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Whether you need to avoid the top 8 food allergens, have one particular food allergy, or are packing lunches and snacks for schools that have allergen restrictions, this post is for you!
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The USDA describes a food allergy as an adverse reaction when the body produces an antibody called IgE in response to a particular food.
“An allergic reaction ensues once a specific food is ingested and binds with the IgE antibody. Most food allergies are caused by certain proteins.”
I did a deeper dive into different types of adverse food reactions and intolerances in this post about at-home food allergy testing kits. This post will help you determine food sensitivity vs allergy.
Most of us are familiar with what have been known as the top 8 food allergies, but did you know that there are actually NINE main allergens?
Technically someone could be allergic to almost any food. But the 9 allergens on this list are responsible for the vast majority of food allergies.
The top 8 food allergens are:
and the addition to make the top 9…
As of Jan 1, 2023, sesame is now required to be labeled along with the other allergens on packaging.
Food allergies, or at least our awareness of them, are on the rise.
It is estimated that about 6% of adults and 8% of children have some sort of food allergy. That breaks down to about 1 in 13 children. So it’s pretty likely that someone in your child’s classroom has a food allergy of some sort.
When you look at the numbers that way, it makes sense why so many school campuses are peanut-free or entirely nut-free.
This is one of the most common questions I get asked as a dietitian!
I can’t tell you how many friends/parents have texted me pictures through the years asking if something looks like an allergic reaction from food. A baby food allergy rash can be cause for concern, but it also may be more benign than it looks!
Food allergies *can* manifest as skin irritation, but there are also some foods that can cause skin irritation without being an allergic reaction. Not every skin irritation is an allergy.
Mild food allergies can result in skin irritation, mouth/tongue swelling, tingly/itchy mouth, or hives on other parts of the body (usually trunk/chest). These are not usually an emergency, but I recommend calling your pediatrician/nurse’s line for guidance.
Severe food allergies are an emergency. They can result in difficulty breathing, swelling of throat, dizziness, and anaphylaxis. Get emergency help if you notice anything that resembles a severe food allergy reaction.
If I just freaked you out, please know that super severe food allergies are relatively rare.
Most food allergies we see are to those top 9 foods mentioned above, so you don’t necessarily need to be on high-alert for every single new food your child eats in their first 10 years of life.
The most severe allergic reactions we see are usually to peanuts.
I don’t say this to scare you! I just want to arm you with the information so that you pay extra attention when introducing allergens to your young eaters.
Most children are low-risk for a severe peanut allergy.
There are some conditions that may put them at a higher risk (such as severe eczema or an existing egg allergy). If that’s the case for your child, there is guidance on how to introduce peanuts in a safe/controlled way. Check out this article for information on severe peanut allergies and find out what your child’s risk level is.
We do recommend that you introduce allergens early and often! We know now that early introduction may actually be protective against the development of food allergies!
If you’re on the cusp of starting solids with your child and could use a little extra guidance on allergens and more, check out my Simply Solids Guide! It’s a free resource I made to help parents confidently navigate the world of solid foods that can seem so overwhelming.
If you’re wondering which foods need extra caution around allergies, here’s the deal. There are common food allergies and uncommon food allergies.
While the most severe types of allergies are usually to peanuts, the most common allergies are to milk and eggs. These can range from mild to severe.
While they are more common- which can seem like a bummer- the good news is that they may not be lifelong.
Yes- some of them! Allergies to milk, egg, wheat and soy can and often do resolve in childhood.
However, allergies to peanuts, tree nuts, fish and shellfish are generally lifelong.
To put that into context, “the prevalence of milk allergy is 2-3% in young children…over 90% of those with a milk allergy will achieve tolerance by adult life.”
If your child is diagnosed with a food allergy, all hope is not lost! These immune responses can change as children grow.
Sometimes children with allergies may be able to tolerate the allergen in different quantities or presentations. This is particularly common for some kids with egg allergy. They can often tolerate egg as an ingredient in baked food but not on its own.
I recommend working closely with your child’s pediatrician and a food allergist to determine the best course of action for your child in regards to an existing allergy and the potential reintroduction of the trigger food.
