This week, I’m joined by A/Prof Debbie Palmer — a leading dietitian and researcher in early life nutrition — to talk about all things food allergy prevention in babies. We cover the latest evidence on eczema care, when (and how) to introduce allergenic foods, and what’s new in the research world. Debbie also shares fascinating insights into why Australia has such high allergy rates and what’s giving researchers hope for the future. Whether you’re a new parent, a curious health professional, or just fascinated by how our bodies develop food tolerance, this episode is a must-listen.
Listen in and discover:
● Why treating eczema early and properly is key to preventing allergies
● The safest way to introduce allergenic foods like egg and peanut (and when to do it)
● How to know if your baby is developmentally ready for these foods
● Why smearing food on skin is risky — and what to do instead
● What’s behind the rise in cashew and pistachio allergies
● The surprising links between early formula use, breastfeeding, and allergy risk
● How oral immunotherapy is changing the future for kids with nut allergies
● What new studies like Nuts for Babies are discovering about allergy prevention
This podcast is for general information only and doesn’t replace personalised medical advice. Please speak with your GP, paediatrician or allergist for guidance specific to your child.
Associate Professor Debbie Palmer is an experienced dietitian and mid-career researcher. She leads a research team which has the primary focus of investigating nutritional strategies for allergic disease prevention. The research team conducts clinical trials, mechanistic studies, and translation activities, all with the goal of reducing the burden of allergies within our community.
Debbie is:
Team leader of the Nutrition in Early Life Research Team at The Kids Research Institute Australia.
Co-Director of the Centre for Human Lactation Research and Translation at the University of Western Australia.
Co-chair of the Food Allergy Stream of the National Allergy Centre of Excellence, and a Chief Investigator on the NHMRC funded Centre of Research Excellence in Food Allergy Research (CFAR3).
Mentioned in this episode:
Website mentioned by Debbie for research participation and allergy studies:National Allergy Centre of Excellence (NACE) / Kids Research Australia ( contains the Allergy Study Directory, where families can search for studies across Australia)
Nipbu / Allergy and Immunology Website: Nipbu – National Allergy Strategy’s allergy prevention hub, run by the National Allergy Centre of Excellence and the Australasian Society of Clinical Immunology and Allergy (ASCIA)(Evidence-based information on Eczema care and treatment, introducing allergenic foods, videos and infographics for parents)
Kids Research (Australia) (Debbie’s research institute, where she leads the Nutrition and Early Life Research team, info on studies like The Pregnant Study and Nuts for Babies)
Do you want to easily understand what’s in the food you buy without any fear mongering or misinformation? Check out my weekly Chewsday Reviews.
Join my online membership programs today! Baby Mealtimes for parents introducing solids, Toddler Mealtimes to navigate fussy eating, Family Mealtimes for guidance when packing school lunches and feeding the whole family, or School Mealtimes to change the way we talk about food in schools.
Transcripts
[:
Dr Kyla
life-changing research into [:
In honor of the Kids Research Institute celebrating 35 years of research next week, I am delighted to welcome Debbie to the podcast. Hi Debbie. Hi, how are you, Carla? Lovely to be here and talking to you today. I'm very proud to have you on the podcast. I think you're an incredible, uh, dietician, incredible researcher, but also it is your first ever podcast. So I feel like this is a really special moment, um, maybe for both of us.
Debbie Palmer
Yes, it is. Yes. But thank you. It's a, yeah, it's a wonderful opportunity to be able to do this podcast with you as my first
Dr Kyla
Yes, and it's two Perth girls. Um, I think that's amazing too. Do you wanna start? Maybe Debbie, just give us a bit of background into you.
Tell us a little bit about your contribution, I guess, to the allergy research specifically, but kind a bit about you as well.
Debbie
Yeah, so my background is I'm a pediatric clinical dietician and I was working with families with allergic disease many years ago now, and really sort of finding that there was a lack of evidence, a lack of evidence about what we provide of families, particularly for food allergy prevention.
We [:
Dr Kyla
Now you can answer all their questions, I'm guessing quite competently. And I actually asked a few of my mealtimes members if they had questions for you, and I've got some specific ones, which I can't wait to ask you at the end of the podcast.
