Allergies to Foods :: Nationwide Children's Hospital

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Allergies to Foods

A food allergy occurs when the body’s immune system overreacts to certain foods. The body then makes antibodies to that food and an allergic reaction occurs. The most common food allergies include milk, eggs, peanuts, tree nuts, shellfish, fish, soy and wheat.

Picture 1 - Be sure to read the label on all foods each time you guy them. Food companies may change ingredients without warning.
Image of reading labels

Food allergy symptoms can vary widely. In some people they may only cause some mild eczema (dry skin). Other people may develop hives, itchy skin, abdominal pain or recurrent vomiting. If someone has a severe food allergy and eats the food they are allergic to, it can lead to respiratory distress (coughing, wheezing, shortness of breath, chest tightness), swelling in the throat area or feeling lightheaded and fainting. In some cases, death may result, especially if use of the epinephrine pen is delayed or if emergency help is not available.

Signs of an Allergic Reaction

Skin

  • Hives (welts) or itching – this usually occurs within 60 minutes of eating food
  • Eczema – may get worse over several days
  • Severe swelling

Respiratory (Breathing)

Usually other symptoms will be present as well.

  • Cough or trouble breathing
  • Wheezing, also called stridor (noisy breathing)
  • Throat gets tight or closes off

Gastrointestinal

Systemic Reaction - Anaphylaxis

Anaphylaxis (anna fil AX siss) is the name that describes a severe and possibly life-threatening reaction. Symptoms usually begin within 30 minutes of eating food and may include the symptoms listed above, with or without:

  • Lightheadedness due to low blood pressure
  • Loss of consciousness (passing out)

If a severe reaction occurs, use the EpiPen and call 9-1-1 to seek emergency help immediately!

If your child has ever had anaphylaxis, talk to your doctor about prescribing an EpiPen (emergency shot of epinephrine).

To Reduce the Risk of Having an Allergic Reaction to Food

  • ALWAYS READ THE INGREDIENTS. The labels on all foods should always be read carefully before eating. Sometimes the ingredients may change and something new may be added. The food your child is allergic to may not be listed as a main ingredient, but the label may state “may contain traces of….” or “processed on equipment that also processes….” Especially if your child is at risk for a severe allergy, assume the food has this and avoid it.
  • TEACH THOSE AROUND YOU ABOUT YOUR CHILD’S FOOD ALLERGY. Tell family, friends, teachers, baby sitters and child care workers about the foods your child should not have. Also make sure they know how to use the Epinephrine autoinjector in case of emergency.
  • BE CAREFUL “EATING OUT.” Many food allergic reactions occur when eating foods prepared outside the home. Buffets, Asian restaurants, ice cream parlors and bakeries are especially high risk. When your child eats out, tell the server and the chef about your child’s food allergy. Ask them about the ingredients used to prepare the food. Many people do not realize how severe food allergic reactions can be. You may want to place your child’s epinephrine injector on the table to remind the server.
  • AVOID FOOD-SHARING. Eating a friend’s food may increase your child’s risk of coming into contact with a food he or she is allergic to. A severe reaction can also result from coming into direct contact by touching or kissing.
  • PEANUTS, TREE NUTS AND SEAFOOD Although someone may be allergic to any food, the most severe reactions resulting in death occur in people who are allergic to peanuts, tree nuts and shellfish. Milk and other foods can also cause severe symptoms. If your child has a seafood allergy, an allergic reaction can occur if the child is in an area where the seafood is being cooked, as seafood proteins can become airborne in tiny droplets.
  • OILS AND SYRUPS If your child’s food allergy includes soy, corn or peanut, eating foods that contain soybean oil, corn oil (or corn syrup) or peanut oil may or may not be okay. (Most refined oils contain the fat and not the protein. Corn syrup contains the sugar but little or no protein). Ask your child’s healthcare provider if you have questions about this.
  • ASTHMA INCREASES RISK. Life-threatening reactions are more likely to occur in people who also have asthma. This group needs to be especially careful.

