Food Allergy
Avoidance is the only treatment for food allergy. There is no cure. Neither desensitization nor shots have proven to be a safe or an effective way of reducing food allergy reactions.
Service – Food Allergy Testing
An allergist is the best qualified professional to diagnose food allergy. Your allergist will take a thorough medical history, followed by a physical examination. You may be asked about contents of the foods, the frequency, seasonality, severity and nature of your symptoms and the amount of time between eating a food and any reaction.
Are you really allergic to certain foods?
Food allergy is when the body mistakes a certain food as “dangerous” and produces an antibody called immunoglobulin E (IgE). This IgE antibody reacts with the allergen (i.e., dangerous food item) and chemicals are released into the body causing an allergic reaction. Symptoms of a food allergy reaction may be mild (rashes, hives, itching, swelling) or severe (trouble breathing, wheezing, loss of consciousness). A food allergy can potentially be fatal.
Food Allergy vs. Adverse Food Reaction
Food allergies are often confused with adverse food reactions. Lactose intolerance is an example of an adverse food reaction. A person who is lactose intolerant lacks the proper enzymes to digest the sugar found in milk and dairy products properly. This affects the digestive system and a person may have symptoms of diarrhea and stomach cramping if he/she ingests a milk or dairy product. The severity of symptoms is generally related to the amount of food ingested.
A food allergy, on the other hand, involves the immune system. While the symptoms of a minor food allergy and adverse food reactions may be similar, the biology is different. The release of chemicals in an allergy attack can cause symptoms as minor as a scratchy throat, sniffles, and puffy eyes to major symptoms like swelling of the tongue and throat, coughing, and/or hives covering the entire body. In rare instances, if someone has a food allergy, ingestion of that food can lead to anaphylaxis, a severe allergic reaction that can be fatal.
Less than 5 percent of the population has a true food allergy. This small number, though, and should not minimize the importance of recognizing and treating a food allergy.
What to Do if You Suspect a Food Allergy
Our allergy specialists can help identify to which foods you are allergic. To aid in the doctor’s diagnosis, keep a journal of everything you eat, what symptoms you experience, and how long after you eat that the symptoms appear. Maintain this journal for one to two weeks and bring it with you when you go to the doctor.
Often the food causing the allergic reaction is obvious. For instance, if classic allergy symptoms appear a few minutes after eating a food on several occasions, further tests may not be needed to identify that particular food as the offender. If a food allergy is suspected, but the offending food is not obvious then allergy skin testing or other types of tests performed by a board-certified allergy and asthma specialist will help in its identification.
Here are some things to keep in mind:
- Know what you are eating. If you are eating out, ask the waiter what ingredients are being used and be very clear with him or her what you can or cannot eat. If the waiter is unsure, ask him/her to check with the chef. In the market, carefully read the labels before you buy.
- Birthday parties can be a challenge to a child with a food allergy. Be sure that the host parents know that your child has allergies. Educate your child, so he or she knows which foods are okay and not okay to eat. Alert teachers or childcare workers of the food allergy and the potential symptoms of an allergic reaction.
- If anaphylaxis is a possibility, you should talk to your doctor about knowing how to use and carrying injectable epinephrine in case of an emergency.
Diagnosis
Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a small amount of extract made from the food is placed on the back or arm. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy.
In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. In this case, your doctor may recommend a blood test for food-specific IgE. False positive results may occur with both skin and blood testing. Food challenges are often required to confirm the diagnosis. Food challenges are done by consuming the food in a medical setting to determine if that food causes a reaction.
Outgrowing Food Allergies
Most children outgrow cow’s milk, egg, soy and wheat allergy, even if they have a history of a severe reaction. About 20% of children with peanut allergy will outgrow it. About 9% of children with tree nut allergy will outgrow it. Your allergist can help you learn when your child might outgrow a food allergy.
When can you develop a Food Allergy?
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.
Don’t suffer from untreated allergies. Schedule an appointment today with one of our board-certified allergists, and move towards a safe, healthier tomorrow.
What are possible 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 asian foods and are ground up and used in baked goods.
Below is a list of foods that may use some of these allergens.
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)
- Soufflés
- 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.
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.
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.
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.