Living with Food Allergies

 

Living with food allergies isn’t easy, especially when you or your family member is newly diagnosed.
It’s important to learn how to live your best life with food allergies while staying safe. The two key issues are:

  • preventing allergic reactions by avoiding your food allergens;
  • being prepared to treat an allergic reaction, should one occur.

What follows are some important issues to learn and tips to make your life easier while you safely navigate life with food allergies.

Family sitting at their kitchen table having an allergen friendly dinner.

Managing food allergies in daily life at different ages

Parents take responsibility for their young child’s food allergy. When and how should children begin taking responsibility? Self-care begins from the moment of diagnosis and is learned in small steps throughout childhood.

  • Infancy/toddler (0-3 years): Parents/caregivers provide all care. This includes recognizing symptoms and giving medications. Self-care skill for children: learn to cooperate with parents/caregivers.
  • Preschool age (3-5 years): Parents continue to provide care. They help the child to learn about his or her body and daily routines (such as carrying medications). Self-care skill for children: tell parents or responsible adults when an allergic reaction occurs. Follow their instructions for treatment.
  • Early elementary school (6-7 years): Parents and adult caregivers (e.g., teachers) help the child navigate separation from parents. Self-care skill: learn to trust, communicate and cooperate with other caregivers.
  • Upper elementary school (8-11 years): As the child focuses on peers and establishing friendships, parents clarify responsibilities outside the home. This may include following safety rules and social etiquette. Self-care skill: recognize symptoms and independently request or use emergency medication.
  • Middle school (12-14 years): Parents provide framework for increased independence and learning life skills. They discuss strategies for more complex tasks. Self-care skill: develop medication routine with parent supervision.
  • Teens (15-17 years): Parents assist in making choices about how to avoid exposures and manage symptoms. Self-care skill: take responsibility for medications (overseen by parents). Take the lead in managing symptoms.
  • Older teens and young adults (18-21 years): Parents provide support as their teen or young adult takes on complete self-care. This can happen at college or in the workplace. Parents remain available for guidance or reinforcement. Self-care skill: demonstrate the ability to manage daily care, medication supply and doctor appointments.

 

Thumbnail icons of food allergy handouts by AAAAI

For more guidance, the Food Allergy Stages handouts from the American Academy of Allergy Asthma & Immunology (AAAAI) is a helpful resource. The handouts are designed to teach children about food allergies at different stages of growing up. Parents can use the Food Allergy Basics for All Ages handout as another resource for more information about food allergies.

If you have questions or want to make changes to your or your child’s food allergy plan, be sure to talk to your child’s health care provider.

Woman standing in the aisle of the supermarket, reading the food label on a pre-made sandwich. She's checking for food allergens.

How do I read food labels for food allergies?

Label reading can be tricky. Understanding the basics can help you identify foods that you can safely eat.

We do have laws on our side to assist us in the United States. The most important is the Food Allergen Labeling and Consumer Protection Act (FALCPA). This law is designed to make it easier for people with food allergies to identify allergens in packaged food products.

How does FALCPA help me read labels for food allergies?

FALCPA mandates that labels of food packages containing one of the “Top 9 food allergens” list the allergen in clear language. It should be listed either in the ingredients or in a “Contains” statement placed immediately after or next to the ingredients, or within the list of ingredients. Be sure to look in both places on the ingredient label.

The top 9 food allergens are:

  • cow’s milk
  • egg
  • peanut
  • tree nut
  • soy
  • wheat
  • fin fish
  • shellfish
  • sesame

 

    The law also applies to any food flavoring, spice, coloring or processing aid that contains these allergens.

    The law does not apply to meat or poultry, certain whole egg products governed by the U.S. Department of Agriculture, and gluten-containing grains other than wheat.

    Molluscan shellfish, such as clams, oysters, mussels and scallops, are not considered a major food allergen under the labeling laws.

    Food manufacturers are not required to list highly refined peanut, tree nut or soy oils. The processing separates the allergen protein from the oil. Highly refined oils are considered safe. Cold-pressed oils may contain the food allergen in them and need to be avoided to those allergic to those foods. If unsure if a product is highly refined or cold-pressed, it’s safer to avoid consuming the food.

    Hide & Seek Food Allergens

    Ingredients derived from common food allergens can be listed under many different names on the food label.

