Your best chance of preventing food allergies in your kids? Exposure.

When our son started to eat solid foods, my husband and I — and sometimes my mother, sister or whatever friend happened to be around — would gather around the table and watch his hilarious reactions to new tastes and textures.

He gave the broccoli a look of profound disgust and us a look of profound betrayal. He forgot he could use his hands to pick up food and face-dove into his tray. He was often more interested in eating his bib than his avocados.

It was all fun, laughs and photos. Then came the first big allergen exposure: milk.

My husband, who tends to be more anxious than I am, was predictably nervous as he stirred a microscopic dollop of yogurt into my kid’s avocado puree.

“It’ll be fine!” I said. “If I can drink milk while breastfeeding, surely he can handle the world’s tiniest yogurt exposure.”

A minute or two in, my husband asked, “Is his lip swelling a little bit?”

“No, I don’t think so,” I said. “He’s fine!”

A minute later, my husband asked, “Is that a large hive on his face?”

Thus ended my insistence that everything was fine. Several pediatrician and allergist visits later, we found out my son was allergic to dairy and eggs, and testing showed he was trending toward a peanut allergy.

RIP my husband’s peace of mind.

What followed was a summer of anxiously staring at our son while he ate new foods. And one Friday night, one tired mom (me) accidentally gave our son cow’s milk instead of soy milk, leading to an epinephrine injection, ambulance ride and emergency department visit.

“It’s really hard to have a child with a peanut allergy, or any food allergy,” says Anupama Ravi, M.D., a pediatric allergist at Mayo Clinic in Rochester, Minnesota. “But at the same time, we can empower these parents and families to live with a good quality of life.”

Now, almost a year later — thanks to the expert advice of Mayo Clinic allergists including Dr. Ravi, dietary interventions and some good luck — my son avoided a peanut allergy and it looks like he’s well on his way to outgrowing his dairy and egg allergies.

Learn from my experience and Mayo Clinic experts as you navigate exposing your kids to allergens, managing food allergies and trying to prevent any food allergies you can.

Allergy signs and symptoms

First, the basics: You have to know what allergic reactions look like. Allergic reactions to food can range from mild to life-threatening.

The “Top Eight” allergens are:

• Peanuts.
• Tree nuts, like walnuts and pecans.
• Eggs.
• Milk/Dairy.
• Wheat.
• Fish.
• Shellfish like shrimp, lobster and crab.
• Soy.

If you introduce one of these foods and notice hives around the mouth and face, contact your kid’s health care team.

More seriously, these foods can produce anaphylaxis. This can look like:

• Wheezing, hoarseness, coughing or trouble breathing.
• Swelling of the face, tongue or lips.
• Hives all over the body.

My husband and I were worried that we wouldn’t recognize anaphylaxis fast enough, as our son is prone to general, just-for-fun vomiting. Our allergists assured us that anaphylaxis is pretty obvious, and it was. After drinking cow’s milk, my son instantly started wheezing, crying and then vomiting. It was so much more intense than his typical gag-and-puke routine.

But anaphylaxis isn’t something to mess around with, and you should call 911 even if you’re not 100% sure what’s happening. If you have epinephrine (EpiPen, AuviQ, others) on hand, inject it in your child’s thigh. Epinephrine will work immediately for anaphylaxis. If you notice symptoms improve but then worsen (for example, your kid has difficulty breathing again), administer the second epinephrine autoinjector.

An epinephrine injection works wonders for an allergic reaction. One allergist told us that many times, children will calm down almost immediately after receiving it.

“Epinephrine is super safe,” Dr. Ravi says. “It works right away. It works every single time.”

Regardless of whether you administer your own epinephrine or the paramedics bring the medication, you’ll need to go to the emergency department afterward. Sometimes the allergic reaction “rebounds” after the epinephrine wears off, making observation necessary.

Who’s at risk for food allergies?

Part of the reason my husband and I were so surprised that our son developed allergies was because neither of us — nor our parents, nor our siblings, not a relative as far as the eye could see — have any food allergies.

While a family history of atopic disease such as a food allergy is a risk factor for allergies, we were totally unaware of another risk factor: eczema. Eczema is also known as atopic dermatitis.

“Eczema is the highest risk factor for developing a food allergy,” says Dr. Ravi. “But it’s important to note that even children who don’t have eczema can develop food allergies.”

We were well aware that our son had eczema and were already following a strict twice-a-day lotion-slathering routine for what we lovingly called his “garbage skin.” The natural question: What does garbage skin have to do with food allergies?

The connection between eczema and food allergies

True food allergies involve something called an immunoglobulin E (IgE)-mediated reaction. Food intolerances and certain dietary conditions — like lactose intolerance and celiac disease — don’t affect IgE.

Sometimes, the immune system mistakenly identifies a specific food or a substance in food as something harmful. In response, the immune system triggers cells to produce a type of protein, an antibody known as immunoglobulin E (IgE). This process — when the body develops IgE against a food protein — is known as sensitization.

An allergist can perform a blood test to try to see if someone has been sensitized to an allergy by looking for specific IgE in the blood. Or they can use a skin-prick test. In this test, a small bit of the allergenic food protein is placed on the skin, then the skin is pricked gently to see if the allergic skin immune cells become activated to produce a hive. Parents can rest assured that skin testing would not result in a full-body reaction.

