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Although food allergy affects fairly low numbers of children in the UK, an estimated 5–8% of children, it is a common concern. IgE-mediated (immediate onset) food allergy, which can cause rapid onset reactions, is less common than non-IgE-(delayed onset) mediated allergy, but generates the greatest anxiety due to the potential for acute symptoms.
Although severe reactions are rare, uncertainty and fear of allergen introduction can lead to delayed or overly cautious feeding practices. It is not unusual to hear of parents taking their babies to hospital car parks to give them their first tastes of foods, usually nuts.
Current UK and Republic of Ireland guidance supports the introduction of the most common allergenic foods before the first birthday. Healthcare professionals play a key part in translating the guidance and relaying it as clear, consistent advice for families.
Providing structured, practical support can help reduce unnecessary avoidance, prevent over-medicalisation, and promote confident, varied feeding during weaning.
The following recommendations are based on guidance from the Scientific Advisory Committee on Nutrition (SACN), the Committee on Toxicity (COT), the British Society for Allergy & Clinical Immunology (BSACI) and British Dietetic Association (BDA) Early Feeding Guidance, NICE clinical guidance, and the Health Service Executive (HSE) in Ireland.
Solids should be introduced when a baby is developmentally ready; able to sit upright in a highchair with good head control, able to coordinate food into the mouth with the hands and is able to swallow (has lost the tongue thrust reflex). For most babies this happens at around 6 months of age and should not be before 4 months (17 weeks).
Where possible, allergens should be introduced from the start of weaning; with all common allergenic foods being offered before the first birthday.
Common allergens to prioritise during weaning include:
Most infants can introduce allergenic foods at home following standard weaning advice. However, a small proportion are at higher risk of developing food allergy and may require more individualised assessment.
Infants considered at higher risk include those:
Babies with eczema are at higher risk of food allergy because the skin barrier is inflamed and broken, and tiny food particles from the environment can come into contact with the immune system through the skin. This can increase the risk of the body recognising that food as a threat rather than learning to tolerate it.
Early introduction can help to support the development of immune tolerance before sensitisation occurs. For this reason, timely introduction of allergenic foods is considered especially important in higher risk infants.
Eczema severity can be subjective, but features that may indicate higher risk include:
Eczema should ideally be well controlled prior to allergen introduction, as active inflammation may make assessment of reactions more difficult.
Infants at higher risk of food allergy, including those with moderate to severe eczema or an existing food allergy may benefit from the earlier introduction of cooked egg and peanut from 4 months of age.
For these infants:
For many higher-risk infants, allergen introduction can still take place at home with appropriate assessment and safety-net advice.
What does not automatically increase risk?
For most babies, home introduction of allergenic foods as part of normal weaning is recommended.
Allergen introduction should take place once the infant is developmentally ready for solids, around 6 months and not before 4 months. Signs of readiness include:
Allergens should be introduced one at a time; so if a reaction occurs it is easy to identify the cause.
A practical approach is to:
Introducing a food once and then not offering it again is unlikely to support ongoing tolerance. This may be particularly important for families whose diet does not regularly include some allergens (for example, plant-based families), where intentional inclusion may need to be planned.
Whilst discussing allergy safety, it is important to also consider other potential risks such as choking.
Examples include:
When supporting families with the introduction of solids, it can be helpful to explain the difference between immediate (IgE-mediated) and delayed (non-IgE-mediated) food allergy. This helps parents understand what to monitor for and reduces unnecessary anxiety about normal feeding behaviours.
IgE-mediated reactions usually occur within minutes, and typically within around 2 hours of eating.
Mild to moderate symptoms may include:
Anaphylaxis is much less usual but requires urgent action. These can be remembered using the ABC approach:
Parents should call an ambulance if ABC symptoms occur so that adrenaline can be given.
Delayed-type reactions typically occur within an hour or two up to several days after ingestion.
Symptoms may include:
Delayed-type allergy does not cause anaphylaxis.
It is also important to reassure parents that not all skin changes after eating are allergic reactions. Redness or mild skin irritation localised to the face is common and does not indicate food allergy.
Providing clear, structured information about what constitutes a true allergic reaction can reduce unnecessary anxieties and food restriction.
If symptoms are suggestive of an allergic reaction when a new food is given, the suspected trigger food should be avoided until further assessment has taken place.
Immediate reactions typically occur within minutes, and usually within 2 hours, of eating the food.
If symptoms suggest an immediate allergic reaction:
If severe symptoms develop — particularly airway, breathing or circulation symptoms (ABC) parents should be advised to seek urgent medical assistance by calling emergency services.
Delayed reactions usually develop several hours up to days after eating the food.
If delayed symptoms are suspected:
Referral for specialist assessment may be appropriate where symptoms are persistent, severe, or associated with faltering growth.
Delayed-type food allergy does not cause anaphylaxis.
Experiencing an allergic reaction can be extremely worrying for parents. Clear guidance from healthcare professionals can help families respond appropriately while avoiding unnecessary long-term food exclusion. Thinking about the following areas can also go a long way to helping families to work through their worries:
Encourage positive feeding experiences: Support families to focus on variety, enjoyment and family mealtimes. Feeding can still be a positive experience even when food allergies are present.
