What 'top nine' means and when to begin
The U.S. FDA lists milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame as its nine major labelled food allergens. That is a U.S. regulatory list, not every possible allergy or the exact categories in all countries.
NHS guidance recommends offering common allergens one at a time, in small amounts, when solids begin around six months. Keep tolerated foods in the usual diet. The 2026 ASCIA guideline prioritises well-cooked egg and appropriately prepared peanut soon after starting solids and recommends continuing tolerated allergens at least weekly as expert consensus, while the optimal food-specific amount and interval remain uncertain.
The strongest allergy-prevention evidence concerns egg and peanut, not a guarantee for all nine foods. NIAID has a separate pathway for babies with severe eczema and/or egg allergy: peanut introduction may be considered at four to six months after clinician assessment. This is not an instruction for every baby to start solids before six months.
When to get medical or emergency help
- Ask a clinician about first peanut exposure if your baby has severe eczema or an existing egg allergy; NIAID recommends an individualized high-risk assessment.
- For a few hives, mild swelling around the eyes or face or a single vomit, with your baby alert and breathing normally, stop the suspected food, watch closely and get same-day medical advice. Do not rely on a generic home challenge to confirm an allergy.
- For difficult or noisy breathing, wheeze or a persistent cough, a hoarse cry, sudden swelling of the lips, mouth, tongue or throat, or a pale, floppy or unresponsive baby, give prescribed adrenaline (epinephrine) first if available, then call your local emergency number. Keep your baby lying flat.
- Severe food reactions need not have skin symptoms. Feeling well after two hours does not rule out every delayed reaction.
- If a food allergy has already been diagnosed, follow your child's individual allergy plan rather than this general guide.
Nine US label categories, with practical food-form examples
Not a prescribed order, dose or deadline. These are ingredient examples, not tested infant-serving photos or medical clearance. Introduce one NEW common allergen per meal, recognize choking and food-safety hazards, and follow any individualized medical plan.
| US major allergen | Examples to explore when appropriate | What to check first |
|---|---|---|
| Egg | Well-cooked whole egg, mashed or in a soft fully cooked dish. | ASCIA 2026 prioritizes well-cooked egg soon after solids begin. If egg allergy is suspected, do not conduct a home challenge or baked-egg ladder. |
| Peanut | Smooth peanut butter thoroughly thinned into a familiar soft food. | Whole nuts and thick sticky nut-butter spoonfuls are choking hazards. Severe eczema or known egg allergy changes the first-peanut clinical pathway. |
| Milk (dairy) | Plain pasteurized yogurt or pasteurized cheese in a suitable texture. | Cow's milk can be used in foods, but not as the primary drink before 12 months. A suspected milk allergy requires an individual plan. |
| Wheat | Well-cooked soft wheat cereal, porridge, pasta or another suitable wheat food. | Wheat may be hidden in mixed dishes; do not assume other new ingredients were already tolerated. |
| Soy | Soft well-cooked tofu or a suitable soy-containing food in a familiar texture. | Check the full label and the child's feeding skills; a soy-containing mixed food may contain other new allergens. |
| Sesame | Smooth tahini thoroughly thinned into a soft food. | Concentrated thick seed spreads can be sticky. Sesame is one of nine US FDA major label allergens, but national labeling differs. |
| Tree nuts | Smooth, thoroughly thinned individual tree-nut butter or a very fine ground nut incorporated into soft food. | Never whole or chopped nuts. Almond, cashew, walnut and other tree nuts are distinct foods: tolerance of one does not medically clear the others. |
| Fish (finned fish) | Fully cooked, carefully deboned fish prepared to an age-appropriate soft texture. | Verify the species and local seafood guidance. Fish is a different label category from crustacean shellfish. |
| Crustacean shellfish | Thoroughly cooked shrimp, crab or similar shellfish in a suitable finely prepared texture. | Never offer raw or undercooked shellfish. Physical preparation and individual swallowing skills need verification; do not equate with finned fish. |
Rules that matter more than a calendar
- Developmental feeding readiness and safe swallowing come before a timetable or app notification.
- One new common allergen at a meal helps identify the possible trigger if symptoms occur.
- Already-tolerated foods can remain in a meal while one new allergen is introduced.
- Well-cooked egg and appropriate peanut forms deserve early consideration rather than arbitrary delay.
- ASCIA 2026 proposes at least weekly continued inclusion of tolerated foods by expert consensus, not a mandatory nine-food dose, nor proof of lifelong tolerance after one taste.
- Whole nuts, thick sticky nut butter, fish bones, raw shellfish and unpasteurised dairy are not suitable infant preparations.
- Different national guidance may recommend different gaps between foods; no exact two-hour observation period guarantees freedom from delayed reactions.
Build a flexible first-year allergen plan
Check readiness and risk
Most babies are ready for solids at about six months and not before four months. Severe eczema, known egg allergy, previous food reaction or an existing allergy action plan warrants medical advice before first peanut exposure.
Start with appropriately prepared egg and peanut
Use well-cooked egg and, at another meal, a small amount of smooth peanut butter thinned into soft food, when clinically appropriate. Avoid whole nuts, coarse nut pieces and thick sticky spoonfuls.
Introduce only one new allergen per meal
Choose a time when you can observe your baby and obtain help if needed. Offer a small, developmentally appropriate amount. Avoid combining several previously untried allergens in one dish.
Add the remaining major allergens without forcing an order
Consider plain yoghurt, wheat, soy, sesame, tree-nut butters, thoroughly cooked deboned fish and thoroughly cooked crustacean shellfish, in safe forms and as relevant to your family's diet.
Keep tolerated foods in regular rotation
Continue offering foods without a concerning reaction. ASCIA's 2026 recommendation is at least weekly, although individual allergy plans and national guidance can differ.
Keep a practical food log
Note the date, food, ingredient form, approximate amount eaten and any symptoms. An app log supports recall for clinician visits; it does not diagnose allergies.
Respond to a suspected reaction
Stop the suspected food and contact a clinician about symptoms rather than repeating a home challenge. For difficult or noisy breathing, wheeze or a persistent cough, a hoarse cry, sudden swelling of the lips, mouth, tongue or throat, or a pale, floppy or unresponsive baby, give prescribed adrenaline (epinephrine) first if available, then call your local emergency number. Keep your baby lying flat.