Should we start kind of in Australia right now? What are our rates of food allergy and is this. Kind of a stable thing, or are you seeing that change?
Debbie
sment of food allergy in the [:
To 2019 that there was a decrease, a small decrease in peanut allergy rates within Melbourne, but we haven't really evaluated that since. So it's another five, six years and we don't know. We're hoping it's continuing to drop. We are not sure, and we actually don't have an Australian wise survey knowing all the different other allergens as well.
two. And then peanut allergy [:
Then we also see cashew allergy as a big emerging, unfortunately, nut allergy. We've now got almost equal rates of peanut allergy and cashew allergy in the studies that we've done. So this is a really a concerning emerging Trina allergy. And interestingly, this has also been seen in Europe. So recently a big Europe wide sort of study, looked at cashews and walnuts and all the other nuts, and found cashew was also increasing in Europe as well.
Dr Kyla
How interesting. Do they have any theories on why cashew would be changing in prevalence?
Debbie
more now, the recent trends [:
Dr Kyla
Yeah, interesting. Really unlocking all of these mis trees isn't. Australia is somewhat of a kind of allergy capital of the world. We have a reputation for having very high rates of food allergy compared to other countries. Any thoughts on why Australia is the hotspot?
Debbie
Yeah. Again, we don't know if we could work this out.
s are born overseas, but the [:
They have some of the highest rates of eczema and food allergy in our population. And so we are not really sure, but we assume it's to do with a changing environment that maybe, um, they don't, from a genetic point of view. And then of course the changing environment. Our bodies are not quite ready to accept these foods and then cause a food allergy. But it's quite common, obviously anyone can get food allergies even if it's not been in the family history before. But often we see that families who have migrated, there's been no family history of allergic disease. And then when they move to Australia, uh, they, their children have food allergies and eczema especially.
Dr Kyla
Wow. That is hard to fathom, isn't it? Such a big Oh, wow. Interesting. Okay. Thinking about these families who have young babies or haven't yet seen any emergence of allergy in their children, what do you wish that they knew more about in terms of preventing food allergy?
Debbie
s. Firstly, it's eczema care [:
It's well treated. Um, it's firstly diagnosed and you receive good care and, and you carry out that care on the baby's skin because babies who have eczema and unfortunately the worse the eczema, then more likely they will have food allergies. So there's a very strong link. Uh, unfortunately between babies have eczema, so if a baby has eczema and some babies have, you know, quite a few, only a few months of age, they will develop eczema.
ally need to start on. Other [:
Peanut butter mixed into their foods to make sure that they stay on these foods and then regularly have them. Excellent. I wanna circle back to both of those points, but with that second one, um, thinking about kind of adding these allergens into the diet.
Dr Kyla
I agree. Like not having those first foods. 'cause I just think it would be such a traumatic experience.
I mean, this is from a purely a family point of view is if your first food is a, a really common allergen and your baby does have a food allergy to that, it can be really hard to then. Introduce other foods, have the confidence to do that. Is there anything from a kind of scientific reasoning that you would delay it?
You know, not being the first foods? Yeah.
Debbie
swallow the food rather than [:
So if you think about it, if you try to give a baby just some peanut butter by itself, for example, and the baby is, it's very, the texture is quite difficult to eat, but also the baby then might naturally be not quite ready to swallow it, spit it out, unfortunately, get it all over their face, and that will potentially sensitize them to the food and actually potentially lead them on a pathway of food allergy.
to other foods that they're [:
Dr Kyla
It's a lot for parents to think about, isn't it? There's messages of like, let them play with their food. Let them be kind of, you know, enjoying their mealtimes.
And also like, oh, the first few times, really try to get it into their gut before their skin. You know, there's a lot and there's only so much you can do. I really wanna reassure families at home that you can, you know, do the best of what you can, and that is absolutely enough. When did it change, Debbie, from kind of, 'cause we're used to the, the old advice was to hold off on allergenic foods in the hope of preventing food allergy.
When did that kind of recommendation change?
Debbie
o question it around the year:
And we sort of soon found with all the result, when all the results of all these trials came in, there's four major peanut trials and nine major egg trials, including three trials in egg that we did here in Australia. That [00:11:00] have shown us that when we introduce egg at around that six month age, as well as peanut butter, that will reduce the incidence of the baby developing food allergy compared to the old advice, which was to delay these foods in the case of egg into at least one.
t, our old advice in the year:
We do see a dramatic drop in food allergy rates.
