Many parents still hear the advice that it’s better to wait to introduce fish to babies until their first birthdays, or even their second. I disagree! And a growing body of evidence suggests that starting fish between 6 and 12 months results in fewer allergies – both in the short run and by the time they become teens.

Giving babies and toddlers fish a couple of times a week, or even a couple of times a month, may be one of the best tips for preventing allergies.

And perhaps today’s babies and toddlers eating less fish is even one of the reasons allergies have been going up in kids overall, potentially from a decrease of omega-3 fats in the diet. This includes food allergies, pet allergies, and pollen allergies.

Babies’ regularly eating fish before the first birthday could also result in less eczema at age 4. Who doesn’t want better skin?

Another study last year found a window from 6-12 months (earlier or later wasn’t as good), where if babies were introduced to eating fish, they were less likely to have asthma or wheezing symptoms later in preschool. Who doesn’t want to breathe easier?

The longest study I’ve seen yet followed thousands of children from their first birthdays all the way until they were 12 years old. It will appear in the June 2013 American Journal of Clinical Nutrition. Those kids who were already enjoying fish at least twice a month by the first birthday were less likely to have allergies every year thereafter.

My favorite fish for kids is wild (or sockeye, or Alaska, or Pacific) salmon, fresh or even canned, twice a week. You can prepare the pouched or canned salmon as if it were tuna. But check out the NRDC pocket seafood guide for lots of great suggestions. And here are some some DrGreene.com recipes.

• Scrumptious Coconut-Crusted Salmon Recipe
• Quick and Easy Roasted Salmon with Pesto Recipe
• Quick and Easy Chipotle Lime Salmon Recipe
• Broiled Wild Salmon Recipe
• Orange Glazed Salmon Kabobs with Yogurt Garlic Dip

Bon appetit!

Bonus tip: Reduced tobacco exposure and increased eating of oily fish during pregnancy and early childhood are all linked to fewer allergies.

Jarvinen KM and Sicherer SH. Prediction, Prevention, and the “Hygiene Hypothesis”: Fish Consumption during the First Year of Life and Development of Allergic Diseases during Childhood. Pediatrics. Nov 2007; 120:S109.

Kiefte-de Jong JC, de Vries JH, Franco OH, Jaddoe VW, Hofman A, Raat H, de Jongste JC and Moll HA. Fish Consumption in Infancy and Asthma-like Symptoms at Preschool Age. Pediatrics. Dec 2012; 130(6):1060-8.

Magnusson J, Kull I, Rosenlund H, Hakansson N, Wolk A, Melen E, Wickman M, and Bergstrom A. Fish Cosumption in Infancy and Development of Allergic Disease up to Age 12Y. American Journal of Clinical Nutrition. Jun 2013. doi: 10.3945/ajcn.112.045377

Oien T, Storro O, and Johnsen R. Do Early Intake of Fish and Fish Oil Protect Against Eczema and Doctor-Diagnosed Asthma at 2 Years of Age? A Doctor Cohort Study. Journal of Epidemiology and Community Health. Feb 2010; 64(2):124-9.

Dr. Greene’s Answer:

Even stubborn allergies can often be brought under control. Marie, it sounds like you and your son have both been through quite a lot. He’s on a powerful arsenal of medications and already under the care of specialists.

With allergies and asthma causing this much trouble, I’m a big fan of allergy testing to identify the specific offending allergen(s), to be able to be smart about reducing exposure to the triggers, and perhaps to treat those allergies specifically.

Whether or not something specific is identified, when the symptoms are in the nose, lungs, and the rest of the respiratory system, the problem is usually something in the air. A powerful study published in the New England Journal of Medicine looking at 1000 kids with asthma serious enough to hospitalize them or send them to the ER on more than one occasion. They found that taking control of the air in the home was as powerful as steroid medications. Those kids had 34 fewer days with symptoms than their peers.

A mold problem in the home is something to consider.

Certain houseplants can be powerful ways to remove problem-causing chemicals from the air. (Chemical fragrances and other volatile compounds (VOCs) can trigger asthma or rhinitis and not show up on allergy testing. They can come from furniture, paint, carpeting, air fresheners, computers, etc.)

There are also a number of treatment alternatives for the symptoms.

For nasal allergies, I like Ortho Molecular D-Hist Jr, which uses quercetin, stinging nettle N-acetyl cysteine, and bromelain to reduce the allergic response and reduce phlegm.

For cough variant asthma I like traditional Chinese medicine herbs, such as Kan Herbals Deep Breath. The NIH Center for complementary and alternative medicines has published a statement on these herbs that the preliminary evidence for using these herbs is promising, with all the studies showing positive results.

