A food allergy is an immune system response that occurs soon after a person eats a certain food. Most food-allergic reactions are mild, but some are potentially life-threatening and require emergency treatment.

What causes food allergies?

A person with a food allergy has an immune system that overreacts to proteins found in certain foods. It is identified as a dangerous invader and the body creates a specific IgE (Immunoglobulin E) antibody to fight it. This triggers a protective response that can include skin, respiratory, heart and/or digestive symptoms.

How many people have food allergies?

Approximately 32 million Americans have food allergies – 26 million adults and nearly 6 million children, according to 2019 data funded in part by the National Institute of Allergy and Infectious Disease (NIAID).

What are common food allergies?

Eight foods account for 90 percent of all reactions in the United States. These eight foods are known as the “top 8” food allergies:

• cow’s milk
• eggs
• peanuts
• tree nuts
• wheat
• soy
• fish
• shellfish

Sesame is often recognized as the 9th food allergen. It’s common in Middle Eastern, Indian, and Asian cuisines and shows up in salad dressing, hummus, granola bars and on hamburger buns.

Less common food allergens include corn, garlic, gelatin, lupin, meat, mustard, poppy seeds and sunflower seeds.

What is the most common food allergy?

In infants and children, the most common food allergy is peanut, milk, shellfish, tree nuts, eggs and fish.

The most common food allergy in adults is shellfish (shrimp, crayfish, lobster), followed by cow’s milk, peanuts, tree nuts and fish (such as salmon).

Can a food allergy go away?

Some children will outgrow their food allergies over time, particularly if they are allergic to milk, egg or wheat. It is less common to outgrow an allergy to peanuts or tree nuts, although it is still possible.

There is now an oral immunotherapy (OIT) treatment for peanut allergy available. In OIT, patients are given the food they are allergic to, starting with a tiny amount and then gradually larger amounts so their bodies become desensitized to it. OIT should only be done under a doctor’s supervision; do NOT try it on your own.

Another peanut allergy immunotherapy option coming soon is the peanut patch, in which a small patch containing a dose of peanut protein is applied to the patient’s skin daily. The therapy aims to desensitize immune cells in the skin to make the body more accepting of peanut in case of an accidental exposure.

Are food allergies genetic?

Genetics play a role in determining who will develop food allergies. If a child’s parents have a food allergy, their children are at an increased risk as well.

Why are food allergies on the rise?

Researchers don’t know for sure why allergy rates are increasing, but they are working hard to find out.

One theory is that parents for years avoided introducing common food allergens – such as peanuts or tree nuts – and that when children were introduced to these foods at an older age, their immune system overreacted. Researchers now believe that eating common food allergens at an early age can train both the immune system and the gut to tolerate these foods.

Similarly, another theory called the “hygiene hypothesis” suggests that living conditions in much of the world might be too clean and children are not fully exposed to enough germs (or microorganisms) that train their immune system (including the gut microbiome) to tell the difference between harmless and harmful substances, including foods.

Another theory suggests that children may not be exposed to enough Vitamin D (or sunlight), especially early in life. Studies show exposure to Vitamin D can help our immune system better regulate itself, develop a healthy response to foreign substances and make us less susceptible to allergies.

How can I prevent food allergy reactions?

The only proven way to prevent an allergic reaction is to avoid foods to which you are allergic.

It’s important for people with food allergies to always be thinking about how to avoid risk and prevent an allergic reaction. Here are some important ways to prevent a reaction:

• Talk with your doctor about how to prevent exposures to the foods you are allergic to.
• Read labels every time before you eat a food to make sure it’s safe for the allergies you manage.
• Make sure you use caution when choosing foods while away from home and when dining out in restaurants. Ask about ingredients, including how meals are prepared and served.
• Do some advance planning to travel safely with food allergies.

How can I be prepared to treat a food allergy reaction?

It is very important to always be prepared to treat a food allergy reaction. Never leave home without your epinephrine auto-injector and know how to use it – even if you are not planning to eat where you are going. Accidental exposures are never planned.

Have an anaphylaxis care plan

Ask your doctor for a written Anaphylaxis Care Plan and give that to your family members, supervisor at work, your child’s school and all caregivers.

Always have epinephrine nearby

Be sure to have two epinephrine injectors available to you at all times to use in an emergency. Epinephrine should be right with you whenever possible, stored in the carrier tube at a temperature between 68 – 77°F (20 – 25°C). The glove compartment of the car is often too remote or too warm or cold for storage, so think about what will work for you.

There are several epinephrine injectors available on the market, be sure you know how to use yours.

Make sure all caregivers and family members know how and when to use your specific epinephrine injector.

Wear a medical alert bracelet

Consider wearing a medical alert bracelet that lists the foods you’re allergic to and has instructions to administer epinephrine if you are unable to do so.

Living with Food Allergies

Living with food allergies is an adjustment and will require you to make some changes to your home, how you prepare foods, and how you interact with others. Someone with a food allergy can do just about anything except to eat the food to which he is allergic. However, you will need to plan in advance and communicate clearly and calmly to others to be successful.

Examples of day-to-day living that need to be planned for include:

• reading labels
• avoiding cross contact
• sending a child off to school or daycare
• using babysitters or caregivers
• ordering takeout food, like coffee
• playdates
• social gatherings and celebrations
• dining out
• traveling

How do I dine out with food allergies?

Allergists recommend the following to dine out safely:

• Call the restaurant ahead of time or check menus online before eating out.
• Communicate with the restaurant staff about your food allergies. Create a chef card that lists your allergies and ask that it be given to the chef or kitchen staff.
• Read menus closely and don’t order foods likely to cause an allergic reaction. Ask about ingredients.
• Carry two epinephrine auto-injectors to treat anaphylaxis.

Establish an open dialogue with everyone – the manager, host, servers and even the chef – to ensure you receive a safe meal. The more you talk with the restaurant staff, the more you develop an intuition whether the restaurant is a safe place to dine. For example, as you speak to the restaurant staff and they seem to be confusing your food allergies with a request for a choice of a gluten-free meal, that’s a red flag.

In order to make the safest choices when dining out, choose meals with simple ingredients that are familiar. It is also helpful to the restaurant staff if you are flexible about safe suggestions that they recommend.

The bottom line is, if you don’t feel comfortable or you don’t feel the restaurant staff fully understands that your food allergy could be life-threatening, then the best choice is not to eat there.

Many restaurants and quick-service eateries now list allergens on their menus and post food allergy awareness information in the kitchen area. Depending on the state you are dining in, some like Massachusetts have laws that require these protocols. Cruise ships will cater to food allergies if you notify the cruise line when you book the trip.

How do I send my child off to school with food allergies?

Planning for a child going off to school will require learning about how your child’s school manages food allergies and then advance planning to make sure your child has age-appropriate skills to manage his food allergies and the school staff know how to manage his food allergies. Advance planning and ongoing clear, confident communication with school staff and other parents about food allergies are the best ways to ensure your child’s safety.

If your child is at risk for a severe allergic reaction to food, make sure your child either carries or has immediate access to epinephrine auto-injectors at school. All 50 states guarantee students the right to self-carry and self-administer prescribed epinephrine auto-injectors at school. Most states also allow or require schools to stock emergency supplies of epinephrine auto-injectors.

© 2021 Allergy and Asthma Network

Last updated : 12/11/2020