    Column 1Column 2Column 3Column 4Column 5Column 6Column 7Column 8

    DAIRY

    CaseinCurdsGheeLactalbuminSodium caseinateTagatoseWhey

    EGG

    AlbuminLysozymeMeringueOvalbuminSurimi

    PEANUT

    Cold-pressed peanut oilGoobersLegumesMarzipanNut meatNougat

    SESAME

    BenneGingillySesamolSim SimTahini

    SOY

    MisoNattoShoyuSoyaTamariTempehTextured vegetable protein

    WHEAT

    FarroFood starchesGraham flourMaltSemolinaSpelt

    What are some label reading tips for food allergies?

    Look for the “Contains” statement

    • Put the item back on the shelf if your allergen is listed in the “Contains” statement.
    • If there is no “Contains” statement, read the full ingredient list to check for your allergen.

    Talk with your allergist to find out if you need to avoid foods with advisory statements

    • Advisory statements can vary from product to product. Examples include: “May contain,” “Produced in a facility that,” or “Manufactured on shared equipment with.”
    • If a food allergen is listed in an advisory statement, this means there’s a chance the allergen is present in the product.
    • Avoid products that contain your allergen(s) in advisory statements

    Read Labels every time you shop

    • Food manufacturers can change ingredients often. Check ingredient lists each time you purchase a food. Ingredients can change based on the different size or packaging of the same product, or if the product is made in a different manufacturing facility.

    If in doubt, don’t eat a food

    • If you’re unsure if a food product contains your allergen, don’t buy it. Check with the manufacturer to find out for sure.

     

    Family preparing breakfast together with allergen friendly foods.

    What is cross-contact for food allergies?

    When an unsafe food allergen comes into contact with a food that’s safe for you, it’s called “cross-contact.”

    Cross contact can happen during food preparation, cooking or serving. Examples of cross contact can include when you:

    • dip a knife in the jelly jar after using it to spread peanut butter
    • use the same grill or pan to cook a hamburger after it was used to cook salmon
    • chop almonds on a cutting board and then slice a tomato without cleaning the board first
    • remove nuts from a salad. Traces of tree nut allergen will still be present in the salad.

    How do I avoid cross-contact?

    Wash hands
    Wash your hands in soap and water before preparing a meal. Commercial hand wipes will also help; hand sanitizers do not.

    Wash all surfaces, utensils and equipment
    Wash cutting boards, dishes, pots, pans and countertops thoroughly after preparing food. Use hot, soapy water after preparing food. Consider using dedicated dishes, pans and sponges that allergens don’t touch.

    Keep safe foods safe
    Store allergen-safe foods on a separate shelf in the refrigerator and cupboard. Use stickers to identify allergen-safe foods.

    Use the no sharing rule
    Never share food, utensils or drinks.

    Avoid buffets or cafeterias
    Buffets and cafeteria-style servings have a greater risk of cross-contact. This is due to shared utensils and spilled foods.

    Food allergy exposures can happen anytime, anywhere. Always carry epinephrine with you for emergency treatment.

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    Download Our Free “Understanding Anaphylaxis” Guide

    Woman at restaurant, with her friends, asking the waitress for allergen friendly foods from the menu.

    Can I dine out with food allergies?

    Eating out is an American pastime. But if you have a food allergy, it requires advance planning. It also requires special attention at the restaurant to make sure the food you order is safe.

    To plan for a safe meal at a restaurant:

    • Call the restaurant ahead of time or check menus online before eating out. Sometimes restaurants will offer an “allergy-friendly menu.”
    • Communicate with the restaurant staff about your food allergies. A chef card that lists your food allergies can be helpful. Ask that it be given to the chef or kitchen staff.
    • Read menus closely and don’t order foods likely to cause an allergic reaction. Ask about ingredients.
    • Carry epinephrine with you to treat anaphylaxis if it should occur.

    Establish an open dialogue with everyone – the manager, host, servers and even the chef. Work with them to ensure you receive a safe meal.

    The more you talk with the restaurant staff, the more you develop an intuition whether the restaurant is a safe place to dine. For example, if the restaurant staff is confusing food allergies with gluten-free foods, that’s a red flag. You may not want to eat there.

    Graphic of a food allergy chef card
    Make safe choices when dining out. Choose meals with simple ingredients that are familiar to you. You can also consider some of the safe suggestions the host, server or chef recommends.

