For children living with severe food allergies — and for their parents — every meal and snack becomes a high-risk event. An allergic reaction is possible every time the ingredients in a bite of food haven’t been thoroughly vetted or if that food has been in close proximity to allergens. The 6 million children in the U.S. with a food allergy (that equates to roughly two in every American classroom) need advocates at home and at school who have done their research about food allergies and know what it takes to keep them safe.
While researchers are exploring potential cures for food allergies, at present, the only way to prevent an allergic reaction is to avoid the foods that trigger it. Luckily, that’s becoming less difficult, as laws compel food companies to increase transparency about ingredients and allergens, educators and school administrators learn more and restaurants make more of an effort to cater to their clientele with food allergies. The key for parents and children learning to take responsibility for managing their dietary restrictions is to learn about their own allergy profiles and devise systems for home, school and dining out to ensure that no allergens sneak onto their plates.
This guide will provide the resources needed to do just that through the following sections:
- Types of Common Food Allergies in Kids
- Responding to an Allergic Reaction
- Enjoying Food While Living with Allergies
Types of Common Food Allergies in Kids
The statistics on food allergies are sobering: Every year in the United States, there are about 30,000 cases of food-related anaphylaxis (that is, severe allergic reactions), leading to 150 to 200 deaths.
Still, that doesn’t mean that children with severe food allergies or their parents need to live in constant fear. The first step in learning how to approach mealtimes with confidence is getting tested and receiving a diagnosis.
Getting Tested for Common Allergies
When it comes to getting tested, there are some important considerations to keep in mind.
Nutrition and food and our reactions to them are far too complicated to rely on hunches and intuition. Various food-induced conditions can masquerade as allergies, and many people who rely on self-diagnosis can end up becoming unnecessarily restrictive with their diets, leading to nutritional blind spots. In fact, studies show that more than half of assumed food allergies don’t actually qualify as such.
Make an appointment with a trusted allergist or immunologist
An allergist or expert in immunology can often provide unparalleled help in getting to the bottom of your child’s food allergy profile — and determining how to meet nutritional goals in the midst of it. Find one with a handy search tool like this one.
Know the types of allergy tests
After a thorough exploration of the patient’s medical history to seek out patterns in food reactions, the allergist or immunologist will often issue one of the following tests or a combination thereof:
Learning About the Eight Most Common Food Allergies
Just eight foods are collectively responsible for about 90% of all food allergies in the United States. Some of these food allergies are much more prevalent in young children, who often grow out of them, and others are more likely to stick around for a lifetime. Learn about these eight foods and their particulars below.
1. Cow’s Milk
Cow’s milk is one of the most common foods that children under the age of 3 are allergic to.
About 90% will outgrow the allergy by the time they reach that age, and studies show that the allergy is more prevalent among infants who have been exposed to the protein in cow’s milk before 6 months of age.
The following foods typically contain cow’s milk:
- Milk powder.
- Ice cream.
For more resources on feeding infants with a milk allergy, symptoms and more, consult this fact sheet from the Anaphylaxis Campaign.
Eggs cause an allergic reaction in more children than any other type of food except cow’s milk,
affecting between 1% and 2% of children. More than two-thirds of children with this condition
(68%) will outgrow the allergy by age 16. Because egg whites and yolks contain different
proteins, it’s possible to be allergic to one part of the egg and not the other. Since proteins in eggs change when they are subjected to high temperatures, many with egg allergies can
safely eat this food in baked goods, like cookies and cakes.
For more support in managing an egg allergy, see this deep dive from the American College of Allergy, Asthma & Immunology.
3. Tree Nuts
Tree nut allergies are one of the most likely to last for life. Research indicates that only 9% of children with this type of allergy will outgrow it. It’s also among the most common allergies, affecting roughly 1% of the population of the U.S. and U.K. Proteins from tree nuts are commonly used in surprising places, like candy, crackers, energy bars and barbecue sauce. They can even be in lotions and soaps.
People with this allergy will react to any type of nut that grows on trees, a category that includes,
but is not limited to:
- Brazil nuts.
- Butter nuts.
- Macadamia nuts.
- Pine nuts.
Find more information about the diagnosis, management and treatment of tree nut allergies here from the American College of Allergy, Asthma & Immunology.
Peanuts cause another of the most common food allergies. It’s important to remember that this is a category distinct from tree nut allergies, since peanuts are legumes. That said, peanut allergy sufferers are often allergic to tree nuts too. A significant number of children experience peanut allergies — between 2% and 5% — though 15 to 22% of them will outgrow the allergy by their teen years.
For information on the latest research on peanut allergies and treatments, consult this site from the American Academy of Pediatrics.
An allergy to soy is most common in children under the age of 3. Beware of the many foods that
can contain soy proteins, including:
- Soy milk and other imitation dairy products.
- Soy sauce.
- Some breadcrumbs, cereals and crackers.
See this fact sheet from FARE (Food Allergy Research & Education) for more in-depth information about soy allergies.
Wheat allergies are frequently misperceived as celiac disease or gluten intolerance —
underscoring the importance of proper testing and diagnosis. Research shows that as many as
three-fourths of those with this allergy grow out of the problem by age 19.
For more information on living with wheat allergies, see this thorough overview from the Mayo Clinic.
Fish allergies are rare among these top eight in that they often emerge later in life. Research shows that up to 40% of people with this allergy become allergic to fish as adults. Symptoms may present as similar to those of eating spoiled or contaminated fish, making thorough testing with an expert important.
