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Food Allergy (including list of possible allergens)

By Neil Gershman, M.D.

A food allergy develops when an individual's immune system perceives a food to be a harmful substance or "invader". The body forms IgE antibodies in an attempt to protect itself from the invader. When the food is eaten again the IgE antibodies and other chemical agents are released as part of the body's "protective response". This response can cause changes in the cardiovascular system, respiratory system, gastrointestinal system and / or the skin. This is expressed in the individual with conditions such as, but not limited to, a tingling sensation in the mouth, hives, a swelling of the lips, eyes, and / or throat, even life-threatening anaphylaxsis.

Anyone may develop a food allergy anytime in his or her life. Children who develop food allergies are particularly at risk as they are not aware of the ingredients in many foods. In addition, children do not like to feel different and want to eat what their friends are eating. However, careful teaching and cooperation of the adults in a child's life (parents, extended family, friends, teachers, etc.) can help a child avoid those foods which are allergens.

Any food has the potential of becoming an allergen; however, meats, fruits, and vegetables are not chief offenders. Approximately 90 percent of food allergens are milk, egg, wheat, soy, fish, shellfish, tree nuts (pecans, walnuts, cashews, etc.) and peanuts. They may be found as an ingredient in any prepared dish, even those which typically would not contain them. As an example of this, an individual with fish allergy ate a cheese pizza and immediately experienced a tingling in his mouth, which progressed to swelling of his lips and tongue. Upon investigation it was found that the chef prepared his pizza sauce using anchovy paste. Another case involved a chocolate bar that appeared to have no nuts, but contained hazelnut paste. Peanuts are often found in oriental foods and are ground up and used in baked goods.

At this time there is no recognized method to desensitize an individual to an offending food, so avoidance is the best course of action to take. To effectively avoid certain foods the individual should read all food labels carefully. Be aware that some foods are not listed using terms you may recognize: casein, lactoglobulin, and whey are just a few of the ingredients a milk allergic person should avoid. The Food Allergy Network has laminated cards that explain how to read a label for most food allergies. These can be obtained by contacting them via email at fan@worldweb.net or by calling 1-800-929-4090. If you visit their web site at www.foodallergy.org you can get recipes, helpful hints, and links to other web sites. We have materials that we will make available to you for specific food allergens.

Although some individuals find treatment with diphenhydramine (Benadryl) can stop an allergic reaction, it should not be assumed that this will handle the problem. It is estimated that, nationwide, between 100 to 200 people die each year from food allergy reactions. Anytime an individual has an allergic reaction to a food there is the potential for anaphylaxis. Calling 911 (Emergency Medical Services), timely self- administration of epinephrine, and immediately going to a hospital for observation and treatment can save the person's life. (See EpiPen® website for more information about that product.)

Anaphylaxis is a severe, potentially fatal, allergic reaction which can involve swelling of the throat, difficulty breathing, or a drop in blood pressure. The reaction can begin within minutes of eating the food; however symptoms have been known to occur up to four hours later. Treatment with antihistamines, either before or after eating an allergy causing food may not be sufficient and the individual may still have a severe reaction. People who have hay fever (allergic rhinitis), latex allergy, eczema, and/or asthma are more likely to develop anaphylactic reactions to foods than the general population.

Milk

Avoid foods that contain these ingredients:

  • Acidified milk
  • Artificial butter flavor
  • Butter / butter fat / butter oil
  • Buttermilk
  • Casein (casein Hydrolysate)
  • Caseinates (any form of caseinates)
  • Cheese
  • Chocolate milk or drink
  • Cream
  • Coffee Mate
  • Coffee Rich
  • Cottage cheese
  • Curds
  • Custard
  • Ghee
  • Half & half
  • Ice Cream (regular and soft serve)
  • Ice Milk (regular and soft serve)
  • Lactalbumin, lactalbumin phosphate
  • Lactulose
  • Margarines (read labels carefully - 100% vegetable oil types okay)
  • Milk (in any form: condensed, derivative, dry, evaporated, goat's milk and milk from other animals, low fat, malted, milkfat, non-fat, powder, protein, skim, solids, 1% milk, 2% milk, whole)
  • Nougat
  • Pudding
  • Rennet casein
  • Sour cream, sour cream solids
  • Sour milk solids
  • Whey (in any form)
  • Whole milk
  • Yogurt (frozen, soft serve, regular, fruit and yogurt bars, etc.)