Dr Kyla
That's incredible, isn't it? I just wonder also what families were putting on sandwiches if they weren't using peanut butter before three. Like it's such an easy spread and I was just mentioning before, um, there's just some recent evidence come outta the US as well, showing a very similar thing that the rates have.
anut allergy in the USA have [:
Um, I'll just circle back to the eczema one as well quickly. I'm not sure in your experience when you are working these clinical trials, but in my experience for families I'm working with the eczema, advice that is given out is wildly different depending on who you see. The diagnosis seems to be really hit and miss.
s developing because they're [:
Debbie
Yes. It's difficult because there's been a lot of changing advice over time. There's been misinformation, which of course, unfortunately always leads to concerns. And unfortunately, um, with so much information available, it, it gets confusing.
There is a really good website, which is also good for food allergy food deductions called, um, a Nibu, and it's run by our National Australian Allergy Center and it's. Evidence based information and that has got extra care and eczema advice, um, which is always updated for evidence as well as food allergy introduction.
ally important even for mild [:
Dr Kyla
Or what I find with mild eczema is that it just constantly sims, right? So kids have these tiny little bits of eczema that don't seem to bother them too much, but that permeability of the skin really impacts their risk of developing a food allergy. And so the the piece of advice I would really love.
Families to take aways, even if it is mild eczema. We wanna treat it quite aggressively and early and repeatedly, and I'll absolutely link to those Neology website and I'll link to the resource that Gemma has done with me and for all mealtimes members, you get that included in your membership. So I will link to all of those things as we go.
Are there any allergies, Debbie, that we know we have more chance of preventing? Or is it just the ones that have had actual research kind of done on them specifically that we know about?
Debbie
the tricky part because not [:
This is something we really don't understand why that happens. In a recent study we did, um, in our study infants, most of them were introduced to fish and many didn't have fish allergies. So that's good news. But shellfish is not something that we commonly eat, and yet shellfish allergies are common in adults, so it's a tricky one.
knowing about milk, egg, the [:
But yeah, fish and shellfish, it's a little bit trickier at the moment.
Dr Kyla
Interesting. There's an urban legend that, um, the rates of shellfish allergy diagnosis on Christmas day is a big thing. Maybe the prawns, particularly in Australia being a common Christmas food that you haven't eaten for a while. Any truth to that?
Debbie
Yeah, I, I mean, I don't that everyone's, anyone really documented it well, but it, it makes total sense because people don't eat your very often and it's one of the times that you would eat it. We do know the other allergens, particularly in baby diets, if you don't have it for a while, if you miss eating the allergen or the baby's not given the allergen on a regular basis, you're more likely to develop an allergy as well.
So it's, it's more than likely the effect that, yeah, when when families sit down and have their Christmas lunch and out comes are shellfish, some people may have never had it before or they may not have had it for years. Yeah, yeah, yeah. It's likely to happen.
Dr Kyla
e think about these kids who [:
Debbie
So recent research has, has sort of been encouraging more than it was in the past, and now it looks like about one in three children with a peanut or a Trina allergy may outgrow that peanut and or Trina allergy. Unfortunately, it's only one in three, but at least that's some children. We, we are still learning why those children do outgrow their peanut or Trina allergy compared to those who don't. But we also know that unfortunately, if they still have a persistent peanut or Trina allergy by the age of. It's less likely they'll outgrow that allergy. So those allergies that are outgrown earlier in life, so particularly before school age more likely to happen, whereas those where it's persisting beyond six years of age, unfortunately at this point in time, they may have it for life.
Dr Kyla
Is there anything that is [:
Debbie
Yeah, there's big hope in this space. So a lot of work's been done, um, in recent years, both here in Australia and overseas. Looking at oral immunotherapy and particularly, um, for the nuts and particularly for peanut is where we're sort of starting here in Australia, given it's the most common.