    Many restaurants and quick-service eateries now list allergens on their menus. They post food allergy awareness information in the kitchen area. Some states like Massachusetts have laws that require these protocols. Cruise ships will cater to food allergies if you notify the cruise line when you book the trip.

    The bottom line is this: if you don’t feel comfortable, or you don’t feel the restaurant staff fully understands your food allergy could be life-threatening, then the best choice is not to eat there.

    Is it safe to kiss with food allergies? 

    An allergic reaction can occur from a kiss due to a food allergen in your partner’s saliva. Studies show saliva can hold an allergen for four hours, even after the food has been absorbed by the body. The risk of a severe reaction is very small, however.

    If your partner has eaten one of your food allergens, it’s best to hold off on that smooch. While it may not be romantic, ask your partner to brush his or her teeth and tongue, and rinse out the mouth, before kissing. Allergens can remain in the mouth for hours after the food is eaten.

    Can I trust a babysitter if my child has food allergies?

    Trusting a babysitter, family member or even other parents to safely care for your food-allergic child can be nerve-racking. But you can’t stay home with your child 24/7. So you have to find people you can trust who will be willing to learn how to manage your child’s food allergy and know what to do in an emergency.

    If you have extended family, they are a comfortable starting place for trusting others to care for your child. If family is not close by, choose a close friend or someone you really trust.

    Anyone that you entrust should understand your child’s Allergy & Anaphylaxis Emergency Plan. They should know what symptoms to look for in a severe allergic reaction. Leave specific instructions and go over them with your sitter before leaving your child in their care. Show them how to administer epinephrine if there’s an accidental exposure.

    Set clear expectations for food and planning around mealtimes. Decide ahead of time if your child is allowed to eat while you are gone. Pick out certain safe snacks they can have while you are out. Be clear with the babysitter that no food that hasn’t been pre-approved by you is allowed to be consumed. Also make it clear that the babysitter shouldn’t handle or consume food that contain the child’s allergens while babysitting due to the cross contact risk.

    Is it safe to have playdates if my child has food allergies?

    Is your child old enough to start having playdates with friends at other homes? There are a few steps to take in order to ensure a fun and safe afternoon.

    First, talk with the friend’s parents about your child’s food allergy. Show them your child’s emergency plan. Explain the signs and symptoms of a severe allergic reaction and how to administer epinephrine if needed.

    Sometimes other parents do not take food allergies seriously. If that’s the case, consider hosting the playdate at your home or at the park.

    Pack a safe snack for your child and the same snack for the friend to eat together during their playdate. Make it clear that no other snacks are allowed and that any other food must be pre-approved by you. Also review cross contact risks so your child is not inadvertently exposed to an allergen while at someone else’s home.

    Can I drink coffee if I have food allergies?

    If you are a coffee drinker and you have food allergies, that simple cup of joe can be complicated to navigate, whether you’re at home or your local café.

    When at home, make coffee that is 100% Arabica beans. Check the package to make sure there are no added ingredients or flavors.

    Do you have a coffee machine (such as a Keurig) that uses pre-made pods? There is a risk of cross-contact from other pods previously used on the machine. For example, a hazelnut coffee pod may leave residue in the filter. Clean out the coffee machine prior to use. Check to make sure no one else is using coffee pods that have your allergen.

    Most cafés now use multiple milk options along with flavors and syrups. As cafes use more milk alternatives, there is a cross contact risk for those with almond (nut), soy, rice, wheat and coconut allergies. There is also a risk of cross contact from surfaces, spoons, heating wands, pitchers and stirrers.

    When ordering coffee, first look at the menu. Check to see what milks are listed and if you see one that has your allergen. Then tell the barista about your food allergy as you make your order. Be specific – tell them you cannot consume your allergen. If possible, observe how your coffee is made so that you feel comfortable drinking it.

    Photo of man dragging luggage through an airport terminal

    Traveling with food allergies

    Food allergies do not have to keep you and your family from enjoying a trip. Safe travel starts with sound planning.

    Schedule a checkup with your primary care physician or allergist prior to a trip. Ask about steps you can take to avoid food allergy symptoms while traveling. Check to see if your epinephrine device is expired or needs to be refilled. Pack important healthcare documents, including:

    • Allergy and Anaphylaxis Emergency Plan
    • health insurance information
    • your doctor’s telephone number

    Plan your travel meals and snacks ahead of time, and pack extra food in case of delays. Try to stay at hotels with a kitchen and a refrigerator to store safe snacks and meals.