Use caution with these foods as they may contain milk proteins:

  • Baked Goods (may be made with butter, milk product, casein, sodium caseinate, or whey)
  • Carmel candies
  • Chocolate
  • Flavorings (both natural and artificial)
  • High protein flour
  • Lactic acid started culture
  • Lactose
  • Luncheon meat, hotdogs, sausages, cold cuts, prepared meatballs
  • Margarine
  • Non-dairy products (example: creamers, frozen desserts, cheese, etc.)

SPECIAL NOTES:

Desserts - avoid those that contain butter, milk, casein, sodium caseinate, or whey.

Fruits - Read labels on all fruit desserts

Vegetables - avoid any creamed type vegetables: peas, spinach, onions, etc.

Avoid au gratin, creamed, and scalloped foods

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

Eggs

Avoid foods that contain any of these ingredients:

  • Albumen
  • Albumin
  • Bavarian creams
  • Custards
  • Egg (any form - dried, powdered, solids, white, yolk)
  • Egg Beater (trademark of Fleischmann's or any similar product)
  • Eggnog
  • Egg White
  • Egg Yolk
  • French Ice Cream
  • Lysozyme (found in Europe or foods imported from Europe)
  • Marshmallows
  • Mayonnaise
  • Meringue (also meringue powder)
  • Ovaltine (Ovomalt - ovomcin, ovomucoid)
  • SoufflĂ©s
  • Surimi

Use caution with these foods as they may can contain egg protein:

  • Breads (especially those with a shiny crust)
  • Cakes
  • Candy
  • Creamed pies
  • Doughnuts
  • Flavoring (both natural and artificial)
  • French toast
  • Fritters
  • Lecithin
  • Macaroni
  • Marzipan
  • Marshmallows
  • Noodles
  • Nougat
  • Pancakes
  • Pastas (any form)
  • Pie fillings (some)
  • Pretzels
  • Pudding
  • Root beer (some)
  • Sauces (Hollandaise sauce usually contains eggs)
  • Sausages
  • Vitelin
  • Waffles

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

Peanuts

Avoid foods that contain any of these ingredients:

  • Arachis oil
  • Artificial nuts
  • Beer nuts
  • Cold pressed, expelled, or extruded peanut oil (foods cooked in these oils)
  • Goobers
  • Ground nuts
  • Mandelonas
  • Mixed nuts
  • Monkey-nuts
  • Nut meats
  • Nut pieces
  • Peanut
  • Peanut butter peanut flour

Use caution as these ingredients or foods may contain peanut protein:

  • Bakery goods (pastries, cookies, etc.) (Some bakeries grind their stale cookies and use them for toppings, ingredients in sauces, and fruit toppings)
  • Candy (including chocolate candy)
  • Chili
  • Egg rolls
  • Ethnic foods (African, Chinese, Indonesian, Mexican, Thai, and Vietnamese dishes, etc.)
  • Enchilada sauce
  • Flavoring (both natural and artificial)
  • Marzipan
  • Nougat

SPECIAL NOTES:

Most allergic individuals can safely eat peanut oil but NOT cold pressed, expelled, or extruded peanut oil.

Most experts advise individuals allergic to peanuts to avoid tree nuts as well.

There is a strong possibility of cross-reaction between peanuts and lupine.

Anything that is produced on equipment shared with peanut products has a strong possibility of being contaminated by the peanut protein (such as: sunflower seeds, certain crackers, corn nuts, etc.)

Some individuals are so allergic that microscopic, airborne particles of the peanut protein can induce allergic reactions. For this reason we suggest that peanuts (in any form) be kept out of the house where an allergic individual lives.

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat that item.

Wheat

Avoid foods that contain any of these ingredients:

  • Bran
  • Bread crumbs
  • Bulgur
  • Couscous
  • Cracker meal
  • Durum
  • Farina
  • Flour (any type: all-purpose, bread durum, cake, enriched, graham, high gluten, high protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat)
  • Gluten
  • Kamut
  • Matzoh, matzoh meal, or spelled "matzo"
  • Pasta (any type - noodles, macaroni, spaghetti, shells, etc.)
  • Postum
  • Seitan
  • Semolina
  • Spelt
  • Vital gluten
  • Wheat (any form: bran, flour, germ, gluten, malt, meal)
  • Whole wheat "berries"

Use caution with these foods as they may contain wheat protein:

  • Ale
  • Beer
  • Baked beans
  • Biscuits
  • Cakes
  • Chili con carne
  • Coffee substitutes
  • Cookies
  • Crackers
  • Creamed vegetables
  • Doughnuts
  • Flavoring (both artificial and natural)
  • Fritters
  • Gravy
  • Gin
  • Hot Dogs
  • Hydrolyzed protein
  • Lunch meats
  • Matzos
  • Meat loaf
  • Melba toast
  • Ovaltine
  • Pancakes / Waffles
  • Pies / Pastries
  • Popovers
  • Rusks
  • Sauces
  • Soups (many contain wheat products, e.g., Campbell's Tomato, bouillon cubes, creamed soups, chowders, bisques, etc.)

