Food Allergies: What You Need to Know
Chances are pretty high you know someone with a food allergy. Food allergies impact an estimated 5% of adults, 8% of children, and about 20% of infants -- and the prevalence is increasing. Food allergies are more common in babies and children, however, they can develop at any age, even in adulthood. It is also possible to develop an allergy to a food you have eaten before.
While it’s possible to have an allergic reaction to any food, the most common food allergies are caused by 8 allergens. They’re commonly referred to as the Big 8.
Below, we’ll go over what food allergies are and how they differ from food intolerance and food sensitivities, review the Big 8 allergens, share common symptoms and treatments, and provide tips on how to manage food allergies to minimize reactions.
Food allergies vs. food intolerances vs. food sensitivities
A food allergy is a body’s abnormal immune response to a certain food. If your immune system incorrectly identifies food proteins as harmful, it launches measures to “protect” you. For most people with food allergies, exposure to a small amount can lead to an allergic reaction. Severe food allergic reactions can lead to anaphylaxis or death.
Food allergies are divided into two main types:
- IgE antibody: the food-specific immunoglobulin E (IgE) antibody is released by your immune system to fight the food protein perceived as harmful. Antibodies help your immune system recognize and fight infection.
- Non-IgE antibody: Your immune system uses other parts to fight the perceived threat without releasing IgE antibodies.
Food intolerances may appear similar to food allergies. They refer to your body’s inability to process or digest certain foods. The primary difference is that food intolerances never involve the immune system, meaning they are not life-threatening. However, they can impact your quality of life.
The most common food intolerance is lactose intolerance, which can lead to bloating, diarrhea, and inflammation. This condition is uncomfortable, and can be prevented by avoiding dairy products or taking lactase enzyme supplements.
Food sensitivities describe symptoms that occur after eating certain foods that are not related to food allergies or food intolerances. Food sensitivities are symptoms that occur in response to certain foods. They are not life-threatening, but can be disruptive and uncomfortable. Symptoms typically include stomach discomfort and pain, rashes, fatigue and lethargy, joint pain, and brain fog. Gluten is the most common trigger of food sensitivities for those who don’t have celiac disease. Removing certain foods from your diet can help prevent symptoms related to food sensitivities.
The 8 most common food allergies
Food allergies can be caused by any food, but the most common allergic reactions are caused by what’s called “the Big 8.” These 8 allergens trigger about 90% of all allergic reactions.
The Big 8 allergens are:
Children typically outgrow milk and egg allergies, while peanut and tree nut allergies tend to be permanent. Certain seeds, such as sesame seeds, are also significant causes of allergic reactions.
Food allergy symptoms
Food allergy symptoms range from mild to severe. It’s important to be aware that reactions can vary from person to person, and even the same person can experience different reactions each time. It’s possible to have a mild reaction one time, and a severe reaction the next time. Due to the unpredictable nature of allergic reactions, it’s recommended to be prepared for the most severe reaction, which is anaphylaxis.
Food allergy symptoms can occur within a few seconds or minutes after exposure. Sometimes they happen a few hours later. Here are some common symptoms to recognize:
- Swelling of the tongue, mouth or face
- Difficulty breathing
- Low blood pressure
- Itchy rash
In severe cases, the reaction can cause anaphylaxis. Symptoms usually occur within seconds after exposure. They include:
- Swelling of throat, tongue, or lips
- Shortness of breath or difficulty breathing
- Difficulty swallowing
- Nausea or vomiting
- Low blood pressure (weak, rapid pulse)
- Abdominal pain
- Itchy rash or hives, flushed skin, feeling too warm
- Tingly hands, feet, mouth, or scalp
If not treated immediately, anaphylaxis can lead to anaphylactic shock, which can then lead to brain damage, kidney failure, and heart attacks. Some cases may be fatal. Here are signs that anaphylaxis has progressed to anaphylactic shock:
- Struggling to breathe
- Dizziness and confusion
- Feeling weak
- Loss of consciousness
Food allergy treatments
The most effective way to prevent food allergy reactions is to avoid the food completely. But that can sometimes be challenging. For example, a product manufactured in a shared facility may contain traces of peanuts or tree nuts even if the ingredient list does not include either of those allergens. We will discuss in more detail below how to read and understand labels to minimize exposure and risk.
Any symptoms associated with anaphylaxis must be immediately treated with epinephrine (adrenaline). Doctors advise those with food allergies to carry an epinephrine auto-injector (Epi-Pen) at all times just in case an unexpected reaction occurs. The Epi-Pen should be used as soon as symptoms of anaphylaxis start, followed by a visit to the emergency room. It is important to seek medical care even if you feel better after using the Epi-Pen because the allergic reaction could return after the medication wears off.
In January 2020, the U.S. Food and Drug Administration (FDA) approved Palforzia for the treatment of peanut allergies in children and teenagers (ages 4 to 17). It is a daily oral therapy that works by modifying the patient’s immune system. This treatment does not eliminate the allergic reaction to peanuts, but it can make the reaction less severe.
Scientists continue to explore therapies, particularly oral immuno-therapies (OIT), and other treatment options to reduce the severity of allergic reactions.