See this page from the European Centre for Allergy Research Foundation for more information about successfully navigating a fish allergy.
Shellfish allergies are often present in people who are not allergic to any other type of fish. This
allergies have their first reaction as adults.
Types of shellfish include:
The American College of Allergy, Asthma & Immunology provides deep resources for those hoping to learn more about allergies in children—including an “Ask the Allergist” chat option, a symptom test, and a search by ZIP code to find an allergist in your area.
Johns Hopkins Medicine Health Library offers information about the types of tests available to determine the cause of food allergies and prevention guidelines.
HungryChildren.org goes in depth in discussing the different types of food allergies and symptoms.
Responding to an Allergic Reaction
When a person is allergic to certain foods or the proteins in them, what’s happening is that his or her body is mistaking the food as a possible threat. In response, the immune system kicks into high gear in an effort at protection. What follows could be a mild reaction or a severe, potentially life-threatening one. In this chapter, we walk you through the symptoms and how to best respond to them.
Recognizing Food Allergy Symptoms
Symptoms can vary considerably among individuals. They can appear immediately after eating, or hours later.
Mild symptoms might mean:
- Itchy skin.
- Skin rash, in the form of hives or eczema.
- Dry cough.
- Runny nose or sneezing.
- Itchiness inside the mouth or inner ear.
- Unrecognizable taste in the mouth.
- Cramps, stomach pain or diarrhea.
Severe symptoms can include:
- Difficulty swallowing.
- Faintness, lightheadedness, confusion, passing out.
- Loss of consciousness.
- Chest pain.
For additional information on recognizing food allergies, consult the online resources on food allergies from the Mayo Clinic.
Responding to an Allergic Reaction
The most severe symptoms above must be treated immediately — every second counts when it comes to staving off life-threatening anaphylaxis.
- Epinephrine (commonly referred to as the “epi pen”) is unique as the only medication that can halt oncoming anaphylaxis. It causes the muscles to relax and blood vessels to tighten. Everyone with a severe food allergy should have an epi pen nearby at all times.
- Steroids can help bring down inflammation after an allergy attack.
- Antihistamines help address the symptoms of a mild allergic reaction.
For a printable resource on recognizing and responding to anaphylaxis, see this one-pager from FARE.
About Kids Health provides a detailed description of how to respond to an allergic reaction in children.
Childcare providers like daycare centers will want to check out the information provided by Extension, which includes preparing to deal with allergic reactions before they happen.
City Allergy breaks down the biology behind an allergic reaction.
Enjoying Food While Living with Allergies
Once you are fully versed in your child’s food-allergy diagnosis — the foods, ingredients and proteins that he or she must avoid; how to identify signs of an allergic reaction; and how to use the potentially life-saving methods that can interfere with an allergic reaction — it’s time to create systems to keep life as painless, convenient and safe as possible. In this chapter, we’ll explain how.
Tips to Promote Food Safety at Home
- Make sure everyone in your household (especially those doing the grocery shopping) can read a food label and scout it for potential allergens. Post this fact sheet on your refrigerator as a constant reminder.
- If one person’s problem foods are going to be allowed into the house so others can consume them, make sure they’re kept in a different part of the kitchen or pantry.
- Scrub and clear counters after cooking, and make sure everyone eating together washes their hands before and after meals to avoid passing allergens from one person to another.
- Post this fact sheet in the kitchen to remind everyone cooking how to avoid cross-contact between foods.
- Make sure everyone in the house — and all childcare providers — know the location of a first-aid kit that includes an epi pen. Also fill out and post this emergency care plan where everyone can see it.
- When cooking and baking, look for suggested substitutions for eggs, milk and other offending allergens.
Tips for Food Safety While Dining Out in Restaurants
- Ask for specific restaurant recommendations from your allergist, friends with the same allergy or online forums.
- Consult lists like this one of the most allergy-friendly restaurants and chains.
- Recognize that certain types of dining-out establishments present an especially high risk because of the possibility of cross-contamination. These include:
- Call ahead and ask the restaurant these questions before you go.
- Check out this video depicting a clearly communicated set of questions and answers between diner and server.
- Always confirm the order with your server before you dig in.
Harvard Medical School offers these additional expert tips for dining out (and cooking alone or with friends) with allergies.
Tips to Help Prevent Allergic Reactions at School
School educators and administrators can check out this toolkit from the Centers for Disease Control and Prevention. Tips include:
- Organize professional development events to teach all staff about food allergies.
- Make sure the school has a clear plan to respond to food emergencies.
- Do everything possible to quash bullying and discrimination that may crop up in response to food allergies.
Parents and caregivers can draw from this list of tips from the Asthma and Allergy Foundation of America. Tips include:
- Clearly explain your child’s food restrictions to the school.
- Work with your child’s doctor to devise an emergency action plan.
- Connect with the school nurse to find out where emergency medications will be kept during the day.
Kids with Food Allergies (a division of the Asthma and Allergy Foundation of America) offers deep resources for those caring for a child with food allergies — from recipes and diet information to collected research to the latest news about allergies.
Food Allergy Research & Education is indispensable for anyone navigating food allergies — the site offers tips for dining out, keeping the kitchen allergy-safe, dealing with life’s milestones, and more.
AllergyHome.org makes its Living Confidently with Food Allergy handbook available online, which includes a FAQ, treatment options and discussion of common challenges.