The introduction of allergens is an area often affected by misinformation and common myths. Some of the misconceptions that might come up in clinical practice are set out below.
Routine screening before introducing allergens is not recommended; it does not show up delayed reactions. Inappropriate testing can lead to increased anxiety, delay introduction of foods and may lead to unnecessary dietary restriction.
Testing may identify sensitisation without confirming clinical allergy, which means some babies may end up avoiding foods they tolerate. Testing is most helpful when guided by a relevant clinical history and when results can be interpreted by a clinician with appropriate expertise.
Introducing a food once is not enough, it should be given for several days. Once tolerated, allergenic foods should be given every week as part of a baby’s normal diet to help with ongoing tolerance.
A negative skin prick test or specific IgE test makes IgE-mediated food allergy less likely, but it does not exclude delayed (non-IgE-mediated) food allergy. Gold standard for assessing allergies is removal of a food following symptoms, and if symptoms are recurring with reintroduction of that food an allergy is confirmed. Any test results should be interpreted alongside an allergy focussed history.
Commercial home tests are not recommended for diagnosing food allergy as they are often not evidence based or accurate. Diagnosis should be based on an allergy-focused clinical history and, where appropriate, validated testing interpreted by an appropriately trained clinician.
Most infants can begin solids at around 6 months and not before 4 months. All common allergenic foods should be introduced before 12 months as part of normal weaning.
Early‑onset moderate–severe eczema and existing food allergy are the strongest predictors of allergy. These babies would benefit from early introduction from 4 months.
Introduce one allergen at a time, in small amounts, and increase gradually over 2–3 days. Use safe textures (e.g., smooth nut butters, well‑cooked egg) and have ongoing regular exposures.
Although it can feel scary introducing foods for the first time, reassure parents that a small number of babies have allergic reactions; and of that number most are delayed onset reactions.
Routine screening before allergen introduction is not recommended. Test results must always be interpreted alongside an allergy focused clinical history.
Normalise concerns and offer practical advice. Emphasise that early, varied feeding supports long term tolerance.
Where possible, aim to refer infants with suspected IgE‑mediated reactions, persistent or severe delayed symptoms, faltering growth, or complex feeding concerns to specialist allergy services.
Scientific Advisory Committee on Nutrition. (2018). Feeding in the First Year of Life. UK Government. (Accessed 19 February 2026).
Scientific Advisory Committee on Nutrition & Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. (2018). Assessing the health benefits and risks of the introduction of peanut and hen’s egg into the infant diet before six months of age in the UK: A Joint Statement from SACN and COT. Food Standards Agency (COT). (Accessed 19 February 2026).
National Institute for Health and Care Excellence. (2011). Food allergy in under 19s: assessment and diagnosis (CG116). NICE. (Accessed 19 February 2026).
National Institute for Health and Care Excellence. (2016). Food allergy (QS118). NICE. (Accessed 19 February 2026).
British Society for Allergy & Clinical Immunology & British Dietetic Association (Food Allergy Specialist Group). (2018). Preventing food allergy in higher risk infants: guidance for healthcare professionals (Early Feeding Guidance). BSACI. (Accessed 19 February 2026).
Stiefel, G., Anagnostou, K., Boyle, R. J., et al. (2017). BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clinical & Experimental Allergy, 47(6), 719–739.
Resuscitation Council UK. (2021). Emergency treatment of anaphylaxis: Guidelines for healthcare providers. Resuscitation Council UK. (Accessed 19 February 2026).
National Health Service. (2022). Your baby’s first solid foods. NHS. (Accessed 19 February 2026).
National Health Service. (2024). Food allergies in babies and young children. NHS. (Accessed 19 February 2026).
Republic of Ireland policy / guidance
Health Service Executive. (2022). Starting your baby on solid foods (weaning). HSE. (Accessed 19 February 2026).
Health Service Executive. (2023). Food allergies and children. HSE. (Accessed 19 February 2026).
Health Service Executive. (2025). Allergies and weaning. HSE. (Accessed 19 February 2026).
Food Safety Authority of Ireland. (2012). Best Practice for Infant Feeding in Ireland: From pre-conception through the first year of an infant’s life. FSAI.
Du Toit, G., Roberts, G., Sayre, P. H., et al. (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803–813.
Perkin, M. R., Logan, K., Tseng, A., et al. (2016). Randomized trial of introduction of allergenic foods in breast-fed infants. New England Journal of Medicine, 374(18), 1733–1743.
Natsume, O., Kabashima, S., Nakazato, J., et al. (2017). Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): a randomised, double-blind, placebo-controlled trial. The Lancet, 389(10066), 276–286.
Lucy is a paediatric dietitian with 13 years’ experience across the NHS, private practice and industry, with expertise in infant feeding, childhood feeding challenges and responsive feeding. Alongside working directly with families, she delivers training for professionals, speaks at conferences, writes behaviour-change programmes and supports evidence-based conversations around infant and child nutrition.