At Stanford, my colleague who was across the hall from me for years, pulmonologist John Marks, MD, has had success with mind-body relaxation techniques in kids, such as massage or guided imagery — sometimes being able to reduce the over-active immune response enough to get kids with asthma off of controller medicines.

Both honey and dark chocolate can be powerful at reducing coughs. The dark chocolate contains a compound similar to theophylline, an asthma drug we quite using, in part, because we had to keep drawing blood tests to be sure the dose didn’t get too high. You don’t have that problem with food.

Speaking of food, how kids eat can have a major impact on asthma symptoms. If they’ll eat that way, a Mediterranean diet such as this has been much-studied and can be a great choice.

With your son’s complex medicine regimen, Marie, you’ll want to discuss any new supplements or remedies with his specialists, though clean air and healthy food are good for any child with allergies and asthma.

Finally, for my own family, I like to brew a cup of Traditional Medicinals Organic Chamomile tea to relax, loosen the phlegm and help calm the cough. It’s a simple, comforting choice you can share.

Our lives revolve around food. We need nourishment to be healthy, for our bodies to function and grow, and food also brings us emotional happiness. Sharing food traditions is very important to many families. But when a food allergy enters the picture, it’s akin to an earthquake hitting that huge part of our lives. Our ideas, beliefs, comforts and traditions are shaken up. And as the dust settles, we have to learn new ways of being, cooking and eating.

Traveling with food allergies, especially that first time, can feel like a huge challenge. Everything you have taken for granted previously goes right out the window. Stopping to grab a bite to eat takes on a whole new set of requirements to ensure that everyone in the family can eat safely.

Embracing Change

Some families have a hard time adjusting to this new way of eating. They may feel grief and loss about missing out on traditional love foods or places to eat. They may even avoid traveling because it feels like too much work to figure out how to keep everyone safe. Those are all normal feelings and it’s important to honor them. But don’t let them prevent you from doing what you love as a family. With a bit of pre-planning, you can make traveling and eating on the road safe and fun for the whole family.

New Normal

The good news is that a lot of restaurants and resorts are more aware of food allergies and the impact on their guests. In fact, it’s becoming relatively mainstream. Many restaurants have gluten-free menus, at least. Restaurant managers and wait staff are becoming experienced at responding to customer questions about food allergies.

The bad news is that while they may ‘know’ what food allergies are, they can be unaware of cross-contamination issues and the meticulous way food much be prepared to keep allergenic guests safe. Don’t assume the restaurant knows how to safely handle food allergies. Part of eating out for you is going to have include a conversation with the manager or wait staff to ensure they know how to safely prepare your family’s food.

If you’re feeling a bit anxious about inconveniencing the restaurant staff, don’t! Their job as your server is, well, to serve you. You can always pay them a compliment at the end of the meal by leaving a generous tip. If you prefer, you can call the manager ahead of time and explain your situation; see what the restaurant can offer you in terms of support and reassurance around eating at their establishment. Just make sure you don’t call during the breakfast, lunch or dinner rushes; 10AM – noon and 2PM – 4PM are probably the best times to call.

Creating Traditions

One of the silver linings of having food allergies is experimenting with foods you may not have previously considered. And it sometimes forces you to be creative and come up with new ways of cooking old favorites. For example, we love popcorn, but with several family members sensitive to corn we can’t enjoy it with a movie like we used to. Enter “pop-rice”. So simple: crumble a couple rice cakes into a bowl, drizzle with warm butter (or butter substitute), and sprinkle with salt. Voila! The kids love it and it feels like a true treat for them.

With a bit of research before you travel, you may be able to scout out some restaurants and eateries that are safe and offer unique treats for your food allergic family. There are vegan (egg and dairy free) ice cream shops and gluten-free bakeries to be found. Food on vacation doesn’t have to be a foreboding prospect, it can be a fun treat for all family members with a little bit of planning.

What part of traveling with food allergies most concerns you?

Parents of food-allergic youngsters know that the most surefire way to safeguard their kids from trigger foods is to prepare all meals and snacks at home in a controlled environment. For this week’s series, I asked three top voices in the Twitter food allergy community, Kim Maes, Cybele Pascal and Robyn O’Brien — all parents of children with food allergies — for their favorite cooking tips, essential tools and strategies to prepare allergen-free food.

If you’re new to food allergies, the task of safeguarding your home kitchen can be daunting. With a few straightforward considerations, however, you’ll be ready to cook allergy-friendly meals in no time.