    Find out where hospitals and pharmacies are located at your travel destination. This way you are prepared if there’s an allergy emergency.

    Airline travel with food allergies

    Dreaming of a vacation in a faraway land? Airplane travel is likely your best mode of transportation to get there. But traveling by air can present challenges for people with severe food allergies. The prospect of an in-flight emergency can be a serious concern. Nearly 2 percent of in-flight medical emergencies are allergy-related.

    Call the airline ahead of time or visit its website to find out policies for in-flight meals and snacks. Information on airline websites can usually be found under “Special Travel Needs.”

    Many airlines no longer serve in-flight free bags of peanuts or tree nuts during flights. However, some snacks and meals may contain traces of nuts. And other passengers can bring them on board.

    People with peanut or tree nut allergies should take the following steps before a flight:

    • Inform the flight crew of your allergy. If you plan to buy an in-flight meal, request an allergen-free meal. However, avoiding airline food may be the safest option.
    • Wipe down seats and tray tables when arriving at your seat. This can help remove any nut residue.
    • Avoid using airline pillows or blankets. Consider bringing something to cover your seat, since debris can sometimes be left behind from previous passengers.
    • Request a buffer zone in which no peanut or tree nut product is sold or served.
    • Bring your own allergy-safe meal and avoid eating the airline food.
    • Carry your prescribed epinephrine with you onboard. Make sure it is easily accessible during the flight.

    Some airlines will allow travelers to pre-board to clean seating areas. When requesting this, print out the airline’s food allergy policy or the information you receive from customer service. Then present it at the gate and to the flight crew.

    Food allergies at amusement parks and theme parks

    Many amusement parks and theme parks have guidelines regarding bringing in outside food and dining options. So plan ahead for your meals when at the park.

    Look online for the food allergy policies of the amusement park or theme park you want to visit. If you’re allowed to bring an outside snack or meal inside the park, check to see if you need clearance or documentation.

    Most restaurants and quick-service eateries at amusement or theme parks will accommodate people with food allergies.

    Check to see if First Aid stations inside the parks have epinephrine on hand. Ask if paramedics or nurses are trained in administering them.

    Tips for going on a cruise

    Buffets are common on cruises. Cross-contact with your allergens can cause an allergic reaction. Allergens can also accidentally get into your food via shared pots and pans, cooking oil and utensils.

    Eat in ship restaurants that will cook and serve individual meals instead of buffets. Before you order, talk with the server and ask to speak with the chef. Inform them of your food allergies and cross-contact concerns.

    Check out restaurant menus for the next day and alert the staff of any concerns. Land excursions require your full attention. If you’re uncertain about eating at a restaurant on shore, pack your own snacks or meal. And don’t forget your epinephrine.

    Peanut allergy in public settings

    How prevalent is peanut residue in public places? In a recent study, researchers tested levels of peanut protein on table surfaces in the following places:

    • restaurants, both those that offered unshelled peanuts and those that did not;
    • airline tray tables during flights that served peanuts and those that did not;
    • library tables;
    • topping counters at frozen yogurt shops.

    Frozen yogurt shops had by far the most peanut protein on their counters. However, none of the surfaces were completely free of peanut. Here is the amount of peanut protein found in each setting:

    • Frozen yogurt shop counter: 11,126.7 ng/mL
    • Airplane tray tables after mid-flight service with peanuts: 175.3 ng/mL
    • Tables in restaurants that serve unshelled peanuts: 41.1 ng/mL
    • Airplane tray tables on flights that do not serve peanuts: 13.5 ng/mL
    • Tables in restaurants that do not serve peanuts: .77 ng/mL
    • Library tables: .75 ng/mL

    Other travel tips to reduce chances of a food allergy reaction

    • Similar to airlines, request special accommodations for food allergies when making a bus or train reservation. Ask for these accommodations again when your board. If there’s food service, request an allergen-free meal or bring one with you.
    • When you arrive at your bus or train seat, clean the tray table and arm rests with a sanitary wipe.
    • Pack epinephrine in carry-on luggage. Keep it with you instead of storing it in overhead bins.
    • Make sure your emergency epinephrine is in an easy-to-reach bag on trips.
    • Communicate with hosts if you’re doing a home-stay (such as an AirBnB or VRBO). Ask that the house is cleaned of all food residue in the kitchen area, including the refrigerator.
    • If you have severe food allergies, it may be best to not rent a home-stay with shared space. The risk of food allergen exposure may be too high.