Managing Food Allergies

  • KNOW HOW TO USE YOUR EPINEPHRINE. Practice using the EpiPen TRAINER if available so you and others who care for your child become more comfortable using it, if it is needed.
  • NO EPI – NO EAT! ALWAYS HAVE YOUR EPINEPHRINE AVAILABLE. Epinephrine auto-injector (EpiPen, TwinJect) should go wherever your child goes. Most people who die from a food allergy reaction do not have their epinephrine auto-injector with them. If it is not with your child, it will not be of any use in case of emergency. This applies to being at school or work, at a friend’s house or restaurant and at home.

The following pages contain a partial list of common foods or ingredients that should be avoided if your child is allergic. Take this list with you to the grocery store, and be sure to read the label each time before buying. Food companies may change ingredients without warning. Give a copy of this list to your child’s teacher and caregiver.

Additional Resources

For more information, tips and recipes, contact:

The Food Allergy Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030-2208
Phone: (703) 691-3179
website: www.foodallergy.org

If testing confirms food allergies, we may suggest that you and your child meet with a registered dietitian. The dietitian can guide you in choosing a well-balanced and nutritious diet.

Allergies to Foods (PDF)

HH-I-205 5/99, Revised 1/12 Copyright 1999-2012, Nationwide Children’s Hospital

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Avoid foods that contain milk or any of these ingredients: Image of dairy products

  • Artificial butter flavor
  • Butter, butter fat, butter oil
  • Buttermilk
  • Casein
  • Caseinates (in all forms)
  • Curds
  • Cream, Half & Half®
  • Cheese (including cottage cheese)
  • Custard, Pudding
  • Ghee
  • Yogurt
  • Lactoglobulin, Lactulose
  • Nougat
  • Sour cream, sour cream solids
  • Sour milk solids
  • Whey
  • Lactalbumin, lactalbumin phosphate
  • Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low fat, malted, milk fat, non-fat, powder, protein, skimmed, solids, whole)

These foods may contain milk protein:

  • Candies and chocolate
  • English muffin
  • Margarine
  • Gum (Trident®)
  • High protein flour
  • Hot dogs
  • Lactic acid starter culture
  • Luncheon meat, sausages
  • Lactose
  • Flavorings (natural and artificial)
  • Non-dairy products and creamers
  • Waffles
  • Soy cheese
  • Ramen noodle cups


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 Avoid foods that contain eggs or any of these ingredients: Image of foods with protein

  • Albumin or ovalbumin
  • Mayonnaise
  • Eggnog
  • Lysozyme (used in Europe)
  • Egg (dried, powdered, solids, white, yolk)
  • Meringue (meringue powder)
  • Surimi

These foods may contain egg protein: (Carefully check ingredients) 

  • Baby foods
  • Egg substitutes
  • Flavorings (natural and artificial)
  • Lecithin
  • Marzipan
  • Marshmallows
  • Nougat
  • Noodle soups
  • Pasta (macaroni, spaghetti)
  • WineImage of egg carton

Note: A shiny glaze on yellow baked goods usually means that eggs are present.

For each egg called for in a recipe, use one of the following suggestions for egg SUBSTITUTE instead:

  • 1 tsp. baking powder, 1 tbsp. liquid, 1 tbsp. vinegar.
  • 1 tsp. yeast dissolved in ¼ cup warm water
  • 1 Tbsp. apricot puree
  • 1-½ Tbsp. water, 1-½ Tbsp. oil, 1 tsp. baking powder
  • 1 packet plain gelatin, 2 Tbsp. warm water. Do not mix until ready to use.