1. Determine the severity of all food allergies in the household. This will help you figure out the degree to which you’ll need to safeguard your house from cross-contamination, according to Cybele Pascal. “If a member of your family is anaphylactic to even airborne traces of peanut, you will be sure to keep peanuts out of the house, and you will do everything in your power to be sure that nothing that’s cross contaminated by peanuts comes into your house. Other families are comfortable having an area of the pantry that is specifically labeled with ‘safe’ foods and utensils for the food allergic person.”

2. Consider a family-wide allergy-friendly diet. Some parents find it easier to avoid cross-contamination by eliminating the allergen from the household, especially following the initial food-allergy diagnosis. “With my son, who has multiple food allergies, in the beginning, I just kept all the offending foods out of the house, and we all ate a completely allergy-free diet, which I found was the easiest way of handling it for me,” said Pascal. “Now, we do have some allergens in the house.”

This article, written by Marissa Brassfield, originally appeared on CalorieLab

If it seems like nowadays there’s someone in every school classrooms with a food allergy, that’s because almost 1 in 12 kids today have food allergies – and 1 in 32 have serious food allergies, serious enough to have already caused the child to have symptoms like trouble breathing, a drop in blood pressure, or shock, according to a 2011 study of almost 40,000 US households.

Peanuts, milk, and shellfish were the top three foods kids were allergic to at any age. Milk was number one from birth to age 2, peanuts from 3 to 13 years old, and shellfish beyond the 14th birthday. Rounding out the top nine allergic foods throughout childhood, in order, were tree nuts, eggs, fish, strawberries, wheat, and soy.

More than half of those who were allergic to peanuts or tree nuts had experienced a severe reaction. Severe reactions were also found in more than 40% of those allergic to shellfish, soy, or fish. Among the top allergy foods, strawberries were the least likely to have triggered a severe reaction – but it still happened in 1 in 5 strawberry-allergic kids.

Other new findings: peanuts and fish both caused allergies in more kids than previously reported. And among kids allergic to any food, more than 30% had multiple food allergies. As one might guess, those with multiple food allergies were even more likely to have had a severe reaction (makes sense, but not demonstrated before).

Allergies can come and go. Food allergies were common in children of every age, but most common from age 3 to 5. Severe food allergies, on the other hand, got more common with age and were more than twice as likely in kids 14 and over than in those 2 and under.

Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, and Holl JL. “The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States.” Pediatrics. Jul 2011; 128(1):e9-17.

Because allergies to pets are common, people long assumed that exposure to pets made allergies more likely. A number of studies have turned this assumption upside down. The August 2003 Pediatrics Synopsis Book summarizes the current understanding.

For a newborn coming into a home, or for a child who has not developed allergies, exposure to a dog or to multiple pets appears to decrease the risk of allergies, eczema, and perhaps (in one study) even asthma. In the studies summarized, as the numbers of cats and dogs went up, hay fever, eczema, and other allergies decreased.

For a child who is already allergic, but not to pets, getting pets does not appear to help or hurt. For a child who is already allergic to pets, there is no allergic benefit to keeping the pets, and exposure will make symptoms worse. If a child has asthma and is pet-allergic, then it may be wise to move the pet from the home.

It’s peak allergy season in many areas, with spring trees still pumping out millions of grains of pollen each day and the summer grasses already starting to contribute their share. Sneezing, running nose, and itching – itchy eyes, itchy nose, itchy throat – wouldn’t it be great to be able to prevent allergies before they even got started. Preventing asthma and allergies is possible, according to a study in the June 2003 issue of Thorax.

Children at high risk for asthma and allergies were recruited in 1990 to be part of this study. Half of them went about life as normal, and the other half had a low-allergy diet as infants – starting with breast milk (with moms on a low-allergy diet) or Nutramigen formula (no milk or soy-based formula). This group of families also undertook significant measures to avoid exposure to house dust during infancy. Both groups were followed for years, and those in the normal group were 4 to 5 times more likely to develop asthma, allergies, or eczema. Prevention worked! The authors conclude that avoiding allergens during infancy is what made the difference. I wonder, though…

Allergies happen when the body is tricked into thinking that harmless particles are dangerous invaders. The immune system tries to get rid of these allergens by sneezing them out, flushing them out with tears or mucus, or dislodging them with nose rubbing. It tries to prevent them from getting into the lungs by constricting the airways. These are all normal responses to toxins and viruses. They are allergies if the trigger is not really a problem.

To me it makes sense that infants’ avoiding those foods that commonly trigger allergies would result in fewer allergies. The immature gut allows intact proteins to slip into the body and trigger an immune response. Babies are built to start life with only one food, and then to have only a limited variety for a number of months. I believe that the hypoallergenic diet helped the children in the study.