Yes and no. The answer to this question is a little complex.
Just because your child has a food allergy does not necessarily mean they are doomed to a life of being allergic to one thing after the next. Many kids only have one allergy.
Are food allergies genetic? It’s hard to say, but there may be some genetic component.
But sometimes certain allergies can mean they’re more likely to have others. Children with conditions like severe eczema and asthma are at a higher risk for food allergies. Children with siblings who have severe food allergies are more likely to have a food allergy.
And there is this thing called cross-reactivity which can contribute to a multiple-allergy situation. Essentially, cross-reactivity is what happens when the proteins in one food are similar enough to the proteins in another food that the immune system reacts to them the same way.
Certain foods have a high degree of cross-reactivity with one another.
So it’s pretty safe to assume that if a child is allergic to cow’s milk, they probably won’t do any better with goat or sheep’s milk.
However, not all cross-reactivity means similar foods will result in the same symptoms. Check out this example about peanuts and other legumes:
This means that entire food groups aren’t necessarily crossed off just because one may be problematic.
The most common question I get on this topic of cross-reactivity is about peanuts and tree nuts. They are differentiated on the allergy list even though most people lump them all together as “nuts.” Some people are allergic to only peanuts. Some are allergic to peanuts and tree nuts.
It is not uncommon for someone to be allergic to both peanuts and tree nuts, but we don’t know for sure that there is a correlation there. One study has shown that there may be some cross-reactivity, but it’s not conclusive.
As we now know, allergic reactions can range from mild to severe. Mild symptoms may be disruptive and uncomfortable, but severe reactions may be life-threatening.
If you notice severe symptoms, get emergency help immediately. If you know your child has a severe allergy, have a plan for emergency response. Some parents find that having epipens in multiple places or in different bags can help safeguard against accidental exposure.
For less severe reactions, I recommend you take note of the particular food/ingredient you think is the culprit. I do still suggest calling your doctor/nurses line. They can help you determine the next best steps.
Here’s a list from foodallergy.org of common things children will say when they notice symptoms:
If your child receives a food allergy diagnosis, I highly recommend doing a workup with a food allergist and a dietitian. They can help you with a specific list of foods to avoid and how to make sure your child’s diet is both safe and nutritionally adequate.
The food allergist may also suggest a treatment plan or a re-introduction plan over time. Children often outgrow allergies to milk, egg, soy and wheat. New research indicates that up to 25 percent of children may outgrow their peanut allergy, with slightly fewer expected to outgrow a tree nut allergy.
A lot of us are worried about a baby food allergy, and I totally get it. I am going to give you my rules of thumb for introducing allergens to your child.
We want to introduce them early and often because that has shown to reduce the incidence of developing a food allergy!
Offer the different allergens one at a time so you can observe any reactions that might occur. That doesn’t mean you can only do one per week, but I like to say one per day.
And I like to tell parents to try to introduce allergens during the day (on a weekday if possible) so that if there is a reaction, you have a much easier time getting a hold of your pediatrician or getting help that day.
I don’t know about you, but it seemed like my kids always got sick on a Sunday when I couldn’t get anyone on the phone!
For a deep dive into how to introduce allergenic foods to your baby, start here! I also recorded a podcast on how to know if your baby has food allergies.
Oral Allergy Syndrome, or OAS, is another type of food allergy.
It manifests only on the mouth, lips, and throat with symptoms like itchy mouth and scratchy throat. It is most commonly associated with raw fruits and vegetables, and tree nuts.
You’re more likely to see OAS if your child is allergic to pollen. There is some cross-reactivity between pollen allergy and foods. For example, if your child has an allergy to ragweed, they might also have symptoms from raw banana, cucumber, melon, or zucchini. Random, I know!
This is also possible when they have allergies to birch, grass, or mugwort pollen. Here’s a list of the fruits they may have a reaction to.
OAS typically does NOT lead to super severe symptoms. However, it’s wise to report to the doctor, especially if your child experiences these symptoms with nuts.
If you have a kid who really avoids certain (or all) raw fruit and veggies, this is sometimes the culprit!
What should you look for on food labels to make sure they’re safe for a child with a food allergy?