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Avoid foods that contain peanuts or any of these ingredients: Image of peanut butter

  • Artificial nuts
  • Beer nuts
  • Goobers
  • Ground nuts, mixed nuts, nut pieces
  • Cold pressed, expelled or extruded peanut oil or Arachis oil
  • Mandelonas
  • Monkey nuts
  • Nu-Nuts® flavored nuts
  • Peanut butter
  • Peanut flour

These foods may contain peanut protein:

  • African, Chinese, Indonesian, Mexican, Thai, and Vietnamese dishes
  • Baked goods (pastries, cookies, etc.)
  • Candy (including chocolate candy)
  • Chili and sauces
  • Egg rolls
  • Enchilada sauce
  • Frozen desserts
  • Flavoring (natural and artificial)
  • Marzipan
  • Nougat
  • Others

Keep these things in mind: Image of baked goods

  • People who are allergic to peanuts should also avoid tree nuts (such as walnuts, pecans, hazelnuts, etc.)
  • Bakeries, ice cream parlors and Asian restaurants may be sources of peanut-contaminated foods.

Some substitutes for peanut butter:

  • Soy butter (soybean)
  • Sunbutter (sunflower)
  • Biscoff (contains soy and wheat)


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Avoid foods that contain nuts or any of these ingredients: Image of tree nuts

  • Filberts (hazelnuts)
  • Pecans (Mashuga Nuts®)
  • Macadamia nuts
  • Pistachios, pralines, walnuts
  • Caponata
  • Artificial nuts
  • Pine nuts (also called pinyon, pignoli, and pignon nuts)
  • Almonds, Brazil nuts, cashews, chestnuts
  • Gianduja (a nut mixture found in some chocolate)
  • Mandelonas
  • Marzipan (almond paste)
  • Nan-gai nuts
  • Nut paste (for example, almond paste)
  • Nut butters (such as cashew butter)
  • Natural nut extract (such as almond or walnut)
  • Nut meal, nut pieces
  • Nut oil
  • Nougat
  • Pesto

Keep these things in mind:

  • Mortadella may contain pistachios.
  • Natural and artificial flavoring may contain tree nuts.


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Avoid foods that contain shellfish or any of these ingredients: Image of shellfish

  • Clams, mussels, oysters
  • Cockle
  • Crab, lobster, crawfish
  • Mollusks
  • Octopus, squid (calamari)
  • Prawns, shrimp
  • Scallops
  • Snails (escargot)

These foods may contain shellfish protein:

  • Bouillabaisse
  • Fish stock
  • Surimi
  • Flavoring (natural and artificial)
  • Seafood flavoring (such as crab or clam extract)

Keep these things in mind:

  • Any food served in a seafood restaurant may have been in contact with fish or shellfish.
  • For some people, a reaction may occur from cooking odors or from handling fish or shellfish.
  • Always carry medication (such as EpiPen) and use it as soon as symptoms develop.


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Avoid foods that contain wheat or any of these ingredients: Image of wheat products

  • Bran
  • Bread crumbs
  • Bulgur
  • Couscous
  • Cracker meal
  • Farina
  • Wheat flour (all purpose, bread, durum, enriched, graham, high protein, stone ground)
  • Wheat (bran, germ, gluten, malt, starch)
  • Matzoh, matzoh meal (also spelled as matzo)
  • Pasta, semolina, durum
  • Spelt
  • Gluten

These foods may contain wheat protein:

  • BBQ flavored potato chips
  • Soy sauce
  • Hot dogs
  • Hydrolyzed protein
  • Flavoring (natural and artificial)
  • Starch (gelatinized starch, modified starch, modified food starch, vegetable starch)


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Avoid foods that contain soy or any of these ingredients: Image of soy product

  • Soy protein
  • Miso
  • Natto
  • Shoyu sauce
  • Tofu
  • Soya
  • Soybean (curd, granules)
  • Soy sauce
  • Tamari
  • Textured vegetable protein (TVP)
  • Soy (soy albumin, soy fiber, soy flour, soy grits, soy milk, soy nuts, soy sprouts)

These foods may contain soy protein:

  • Asian cuisine
  • Flavoring (natural and artificial)
  • Waffles  
  • Vegetable gum
  • Vegetable starch
  • Bread crumbs
  • Canned tuna
  • Vegetable broth or bouillon cubes

Keep this in mind:

  • Most people who are allergic to soy may safely eat soybean oil.


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