Avoiding inhaled allergens, though, may be another story. Other studies have shown that babies who are exposed to dogs and cats before the first birthday, for example, are far less likely to develop allergies later. It seems to me that the nose is designed to detect changes (which is why you often no longer notice even very strong odors if you are around them long enough). It seems to me that a baby’s nose learns what is “normal” to have around them in the air during the first year or so, and then begins to consider some later arrivals as dangerous invaders – the body develops an allergic response to them. Perhaps the allergy prevention would have been even stronger without the mattress covers! Once allergies are present, avoiding the allergens – whether they are pollens, pets, dust, foods, or anything else – is a powerful way to reduce the allergies. Avoiding one item you are allergic to can even reduce your allergies to something else (some people are only allergic to certain foods during the pollen season, for instance). But for babies who have not yet developed allergies, too clean may make matters worse.

There may have been other differences between the two groups in the study. One half certainly worked harder and paid more attention to allergy issues. We still have a lot to learn. What’s exciting about this breakthrough study is that it demonstrates that preventing allergies, asthma, and eczema is truly possible. Now we just have to learn how best to do it.

Dr. Greene`s Answer:

One of the most common reasons for blood in a young baby’s stools is an allergy to the cow’s milk protein in dairy products. The same allergy that can cause inflammation in the intestines (colitis) can also cause eczema in the skin. The allergy is not to breast milk, but it is true that enough cow’s milk protein from mom’s diet can come through in the breast milk to cause symptoms in an allergic baby. (Other food allergies can also do this. Milk is the most common, but enough soy, peanut, and eggs can also go through breast milk to cause allergic reactions).

La Leche League is right that the offending foods are usually gone from the breast milk within seven days of removing them from mom’s diet — often even sooner. Most allergic babies do get better while breastfeeding if their mothers give up cow’s milk and foods that contain cow’s milk (which can show up as whey, casein, milk hydrolysates, butter on food labels). But, even after avoiding cow’s milk, there are a few babies who do not improve. If your baby doesn’t get better, you might try eliminating all four of the most common allergens from your diet (milk, soy, peanuts, and eggs). Be sure you find another way to get plenty of calcium.

I would not stop nursing for this unless, perhaps, if your baby were anemic and/or had low protein on a blood test. Even then, I would recommend seeing a pediatric GI doc before deciding to stop. There would probably be a safe way to continue nursing.

Many doctors are not aware of this, but even though Nutramigen is a great hypoallergenic formula that can be very effective for babies who are allergic to milk-based formulas, it does still contain traces of milk. In my experience, those who react to traces of milk in dairy-free breast milk will also react to Nutramigen (within a few weeks, if not at first) and would ultimately need a formula called Neocate, which contains none.

In short, I admire your decision and your pursuing more information. The advantages of nursing far outweigh a tiny bit of inflammation and blood loss in an otherwise growing baby. I wouldn’t stop nursing for that.

Dr. Greene’s Answer:

There are many types of food intolerances, and some of them can trigger eczema and cause poor weight gain.

Both wheat and dairy commonly cause allergies and worsening eczema in babies. Many of those who are allergic to dairy are also allergic to soy.

Your baby needs a good source of protein, calories, fat, and other nutrients. For infants, breastmilk or formula is usually the best way to get these things. While breastmilk is preferred over formula, some babies with severe or multiple allergies may need a hypoallergenic formula because allergic components of food can pass from mother to child through breastmilk.

Hypoallergenic formulas include protein hydrolysate formulas, such as Nutramigen and Alimentum. Some kids with severe allergies need to be on an even more elemental formula, such as Neocate, but you will want to work with your pediatrician before making that choice.

There is now a blood test for diagnosing celiac, called the serum IgA-endomysial antibody test. It is possible that this condition or eczema could be linked to low weight gain, but keep in mind that 10 percent of healthy kids are at the 10th percentile so it could also be the size she is built to be.

Related concepts:

Nut allergy, Life-threatening food allergies

Introduction to peanut allergies:

A child eats every few hours to take in the fuel that he needs for energy, growth, and bodily repair. Usually, eating is both fun and helpful. However, sometimes it is deadly.

What is a peanut allergy?

Some individuals have reactions to particular foods. These reactions can range from mild intolerance to fatal allergies. Most children have mild to moderate reactions (rash, wheezing, tingling, diarrhea, etc.) to the offending food before the allergy becomes severe. In a few children, the first time they eat the particular food, they become sensitized and the second time they eat even a miniscule amount of that food, an explosive reaction occurs.

