A recent study published in the Journal of Allergy and Clinical Immunology: Global examines a paradox: despite clinical guidelines shifting toward early introduction of allergenic foods to prevent allergies, emergency department (ED) visits for infant food-induced anaphylaxis and allergic reactions are rising. The research, titled “Rising trends in infant ER encounters for food-induced allergic reactions in the era of early allergenic food introduction,” underscores the urgent need to understand the practical challenges families face during this critical developmental window.
The study analyzed data from a large pediatric healthcare system over several years, focusing specifically on infants under age one. Researchers found that ED encounters for food-triggered allergic events increased significantly in the period following the 2017 NIAID guideline changes. These guidelines recommend introducing peanut products to infants as early as 4 to 6 months to reduce the risk of developing a permanent allergy, a shift the study notes has led to “more infants being exposed to potential allergens at an earlier age.”
The study found that emergency department visits for food-related allergic reactions in infants increased steadily over time. On average, infant ED visits for food-induced allergic reactions rose by about 15% per year. Even more concerning, visits for food-induced anaphylaxis increased by roughly 25–30% per year, indicating a particularly sharp rise in the most severe reactions.
While the shift toward early introduction is grounded in strong clinical evidence—most notably the LEAP study—and has been shown to reduce peanut allergy rates in children, real-world application has led to more frequent acute reactions at home. The researchers noted that as more parents follow these recommendations, there is a natural uptick in the “unmasking” of existing allergies. The study points out that “the increase in ED visits may reflect the challenges of identifying and managing allergic reactions in infants,” whose symptoms can be more subtle than those in older children.
A key finding of the research is that many of these infants presented with symptoms that their caregivers did not initially recognize as anaphylaxis. Common signs in this age group include hives, vomiting, or lethargy, which can be mistaken for general illness or “spitting up.” The study emphasizes that “caregivers often hesitate to administer epinephrine,” either because they do not recognize the severity or because they are anxious about using an auto-injector on a small infant.
The data also revealed disparities in how these emergency encounters are managed and followed up. While ED visits increased, the rate of follow-up with specialized allergists did not always keep pace. This gap suggests that although the healthcare system is seeing more acute reactions, the transition to long-term management and education is not always seamless. The authors emphasize that “successful early introduction requires not just clinical advice, but robust support systems for families navigating the process.”
Furthermore, the study examined which specific foods were responsible for these encounters. Although peanuts are the most frequently discussed allergen in early introduction, the researchers found that milk and eggs remain primary triggers for infant ED visits. This underscores that “early introduction strategies must encompass a broad range of allergens” beyond peanuts, as the timing of introduction for various foods can influence the frequency of accidental reactions.
Ultimately, the article calls for a more nuanced approach to public health messaging on infant feeding. While the goal of early introduction remains to lower the overall prevalence of food allergies, the study underscores that this transition phase carries its own risks, which require better caregiver education and ED preparedness. The researchers conclude that “identifying these trends is the first step toward optimizing safety” as the medical community continues to refine how and when we introduce common allergens to the youngest patients.