And it can be lifelong. And so for children, at from around the age of approximately one year of age, there's a new program which has been rolled out across Australia in many cities where babies have had the opportunity, um, is, um, referral from their allergist opportunity to participate in this oral immunotherapy peanut program.
e is that when it's given to [:
But at the moment, the big hope is for the younger children who are diagnosed around the age of one that we might be able to intervene, so to speak. To help them develop that natural tolerance rather than persistent allergies.
Dr Kyla
And so it's the idea for those younger children that eventually they would outgrow it once the tolerance increases,
Debbie
that that's the hope.
we can induce more children, [:
So. We are really doing a lot of research now in that area and hopefully, um, that that's encouraging and there's always research looking at ways to try and reduce, um, food allergy burden on families and particularly hope for new treatments in the future as well. And from what I understand with those slightly older children, this tolerance building. Really reduces their risk of a severe, immediate reaction so that even if there was a small amount of contamination, their body could handle that. Yeah. That's the idea that even if they can't sort of fully tolerate a, a meal of sitting down with lots of peanuts in it, for example, or peanut butter toast, they can tolerate a larger amount. So if there's like a trace of, or tiny bit of peanut in a biscuit they're given, um, or taken by mistake, then it reduces their chance of having a severe food allergy. And so it gives a bit of more protection or [00:21:00] safety net around, um, their, their allergy.
Dr Kyla
So that even a tiny bit helps and that just reduces the burden on families quite significantly.
Yeah, because the anxiety of, you know, sending your child to childcare or school where there's a risk, that there's a small contamination that could, you know, have a life changing effect is, is big for families. So it's really encouraging that that's happening in this space. Is it up to kind of allergists to decide who goes into these trials?
Can parents ask for this? What are their options?
Debbie
t your own specific child's, [:
Dr Kyla
Excellent. Um, I'm gonna ask you some specific questions that came through from my baby meal signs and toddler mealtimes members.
Some of these are kind of individual child questions, so feel free to kind of talk to the bigger pictures. And this was from a mom who said she'd like to know more about allergies appearing while her Barbies only breastfed. So they hadn't introduced solids, but the baby had reacted multiple times to what they're assuming was almond.
So they saw a kind of a repeated reaction. Then reacted again after the mom reintroduced, uh, almonds to their diet after two months. So they saw a rash over the face, tummy and neck, and projectile vomiting. The advice this family has been given is to avoid introducing almonds through solids until 12 months, but this mom is worried about that increasing her risk of a longer term allergy.
What's the kind of general consensus around that?
Debbie
the moment, we know that the [:
If you eat the same amount of food allergen, you are likely to have different amounts in your breast milk. And we also may be seeing different amounts on different days, and we really don't understand this yet, but we're hoping, we're currently doing quite a, quite a number of studies in this area to try and really understand this in more detail. One of the things we do know though, is three babies different, but sometimes a milder reaction in babies when you need to really know that it is actually a food allergy and it's not a coincidental baby symptoms. And that's really tricky 'cause babies get rashes, babies vomit. Babies have unusual poos and stools on a common basis, and that's sometimes just their digestive system getting used. To foods, and there can be other things in the breast milk if they're totally breast milk bed. Um, we know that even flavors and spices go [00:24:00] through breast milk, which is often a good thing for babies to learn different tastes, but some of the other things could be irritating the baby's gut. So it's pretty important to really know is it actually a food allergen causing this or is it just a coincidence?
And we do know that when all of these babies are tested, it is a coincidence. Food allergy purely through breast milk is actually extremely rare. So it's important to, to have that checked out. And we also know it's quite transient, so for many babies they, even if they did have a food allergy, and often the common one is cow's milk, if they do have a cow's milk allergy associated with the cow's milk protein going through breast milk, they may actually outgrow it quite quickly.
And so regular re-challenging of the mom's diet with small amounts of the cow's milk protein, building it up can hopefully introduce that baby to the cow's milk protein again through the best breast milk and get, get them back onto that as quick as possible. It's really important to note it's not only the.
[:
Dr Kyla
And I wonder for this, like it's, it feels really risky to me to give advice to wait until a date, as we know kind of that longer period of not exposing them actually does increase that risk. I would probably feel more confident if this family had an appointment with an immunologist or allergist and really had a plan for managing this.
You know, even introducing at home. If there was a food allergy that has already kind of started in early infancy, the risk that that reaction is bigger is, um, you know, would you agree with that?