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

Soy

Avoid foods that contain any of these products:

  • Edamame
  • Hydrolyzed soy protein
  • "Meat extender"
  • Miso
  • Natto
  • Shoyu sauce
  • Soy (in all forms: soy albumin, soy fiber, soy flour, soy grits, soymilk, soy nuts, soy sauce, soy sprouts)
  • Soya
  • Soy protein (curd, granules)
  • Soy protein (concentrate, isolate)
  • Soy sauce
  • Tamari
  • Tempeh
  • Textured Vegetable Protein (TVP)
  • Tofu

Use caution with these foods as they may contain soy protein:

  • Brownie mixes (Betty Crocker, Duncan Hines, Pillsbury)
  • Cakes (frozen)
  • Cake mixes (Betty Crocker, Jiffy, Duncan Hines, Pillsbury)
  • Cookie mixes (Nestle, Quaker Oats, Betty Crocker and Duncan Hines)
  • Ethnic foods (Chinese, Thai, Japanese, Vietnam - Oriental / Asian)
  • Flavoring (both artificial and natural)
  • Frostings (mixes and ready to spread)
  • HoHo Fruit Pies and Cup Cakes
  • Jello Instant Cheesecake
  • Pie crusts (Johnston's Ready Crust, Jiffy, Betty Crocker)
  • Pies (frozen - i.e. Mrs. Smith's, Morton's)
  • Vegetable broth
  • Vegetable gum
  • Vegetable starch

SPECIAL NOTES:

Most people allergic to soy can safely eat soybean oil and / or soy lecithin.

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

Tree Nuts

Avoid foods that contain any of these products:

  • Almonds
  • Artificial nuts
  • Brazil nuts
  • Caponata
  • Cashews
  • Chestnuts
  • Extracts (avoid pure nut extracts - imitation or artificial flavored are usually okay)
  • Filbert
  • Glanduja (usually found in chocolate)
  • Hazelnuts
  • Hickory nuts
  • Macadamia nuts
  • Marzipan (Almond Paste)
  • Nougat
  • Nu-Nuts (trademark name for artificial nuts - but use real nuts in process)
  • Nut butter (ground cashews)
  • Nut Meal
  • Nutmeats
  • Nut Oil
  • Nut Paste
  • Nut Pieces
  • Pecans
  • Pignoil
  • Pine nuts (pinyon nuts)
  • Pistachios
  • Walnuts

Use caution with these foods as they may contain tree nut protein:

  • Bakery goods (pastries, cookies, etc.) (Some bakeries grind their stale cookies and use them for toppings, fillers, ingredients in sauces, and fruit toppings.)
  • Candy (including chocolate candy)
  • Ethnic foods
  • Flavoring (both natural and artificial)
  • Marzipan
  • Nougat

SPECIAL NOTES:

**Tree nuts can be an ingredient in many foods that you would not normally think of as containing nuts - i.e. flavorings (natural or artificial), sauces, ice cream, cereals, breads, crackers, oriental foods and other ethnic dishes.

If you are allergic to tree nuts you should avoid peanuts as well.

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

Shellfish

Avoid foods that contain any of these products:

  • Abalone
  • Clams (any variety)
  • Calamari
  • Cockle
  • Crab
  • Crawfish
  • Crayfish
  • Escargot
  • Lobster
  • Mollusks
  • Mussels
  • Octopus
  • Oysters
  • Prawns
  • Scallops
  • Sea Urchin
  • Shrimp
  • Snails
  • Squid

Use caution with these foods as they may contain shellfish protein:

  • Bouillabaisse
  • Cuttlefish ink
  • Fish stock
  • Seafood flavoring of any kind (including natural and artificial or imitation)
  • Surimi

SPECIAL NOTES:

Eating any food prepared in a seafood restaurant may be dangerous as it can be contaminated with fish or shellfish during the handling and/or cooking.

Even smelling or handling fish/shellfish can cause a reaction in some individuals.

There may be some individuals who are allergic to shrimp, lobster, crab, and crawfish (as these are all closely related), but who can tolerate mollusks and clams. However, do not attempt to eat any shellfish without talking to your allergist.

This list may be incomplete. Please read all labels carefully and if in doubt, don't eat the item.

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