Expect:
- Hives from foods often last just a short time.
- They often are gone in less than 6 hours.
Return to School:
- Hives cannot be spread to others.
- Your child can go back to school once feeling better. The hives shouldn't keep him from doing normal things.
Call Your Doctor If:
- Trouble breathing occurs
- Trouble swallowing or drooling occurs
- Severe hives not better after 2 doses of Benadryl
- Hives last over 24 hours
- You think your child needs to be seen
- Your child becomes worse

Treatment of Oral Allergy Syndrome Symptoms

What You Should Know:
- Oral Allergy Syndrome (OAS) is very common. It happens in 10&percnt; of people. Most of them also have pollen allergies.
- The symptoms are not harmful and can be treated at home.
- Needed for OAS: Your child has never had any serious symptoms with this food.
- OAS symptoms don't last very long.
- Here is some care advice that should help.
Rinse the Mouth:
- Rinse the lips and mouth with warm water. Do this a few times.
- Reason: To remove any traces of the food.
Cold Pack:
- Use ice or a cold pack to the swollen lips or tongue for 10 minutes.
- Reason: To lessen the swelling and the itch.
Allergy Medicine:
- One dose of Benadryl may help the symptoms go away faster.
- No prescription is needed. Age limit: 1 or older.
How to Prevent Future OAS:
- Keep a list of the foods that cause your child's symptoms.
- Avoid these foods if they are raw (fresh).
- The cooked version of these foods usually won't cause any symptoms.
What to Expect:
- With or without treatment, the itching will go away in 1 to 2 hours.
- The mouth swelling will also go away quickly.
Call Your Doctor If:
- Trouble swallowing or drooling occurs
- Trouble breathing occurs
- Swelling or rash occurs anywhere else
- You think your child needs to be seen
- Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 03/03/2023

Last Revised: 12/30/2022

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