Debbie
Yeah. They, [:
Around that time, um, hopefully even having a challenge to that food to know. Um, and you know, it could be given to the baby directly in a food challenge situation with an allergist and then, you know, but ideally you don't wanna do it at home if you're not a hundred percent sure what's gonna happen.
'cause baby could have a severe reaction, but at the same point, delaying too long may be a problem. So, but generally, if you put it back in mom's diet first. Is the first step and see how that goes. But seek early advice and regular advice to make sure that you're not delaying the reintroduction if possible.
Dr Kyla
Yeah, and that was my next question. The was, is there evidence that reintroducing allergens via breast milk actually helps with tolerance?
Debbie
re they looked at cow's milk [:
Mom had higher levels of these cows milk antibodies in her breast milk, and the babies had less, were less likely to develop cows milk allergy in the longer term. So again, we're doing some active research in this area. We suspect that a really limited period of delaying or avoiding these foods is ideal and that these foods are naturally designed to go through breast milk and naturally tolerate the baby to develop, um, tolerance rather than than allergic reaction.
Dr Kyla
Yeah. Interesting. And I guess this next question feeds into this beautifully again, great work from my members. Interested to know if introducing formula top-ups to a brand new breastfed newborn increases the risk of dairy allergy in the future. So this mum's son had formula top-ups until he was six to eight weeks old.
y when we introduced it. Six [:
Debbie
So there's a couple of things here that we've learned recently, which is really interesting.
In fact, a recent study from here in Perth just published in the last week or so, looked at babies that have had infant formula in the first three days of life. So often it's, it's now up to almost half of babies receiving some form of formula in the first few days of life. And this study looked at the babies who had the infant formula of some kind. In the first three days versus those who didn't and that were exclusively colostrum, breast milk fed. And what was really interesting is that the babies who had the infant formula had a higher rate of multiple food allergies, 11 times higher rate of multiple food allergies. And what's even interesting, 'cause there has been previous studies to show that it does increase the rate of cows milk allergy.
In these babies, they also [:
Dr Kyla
Uh, interesting. And I'm wonder if there is. I mean, we wouldn't know.
nged and this applied to me, [:
I remember with my first baby having expressed colostrum from 36 weeks, but actually there wasn't any clinical guidelines as to how much to give a baby based on their blood sugar level. So she was given formula even though I had colostrum. And you know, in the moment of. Having a baby and all of the decisions, I, I didn't have a plan or I didn't know what to ask for. But it's an interesting one, isn't it? And I, I understand completely from a medical point of view as well. Like if a baby has low blood sugar, we absolutely wanna be treating that appropriately. There's just so many things to learn, isn't there to really make a, a positive impact for these families.
Debbie
d infant formula for medical [:
Dr Kyla
Thinking then again about [:
How. Is that kind of changing in the market, do you think? Like we are pretty consistent with the evidence now that introducing food products through the skin is a problem. And then I guess my kind of second question is, I know there's some research in the nicu, um, in that kind of neonatal intensive care space that contact with, um, these newborn prem babies with coconut oil in particular on their skin actually has had some positive outcomes.
Are we seeing this increase in coconut allergy in these babies? Is there a risk of these kind of food proteins doing damage?
Debbie
he things to think about is, [:
And the instance of coconut allergy is extremely low and rare. Okay. We've sort of encouraged that the use of coconut oil and obviously the more pure the oil is, the less likely it has protein in it, which is a good thing. So it's the proteins that unfortunately trigger off allergic reactions. So having more pure oil products, they're less likely to cause a reaction. We haven't seen a spike in coconut oil or anything like that. It's, it's obviously something to, to keep looking out for, but it's probably less likely a problem than rubbing other foods or getting other foods on baby's skin. And that's definitely, we've learned over the last decade or two that that is a problem.
ing it or smearing it on the [:
Unfortunately, I think the real key is not to put things on the baby's skin that's got food proteins in it, but if it's something like coconut oil, it's probably not so much concern.