Who gets peanut allergies?

Most children who develop life-threatening food allergies either have asthma or a family history of asthma, eczema, or hay fever. Life-threatening food allergies are not rare. Fortunately, as deadly and as common as they are, very few children actually die from them.
Note: Peanut allergies and nut allergies are different allergies. Peanuts do not grow on trees and are not true nuts.

What are the symptoms of a peanut allergy?

Life-threatening food allergies can kill children in two ways. The first is called laryngospasm. As the food is swallowed, it produces immediate swelling that spreads to the vocal cords. If the vocal cords swell shut, the child is unable to breathe and dies with terrifying rapidity. The second mechanism is called anaphylactic shock. The child swallows and digests the food and, as long as two hours later, goes into shock and dies.
Common foods that cause anaphylaxis include nuts, peanuts, shellfish, fish, eggs, celery, legumes, and cheeses that contain mold.

Are peanut allergies contagious?

No.

How long does a peanut allergy last?

Children with life-threatening food allergies do not tend to grow out of them. Without treatment, they should be considered lifelong conditions.

How is a peanut allergy diagnosed?

Anyone with a suspected nut or peanut allergy, or with a suspected life-threatening food allergy, should be evaluated by an allergist. Possible tests include a diagnostic blood test, called a RAST test, which measures antibodies to specific allergens. Skin testing might provide useful information, but must be done carefully as it is riskier than RAST testing in severely allergic individuals.

How is a peanut allergy treated?

The core of treatment is absolute and complete lifelong avoidance of the offending food in any form.
Most intake of nut products by people with known nut allergies occurs when the nuts are present as a hidden ingredient, perhaps in a cake, cup cake, or even chili. One young man ordered a chocolate chip cookie with no nuts at a nationally known cookie store. On his first bite, he recognized it as a peanut butter chocolate chip cookie. This wasn’t soon enough — moments later a full-scale resuscitation was underway. He left the cookie store on a ventilator. Thankfully, he survived.
No matter how careful you are, it is almost inevitable that it will happen — your child will eat the dangerous food. I say this now in hopes that when it happens, you will remember my thoughts and see yourselves with the same compassion that I feel for you at this moment — not with guilt or judgment. I also tell you this so you will take the second phase of treatment seriously. You must be prepared to deal with the emergency when it happens.
Learn CPR. Now.
Children with life-threatening food allergies need a kit with easily injectable epinephrine (also known as an Epipen). Make that two kits. Epinephrine is the one drug that can stop this reaction in its tracks. Parents should each carry an Epipen with them at all times, 24 hours a day. It is important that parents are comfortable using it.
Signs of an allergic reaction include facial or neck swelling, breathing difficulties, lightheadedness, nausea, vomiting, rash or flushing associated with a nut ingestion.   If you think there has been any nut ingestion and your child exhibits any signs of an allergic reaction, USE IT! Don’t wait and see. Use the Epipen and take your child to the emergency room immediately. If your child is having difficulties breathing, you should call 911.
Once you have educated yourself on emergency care, it is vital that you educate any other adult who will be caring for your child. These adults should know CPR and should have an Epipen kit. In a chilling study from Johns Hopkins University, thirteen children with life-threatening nut allergies were followed and six of them died. All six of these children had ingested nuts while at their various schools. They immediately went to their school nurses who told them to lie down and see if they felt better. Each of them did feel better and went back to class — and died. Speak with your child’s teachers, principal, and school nurse – in person. Any adult taking care of your child should be given a written note that indicates your child has a life-threatening allergy. Consider purchasing a medical alert bracelet—an identification bracelet that has your child’s name and allergy.
You will also benefit from links to other families going through the same thing. Food allergy support groups are available in many locations.
Some of the research being done right now in life-threatening food allergies is very exciting. Companies are working on products to block this type of allergic response at the cellular and molecular level. This research is quite promising, but still only investigational.

How can a peanut allergy be prevented?

Raising children in a smoke-free environment, beginning in before birth, can help prevent development of severe allergies. Pregnant women with a strong family history of allergies should avoid peanuts during pregnancy.
Breastfeeding can help prevent severe allergies, especially if the offending foods are avoided during nursing. This is more effective for some foods than for others. Delaying the introduction of allergic foods and exposures can also reduce food allergies.

Related A-to-Z Information:

Allergies (Allergic Rhinitis), Asthma, Celiac Disease, Cough, Diarrhea, Eczema, Food Allergies, Hives, Respiratory Distress, Sudden Infant Death Syndrome (SIDS), Wheezing