You may wonder why it’s not standard practice to perform panel testing for all the allergenic foods. Allergists typically won’t routinely perform these types of tests unless your kid has actually had a symptomatic reaction.

That’s because being sensitized to an allergen does not necessarily mean you are or will become allergic — that is, develop allergic symptoms. In other words, someone can have a positive test but may tolerate the food without any negative reactions.

In an allergic reaction, the IgE antibodies on the allergic immune cells sense the allergen and signal these immune cells to release a chemical called histamine, as well as other chemicals. These chemicals cause the symptoms of an allergic reaction.

Now for the skin connection: Your body can produce IgE in response to food proteins that come in contact with the skin immune cells. This is because the skin is part of the immune system. So it may be possible to be sensitized to a food allergen without ever actually eating it.

And this is especially true in eczema. If someone has eczema, their skin immune cells are in a “hyper-activated state,” says Dr. Ravi.

“So for example, if a family member is eating lots of peanut butter regularly, then through those revved up skin immune cells, the infant with eczema starts making more and more IgE to peanut. So some children by the age of 4 months might already have so much IgE against peanut that they may already have a peanut allergy even before consumption of peanut,” she says. “That exposure to that allergen in the child’s environment is causing sensitization through the skin.”

Can I prevent my kid from developing food allergies?

In recent years, doctors and researchers have come to better understand how to prevent food allergies. A prime example: peanuts.

Old guidelines released in 2000 recommended that parents avoid giving children at high risk for allergy any peanut-containing products before 3 years of age. But peanut allergies actually increased — from an estimated 0.4% to 2% of kids — from 1999 to 2010. Some researchers started to suspect that it might be better to expose kids to peanuts earlier, rather than later.

These researchers looked at Jewish children in the U.K. and Israel. Peanut allergies were 10 times more common among Jewish children in the U.K. than Jewish children in Israel. What could be driving such a big difference?

In Israel, peanut-containing foods were commonly given to Jewish kids under 1 year, while U.K. parents generally avoided giving their kids peanuts early in life. However, the U.K. kids were likely still exposed to peanuts through their skin if their parents or families were eating peanuts in the home environment.

Researchers put this idea to the test and assigned infants who were considered high risk for peanut allergy to avoid or regularly eat peanuts until they were 5 years old. They found that early peanut exposure actually helped. Some of the kids who ate peanuts did develop peanut allergies, but at a significantly lower rate than those who avoided peanuts.

This was recently backed up by an analysis estimating that if all kids were introduced to peanuts at 4 to 6 months (depending on their risk level), it could cut down on peanut allergies in the overall population by 77%. This research suggests that early oral consumption significantly helps to prevent food allergies.

The takeaway? If it’s in your house, it needs to be in your kid’s mouth. You’ll want to introduce major allergens — especially the ones you eat! — into their diet at 4 to 6 months, and then continue to have them regularly consume those allergens in their diet.

“I really want to emphasize that at 9 months of age, typically whatever parents are eating children can eat too, as long as it’s not a choking hazard,” says Dr. Ravi. “Whatever the dietary preferences and allergenic foods the parents eat, it would be really helpful to introduce those allergenic foods to the child.”

Preventing peanut allergies in high-risk kids

If your kid has severe eczema, another food allergy or a parental history of an allergic disease, they’re at higher risk of developing a peanut allergy. Kids who aren’t white also seem to be at higher risk of peanut allergies. Introduce peanuts to your kid at 4 to 6 months of age. Once you’ve introduced peanut, have your kid eat peanut products regularly.

Can kids outgrow food allergies?

Yes! Sometimes kids outgrow their food allergies. It’s more likely that your kid will outgrow allergies to cow’s milk, eggs, soy and wheat. It’s less likely that they’ll outgrow allergies to peanuts, tree nuts, fish or shellfish.

And for cow’s milk and egg allergies, it’s possible that the ability to regularly eat baked versions can help your kid get over their allergies faster or increase the odds of outgrowing their allergy. Only do this under medical supervision and know that there are strict definitions for what qualifies as “baked” — a pancake won’t cut it. Mayo Clinic experts advise at least 25 minutes at 350 degrees.

“That’s the minimum temperature, minimum duration that we know helps to alter the protein structure enough so that sometimes those proteins are better tolerated,” says Dr. Ravi. “It’s been shown that if children are able to regularly consume it in that baked form, this can help them outgrow their allergy faster.”

After blood tests, my kid underwent a supervised food challenge for baked eggs (specifically, egg muffins) and baked milk (muffins made with milk). After he passed, he was “prescribed” regular egg and milk muffin consumption, his dream come true.

If your kid has one of the more-persistent allergies, there may be hope. About 20% of kids outgrow peanut allergies, for instance. And if they don’t, there are treatments such as the first FDA-approved oral immunotherapy, which can help decrease the likelihood of anaphylaxis after accidental exposure to peanuts.

“Support is a crucial part. Know that you’re not alone, that there are other parents out there that are going through exactly what you are.” Dr. Ravi says.

Relevant reading

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