Dr Kyla
d been advised to just try a [:
Debbie
been some really, really big [:
It's just really complex because with the probiotics, they're the good bacteria. There's many, many, many types, and we know that more diverse number of so many more different numbers of probiotics in your gut. The good bacteria is a good thing. So you don't wanna just take like the supplement of one type and continuously take that, but it's not [00:37:00] going to help. You need lots of different probiotic type, good bacteria, but also most importantly, many people forget that they need to eat. The bacteria actually need to eat something, and they need to eat prebiotics or good foods, often plant-based foods that will actually to make them survive. They can't, they can't live there without food. So it's a combination of a good, healthy diet along with the good, healthy gut bacteria and getting diverse bacteria is good. And that's good for anyone, whether it's a mom in pregnancy, whether it's an infant, to have a variety of plant-based foods in particular and other foods that contain these is good prebiotics is important, along with a variety of good exposures to different bacteria, and we know that the bacteria respond quite quickly in the gut.
biotics and, and try hard to [:
Dr Kyla
And that's a difficult, isn't it? Because there's no. Threshold that there's no guarantee you can do all of the things and still end up with a baby who has a food allergy. There are, you know, there are times when you need antibiotics to, you know, save your life or your baby's life, and that's absolutely the priority.
I really feel for families who have been through this path because there's so many what ifs aren't there. Do you know what if we had this or what if that had been different? And yeah, it's an area, I think we're gonna see a huge spike in research and outcomes hopefully in the next 10 years or so, would you say?
Debbie
years, I think. And we have [:
Around Australia. And that's been looking at how much dose wise or amounts that moms eat of eggs and peanut. Pregnancy and breastfeeding and, um, we're less than 20 babies to finish now. Um, wow. We have results by the middle of next year or even sooner, hopefully. And that's really exciting. So we'll be able to hopefully from that study, get so big. All those families, we really appreciate their important time into the study that all have a history of allergic disease, so we know that whatever the result is, we will have a very good answer on that, which is really, really good. So we can, again, fine tune advice particularly for women during pregnancy and early breastfeeding.
ts of peanuts, but also this [:
Cashew nuts in moms diet from birth until six months postnatal. And looking at, um, having these food proteins pass through breast milk, how much is a good amount? What effects that that has on hopefully preventing food allergies and particularly nut allergies in babies, again, by the time they reach one.
So we've got a couple of big studies happening and we've also got a new, um, field of research looking more into food allergy in the breastfed babies, the young ones. So we are gonna doing some focus groups at the moment and hopefully launching a new study in that area again by the middle of next year.
, you can try everything and [:
Everyone's circumstances are different. Everyone's genetics, everyone's environment is different. But we, we are learning a lot and we've made huge advance in in the last
Dr Kyla
you are doing. Incredible work, like just life changing work. How do families get involved in this research? Can they register for a wait list?
Is there somewhere they can go? How do they find out about this?
Debbie
Yep. So there's a couple of ways. One of the, um, ways nationally you can get involved in any form of allergy research and, and that include and hate, fever, research, other types of research. To look up. We have a National Allergy Center of Excellence, and we have a website.
e something that's available [:
But there's, there is quite a lot of allergy research luckily being done in Australia. Everyone ask for baby study if you're pregnant, when you live in Western Australia and or in Victoria. Um, yeah, just a selfish plug for our own study. Oh, please. I'm gonna promote it everywhere. So hit us. We are, um, recruiting now for another three years then that for baby study.
So looking for, we enroll moms late pregnancy, so if you're pregnant, then let us know and you do not have to have a history of allergies for this. Study is open to any family, regardless of whether your existing have any form of allergies or not. That's why the study's really big. Gonna have 4,000 moms and babies.
But that's, that's the study that yeah, we're actively recruiting for at the moment. So reach out to us at the kids researching Australia and for that, for babies study if you're interested in that as well.
Dr Kyla
ind that and be part of life [:
Incredible. Debbie, you, I feel overcome with just how much I've learned from this, how much I've enjoyed speaking to you. You sound like a seasoned podcaster, so I think incredible work. I think this is gonna be so useful for families and I'm really thankful for you coming on.
Debbie
Thank you very much for the opportunity to talk about these really important topics and hopefully we can, uh, help some more families, prevent some more allergies.
That would be amazing. Thank you.
Dr Kyla
Absolutely. And I think there'll probably be more questions from this, so perhaps we can do another one in a, a little while and kind of touch on some of those. Thanks again.