Some foods/ingredients can fly under the radar if you don’t know what to look for. If your child has a food allergy, it’s important that you are skilled at reading food labels.
There are labeling requirements that mandate brands to disclose allergens that could be present in a product, but it may not even cross your mind to look at certain labels!
A common example I see of this is hummus. Traditionally, hummus is made using an ingredient called tahini, which is made from sesame seeds.
I was definitely an adult before I really knew what tahini was or what foods might contain it! That one would’ve slipped past me as a potential allergen.
“The law requires that food labels identify the food source of all major food allergens used to make the food. This requirement is met if the common or usual name of an ingredient already identifies that allergen’s food source name (for example, buttermilk). Otherwise, the allergen’s food source must be declared at least once on the food label in one of two ways.
The name of the food source of a major allergen must appear either:
In parentheses following the name of the ingredient
Examples: “lecithin (soy),” “flour (wheat),” and “whey (milk)”
-OR-
Immediately after or next to the list of ingredients in a “contains” statement.
Example: “Contains Wheat, Milk, and Soy.”
This means that you don’t have to know what every ingredient means, you just have to look out for these statements that declare common food allergens.
Always, ALWAYS check the labels if you’re working with a food allergy! Sometimes recipes or manufacturing processes change. I know it’s very tedious and time consuming but it’s worth it to avoid a severe reaction.
First of all, I want to say that working with multiple food restrictions is so HARD. If you’ve got a picky eater who also has food allergies, give yourself grace! Their diet may not be perfect (whose is?) and you may have to rely on certain foods more than you’d like.
Find a few foods that are safe and work for them and don’t feel bad if you have to serve them on repeat. I would make a physical list that you keep on the fridge or on your phone so you can easily reference it when shopping. It’s most important that they get enough food in their little bodies, even if they’re not able to eat the widest variety right now.
Try to make swaps/add-ins with those safe foods to make them more nutrient dense. I’ve got a few tricks up my sleeve for this!
You can use calorie-dense ingredients like butter (if they aren’t allergic) or oil to increase the fat content of carbohydrate foods like pasta, rice, or toast.
Choose the whole-fat version of dairy (if they can eat dairy).
You can snag a kid-friendly nutrition shake mix- my favorite is from Nutrikid– to have on hand if they need a boost. Or you can offer them smoothies with a small portion of your favorite protein powder mixed in.
Check out this post for more information on kids and protein powder. Also, these Elk and Friends cups on my favorite toddler cup board are my favorite for smoothies!
If you need to do top-9 allergen free, there are some widely available brands with good product selections! Keep an eye out for brands like Partake, Made Good, and Enjoy life. All of their products are top-9 allergen-free.
Bookmark this website – snacksafely.com – it is an amazingly helpful resource for finding safe products to buy!
Many other brands are not entirely top-9 free but have many top-9 free products. I like to buy packaged snacks like these apple Crunchables and freeze-dried fruit variety packs,. There are also several Skout bar flavors (use my code MAMAKNOWS for 20% off) without the common allergens. Check out their website for more allergy information.
I’ve also tried to make it a little bit easier for those of you packing nut-free lunches with 40 nut-free lunch ideas.
If you’re working with an egg allergy, I got you! 33 easy, egg-free ideas for breakfast, lunch, and snacks here!
These zucchini chocolate chip banana bread muffins are actually surprisingly allergy-friendly as well since they’re made with oats! Just make sure you use certified gluten-free oats if you have a gluten allergy.
And finally, don’t forget that you can always just grab fresh fruits and veggies. They don’t have any of the top-9 allergen concerns and are easy. That doesn’t mean someone couldn’t still be allergic to them, but they’d be safe for school campuses and less likely to be a problem.
Allergies can be tricky to work around, but I fully believe you can still get your child a safe, nutritious diet with just a little extra strategizing!
If you’re struggling with your picky eater- allergies or not- I can help!
I’ve made a free Picky Eater Starter Guide that can help you nail your approach to introducing foods to your picky eater. You, of course, will have to make sure the foods you choose are safe for your child, but the principles in the guide can help inch you towards greater food acceptance no matter what restrictions you may be working with!
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