Once you have the hang of allergen free breast feeding, the next inevitable question is: When and how do we try reintroducing food allergens? Many infants will develop a tolerance to allergens by their first birthday and no longer need restrictions. However, it is important to test for continued allergies safely and effectively. Work with your medical team and consider the following courses of action.
Since food allergens ingested by mom do not always appear in breast milk, it is best to introduce the allergen directly to the child. Using a method reliant on the mother’s consumption could result in believing your child is not sensitive to an allergen, but instead they are simply not being exposed to it.
After your baby is six months old, you can begin introducing solids into their diet. For children with food sensitivities, start out with less-allergen solids that you haven't experienced any response to through your own diet. Choose one food to introduce at a time, giving only that food for 3-5 days to test for any reaction. Once you have offered a variety of non-allergen foods without any adverse effects, you can attempt allergens. It is up to you if you want to start allergens after 6 months or wait until they are one. Obviously doing so earlier could significantly loosen the restrictions on mom’s diet.
Research suggests a "ladder" system which involves differing levels of preparation. Using this method, baby is given the most broken down form of the protein by cooking it at various levels. For example, offering dairy in the form of a cooked muffin then cheese then actual milk. Each of these represent a different level of heat which will change the structure/size of the protein. More heat = more broken down protein. A Google search can give you each step of the ladder for foods like dairy, soy, and egg.
Introduction through Breast Milk
If your baby is too young to introduce directly, you may decide to trial through your own diet. This is trickier as mentioned because not every ingested protein will enter your milk every time. For this reason, it is recommended to trial for a longer period of time. Since non-IgE reactions can take up to 48 hours to occur, it is often recommended to use an every-other-day trial. Add the protein back in one serving every other day and monitor for changes. Do so for a minimum of 2 weeks to ensure baby has had a high probability of being exposed to the protein through your milk before moving on to another trial. Hopefully, current research and a future at-home testing mechanism will make this process much easier.
In my own experience, I decided to start introducing allergens to my daughter when she was about 9 months old. By then she had been eating different fruits and vegetables like a champ. I started with the allergens that I believed were least likely for her to be sensitive to. I gave her a small serving a day for three days to elicit a response. Each time there was no reaction, I would try another version of the same allergen for an additional three days. If no reaction occurred, I crossed that allergen off our list.
Below are ideas for each allergen reintroduction:
Dairy: Yogurt, cheese, pancakes, milk added to a puree.
Soy: Edamame, tofu, soy alternatives such as yogurt and milk.
Egg: Cooked egg, egg noodles, mayonnaise, egg custard.
Peanut: Peanut butter, peanut oil, peanut powder mixed into other foods.
Tree Nuts: Nut butter, almond/cashew milk.
Wheat: Cereal, cream of wheat, bread, pasta, biscuits.
Fish: Start with “white flesh” fish which are lowest on the allergen list (flounder, haddock, cod).
Shellfish: Shrimp, clams, lobster (recommended to wait until 12 months old).
Keep an eye out for any possible reactions and consider having an epi-pen on hand in case of an emergency.