Diagnosing food allergies
The best way to diagnose food allergies is to be evaluated by an allergist. As part of the process, an allergist will review your family and medical history and determine which tests to perform. Information to bring to an appointment with an allergist include:
- The food eaten
- The quantity consumed
- The symptoms that occurred
- How quickly the symptoms appeared after consumption
- How long the symptoms lasted
Allergy testing involves skin tests or blood tests, sometimes both. These help determine whether food-specific immunoglobulin E (IgE) antibodies are present in the patient’s body.
Skin tests involve pricking your skin to allow a tiny amount of a suspected food allergen under the skin. This is typically performed on your arm or back. After about 20 minutes, a positive result will reveal red bumps (similar to a mosquito bite) at the site of the allergen. To compare the results, another area of your skin will be pricked with a liquid that doesn’t contain the suspected allergen. The reaction of both skin pricks will be compared to determine whether or not a food allergy exists.
Considered less exact than skin tests, blood tests are designed to measure the amount of IgE antibody to the suspected food allergen. Results typically take about a week to come back.
The results of skin and blood tests will help your allergist make a diagnosis. Keep in mind a positive result doesn’t necessarily mean an allergy exists, but a negative result can rule them out.
Oral food challenges
If the skin and blood tests are inconclusive, your allergist may recommend an oral food challenge. This must occur under strict medical supervision in case there is a severe allergic reaction. During an oral food challenge, the patient consumes tiny amounts of the suspected trigger food under close observation in a medical facility. The quantity of the food increases over time and reactions are recorded and monitored to determine whether a food allergy exists. This can also be done to determine whether a food allergy has disappeared.
Who is at risk for food allergies?
Food allergies tend to run in families, but it’s impossible to know whether a child will inherit their parent’s food allergy. It’s possible for a child to have a food allergy even if there’s no family history of any.
It’s unclear whether food allergies are temporary or permanent. Studies indicate allergies to milk, eggs, wheat, and soy are more likely to fade over time, while allergies to peanuts, tree nuts, fish and shellfish tend to be permanent. Research also indicates allergies in babies and children are more likely to disappear over time, especially those to milk and eggs.
How to manage food allergies
Avoiding foods that cause allergic reactions is the best way to protect your health. However, that’s not always possible if it’s an ingredient that’s not visible or if you’re consuming products that you didn’t personally make yourself.
Here are ways you can minimize your chances of accidentally consuming trigger foods.
It’s important to carefully read all ingredient labels. Make sure you recognize the trigger food if it is called or known by other names. In addition to reading the ingredient list, also look for allergen warnings. The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) requires consumer packaged goods (CPG) manufacturers to clearly state the presence of the 8 most common food allergens. Currently, there is a legislative push to add sesame to this list.
Many manufacturers go the extra step of writing precautionary statements, such as “may contain traces of...” or “made in a shared facility” so consumers are aware there may be cross-contamination. However, advisory warnings are not regulated by law so there is no standard definition. In general, if your trigger food is mentioned under the precautionary warning, it is recommended that you avoid that product.
Note that FALCPA does not apply to foods regulated by the U.S. Department of Agriculture, such as meat, poultry, and certain egg products. The Act also doesn’t apply to health and beauty products, including cosmetics and shampoo.
Carry an Epi-Pen
Since there is no way to know when and how severe the next food-related allergic reaction is, allergists recommend that patients carry an Epi-Pen at all times.
Ask questions when dining out
Similar to ingredient labels, it’s also equally important to read menus when dining out. Most chain restaurants publish ingredients online. For those that don’t, be sure to tell your server about your food allergy and request to speak directly with the chef. Make sure the chef understands what your trigger food is to make sure there is no cross-contamination with shared pots and pans, cooking utensils, and preparation surfaces. The chef can also suggest dishes that are free of the food allergen.
Join support groups
Find a support group of others with food allergies to get advice, tips, or simply share support. If your child is newly diagnosed with food allergies, you may feel overwhelmed and concerned about how to handle school lunches and birthday parties. Having a network of people who understand your fears and concerns can help alleviate some of your worries and help you feel less alone. Facebook groups are a popular option.
Consult a dietitian
If the trigger food is something that may cause nutritional deficiencies, consider seeking the advice of a registered dietitian. This may be especially helpful for children who are allergic to dairy or eggs. Dietitians can help you come up with allergy-free options to help your child meet their nutritional needs.
Have an action plan for school
If your child attends school (as opposed to virtual schooling or homeschooling), confirm that the school has a written emergency action plan for food allergies. The plan should include guidance on preventing, recognizing, and managing food allergies. Make sure all of your child’s teachers are aware of the allergy and that it is communicated to other parents if necessary. If your child carries an Epi-Pen, make sure teachers and administrators know how to use it. It’s also important that your child understands their food allergy and can be their own advocate. It is recommended that two Epi-Pens be available for each child with a food allergy at school.
Find trusted allergen-free brands
Finding allergen-free products can be challenging. Even brands that say they’re allergen-free may contain traces of allergens or may be manufactured in a shared facility with allergens.
When shopping for allergen-friendly products, look for brands that:
- Don’t contain the Big 8 allergens
- Test their ingredients as well as their final products
- Are manufactured in a dedicated allergen-friendly facility
Without A Trace Foods is an example of a brand that does not use the Big 8 allergens, sesame, and gluten, carefully sources all ingredients, does routine testing on all ingredients and finished products, and manufactures in a dedicated allergen-free facility.
With increased awareness and understanding, continued research in developing new treatment options, and constant innovation in the food industry, living with food allergies continues getting easier and more manageable.