Food Allergy Testing and Introduction in Newborns

When Testing Should NOT Be Done

The American Academy of Pediatrics recommends against performing allergy testing in asymptomatic newborns or infants, even with a family history of food allergy, as the tests are sensitive but poorly specific 1, 2
The American Academy of Pediatrics advises against testing before introducing highly allergenic foods (cow's milk, egg, peanut) in standard-risk infants, as there is insufficient evidence to support this practice 3, 2
The American Academy of Pediatrics suggests never testing based solely on family history in a close relative, unless the infant has already experienced symptoms with a specific food 1

The American Academy of Pediatrics recommends testing children younger than 5 years with persistent moderate-to-severe atopic dermatitis for cow's milk, egg, peanut, wheat, and soy if the eczema persists despite optimized topical therapy or if there is a reliable history of immediate reaction after ingesting a specific food 3, 2, 4
Up to 37% of children younger than 5 years with moderate-to-severe atopic dermatitis have IgE-mediated food allergy, according to the American Academy of Pediatrics 3, 2
The American Academy of Allergy, Asthma, and Immunology notes that optimizing skin care first before attributing symptoms to food allergy is crucial, as many cases are misattributed when the real issue is inadequate eczema management 5, 4

The American Academy of Pediatrics suggests that infants with severe eczema should undergo evaluation by an allergist between 4-6 months, which may include skin prick testing, before introducing peanut 6
The American Academy of Pediatrics recommends that infants with diagnosed egg allergy in the first 4-6 months should also be evaluated before peanut introduction 6
The American Academy of Allergy, Asthma, and Immunology advises using skin prick testing rather than serum IgE in this population, as IgE testing results in considerably higher rates of sensitization and unnecessary oral food challenges 6

The American Academy of Pediatrics recommends testing when an infant has experienced anaphylaxis or immediate symptoms (hives, facial swelling, vomiting, respiratory symptoms) within minutes to hours of ingesting food, especially if symptoms occur repeatedly 3, 2
The American Academy of Pediatrics suggests considering testing in infants with persistent gastrointestinal symptoms such as eosinophilic esophagitis, gastritis, enteritis, enterocolitis, or allergic proctocolitis 3, 2

The American Academy of Allergy, Asthma, and Immunology recommends that skin prick testing (SPT) should be performed with both negative and positive histamine controls, in duplicate, with maximum wheal diameter measured 6
For peanut SPT, the American Academy of Allergy, Asthma, and Immunology notes that a wheal ≤2 mm indicates low risk, 3-7 mm indicates moderate-to-high risk, and ≥8 mm indicates high likelihood of allergy 6
The American Academy of Pediatrics warns that false-positive tests are common and ensures children are clinically allergic and not just sensitized before implementing dietary restrictions 3, 2

The American Academy of Pediatrics recommends introducing allergenic foods (peanut, egg, dairy, wheat) around 6 months but not before 4 months in standard-risk infants without prior testing 5, 7, 6
For high-risk infants (severe eczema or egg allergy), the American Academy of Pediatrics suggests introducing peanut between 4-11 months after appropriate evaluation, as this reduces peanut allergy risk by up to 80% 6

The American Academy of Allergy, Asthma, and Immunology warns that maternal dietary restriction during pregnancy or lactation is not recommended as a prevention strategy 5, 8, 9
The American Academy of Pediatrics cautions that excessively restrictive diets can cause serious harm, including weight loss, poor growth, calcium deficiency, hypovitaminosis, and kwashiorkor, and should only be implemented with documented, clinically relevant food allergies under medical supervision 4
The American Academy of Allergy, Asthma, and Immunology notes that the severity of allergic reactions cannot be predicted by food-specific IgE levels or skin test wheal size, though the likelihood of reaction is directly related 3