For years, parents were told to delay introducing allergenic foods — peanuts, eggs, fish — until age 2 or 3, sometimes longer. That advice has been completely overturned by evidence. Not just revised — reversed. The current guidance is almost the exact opposite: introduce allergens early.
In 2015, the LEAP Trial (Learning Early About Peanut Allergy) published results that shook the allergy world. 640 high-risk infants (with severe eczema, egg allergy, or both) were randomised to either:
The result: 81% reduction in peanut allergy in the early-introduction group. This effect has been shown to be durable into adolescence (LEAP-On study). The NEJM paper by Du Toit et al. (2015) is now one of the most cited studies in paediatric allergy.
Subsequent studies — EAT, PETIT, SPADE — confirmed similar findings for egg and other allergens. The message is consistent: the gut, when exposed early, learns tolerance. Delay creates risk.
| Allergen | Safe infant form | Target age |
|---|---|---|
| 🥜 Peanuts | Smooth peanut butter thinned with water/breast milk; peanut puffs softened with water | 4–6 months |
| 🥚 Eggs | Well-scrambled egg, hard-boiled egg mashed | 4–6 months |
| 🥛 Cow's milk | Yogurt, cheese (not plain cow's milk as main drink before 12 months) | 4–6 months |
| 🐟 Fish | Flaked soft white fish (well cooked, boneless) | 4–6 months |
| 🦐 Shellfish | Finely minced prawn/crab (well cooked) | 6 months |
| 🌾 Wheat | Congee with wheat cereal, soft noodles | 4–6 months |
| 🫘 Soy | Tofu (silken), soy-based infant food | 4–6 months |
| 🌰 Tree nuts | Cashew/almond butter thinned with water (smooth only) | 6 months |
⚠️ Never give whole peanuts, whole nuts, or large chunks of nut butter to infants. These are choking hazards. Always thin nut butters to a runny consistency or use allergen-specific infant puffs.
No eczema. No food allergies. No family history of severe allergy.
Action: Introduce all allergens freely from 4–6 months with first complementary foods. No doctor visit needed first.
Mild to moderate eczema (not severe).
Action: Introduce peanut and egg around 6 months. Consult your paediatrician first, but pre-testing is generally not needed.
Severe eczema, AND/OR existing egg allergy.
Action: Refer to an allergist before home introduction. Supervised introduction or skin-prick testing / peanut-specific IgE recommended.
Most reactions appear within 15–30 minutes of eating. Signs range from mild to severe:
🚨 If you suspect anaphylaxis: call 995 immediately. If an EpiPen (adrenaline auto-injector) has been prescribed, use it. Do not wait to see if it gets better. Lay your child flat with legs raised (unless breathing is difficult). Do not give antihistamines alone for anaphylaxis — they are too slow.
Singapore's hawker culture is wonderful — and allergen-dense. Peanuts appear in satay, rojak, popiah, and many sauces. Shellfish paste (belacan) is in sambal. Eggs are in kueh, chai tow kway, and carrot cake. Fish sauce is near-universal.
The good news: once you have successfully introduced an allergen and your child tolerates it, continued regular exposure maintains tolerance. In fact, stopping exposure after successful introduction can reverse that tolerance over time. So eat at hawker centres with confidence — it's good for your child's immune education.
For first allergen introduction: put a tiny amount (tip of a clean spoon) on your child's lower lip first. Wait 10 minutes. If no reaction, give a small amount on a spoon. Wait 20 minutes. If no reaction, give a full serving. This staged approach gives you an early warning sign before a larger dose.
Many parents introduce peanut once, see no reaction, and then don't give it again for months. This is a missed opportunity. Aim for peanut-containing food at least 2–3 times per week once tolerated. Consistency is what trains and maintains immune tolerance. Thin peanut butter on toast soldiers, peanut puffs as snacks, or a small scoop of peanut sauce — all count.
Children with eczema have a disrupted skin barrier. Allergens (including peanut proteins in house dust) can penetrate through the skin, triggering sensitisation before the child has ever eaten the food. This is why early oral introduction is protective — it trains immune tolerance through the gut (the "right" route) before sensitisation through the skin occurs. Treating eczema aggressively with emollients is also allergy prevention.
References
Du Toit G et al. Randomized trial of peanut consumption in infants at risk for peanut allergy (LEAP). NEJM. 2015;372:803–13
Perkin MR et al. Randomized trial of introduction of allergenic foods in breast-fed infants (EAT). NEJM. 2016
NIAID-Sponsored Expert Panel Guidelines: Addendum for Peanut Allergy Prevention (2017, updated 2024)
AAP Policy Statement: Infant Food Introduction and Food Allergy Prevention. Pediatrics. 2024
Australasian Society of Clinical Immunology and Allergy (ASCIA): Infant Feeding and Allergy Prevention Guidelines. 2023
Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. 2008 (skin sensitisation hypothesis)