     

    Happy Muslim man around table with his family, enjoying an ethnic meal cooked without food allergens.

    How can I safely attend gatherings and celebrate holidays with food allergies?

    Whether it’s Easter, Passover, Halloween, Thanksgiving, Hannukah or Christmas, you can make holiday celebrations and social gatherings safe for people with food allergies.

    Bring up food allergies when the invitation to the get-together is offered. Ask about the menu, including ingredients. If there’s no acceptable food for you or your child to eat, it may be best to bring your own meal or snacks.

    Keep dishes that may contain allergens separate from allergen-free dishes. Label each dish to clearly identify it. If serving a buffet, encourage those with food allergies to serve themselves first. Have a separate serving spoon for each dish.

    Consider asking everyone at the get-together to bring an allergen-safe food item. When the whole menu is allergen-safe for everyone at the table, then everyone feels included.

    Since many holidays are often centered around food, make sure there are non-food traditions that you and your child can look forward to as part of the celebration.

    Tips about the most common food allergens at various holidays

    • Parents should inspect their children’s Halloween candy. Check each label carefully. Federal law requires food labels – even mini-size candy bars – to list common allergens. If you cannot read the ingredient label, it is safest to avoid eating the candy. Remember also that snack size candies may have different ingredients than their full size counterparts.
    • If one child in a family has food allergies and another does not, then separate out the holiday candy with allergens so there’s no chance of an accidental exposure.
    • Coloring eggs is a safe activity during Easter – as long as the person with egg allergy does not eat the eggs. Touching the hard shell poses no threat.
    • During Passover, instead of placing a hard-boiled egg on a Seder plate, consider using a flower or a plastic egg.
    • Use plastic eggs for your Easter egg hunt and fill them with toys, money or stickers instead of candy. You can also use plastic eggs instead of real ones when playing the “egg in a spoon” race.
    • Making foods that contain egg? Try these substitutes: unsweetened applesauce, apricot puree, banana or plain gelatin.
    • People with latex allergies may also develop allergic reactions to some fruits and vegetables. About half of people with a latex allergy may develop allergy symptoms from avocado, banana or kiwi.

     

    A line of children with backpacks excitedly running towards their school

    Managing Food Allergies at School

    Managing food allergies at school can be scary for both parents and children. Fear of an accidental exposure can cause a lot of anxiety. It is important that school nurses, teachers, coaches and other staff are prepared to help children stay safe at school. It’s also important that children with food allergies are not excluded from activities.

    • Make arrangements to see your doctor or allergist during the summer before school starts. Update their medication forms. Be sure to fill out a Allergy & Anaphylaxis Emergency Plan.
    • Check the expiration date on epinephrine that your child takes to school. Mark down the date on your calendar. Be ready to provide updated medication when needed.
    • Ask the doctor for a note for the food service department identifying your child’s allergy. Also identify any needed food substitutions. For example, if your child has a milk allergy, you may want them to substitute juice or water.
    • Make an appointment, preferably before the beginning of the school year, to visit the school. Discuss your child’s food allergy with your child’s teacher and school nurse, if available.
    • Talk about any accommodations that your child may need in the cafeteria or classroom. Drop off forms, medication and your child’s Allergy & Anaphylaxis Emergency Plan with the school nurse. Provide the school with written permission to call your child’s pediatrician with any questions.
    • Make a plan to update the school if your child has a severe allergic reaction outside of school.

    Children with food allergies are vulnerable to bullying at school and online. It could come from classmates who tease or harass them because they’re “different.” Bullying can even involve the deliberate exposure to a food allergen. It can negatively impact a child’s social development and self-esteem – just as they are learning how to self-manage their food allergy.

    Bullying may be an age-old problem, but it must be addressed if we expect children to thrive. Stopping confrontations before they start creates an environment where all children feel protected.

    Parents: get involved with children and help them talk about their feelings about school. Build their self-confidence. Role-play situations and practice assertive language that children can use to stand up for themselves. When parents are aware of bullying, the chances of a positive outcome are more likely.

    Schools: Build a healthy environment. Establish a zero tolerance policy for bullying – and enforce it. Educate all students about food allergies. When children understand why there are certain accommodations, they become more accepting and supportive.

    Resources for Managing Allergies in School

    Mother at the kitchen stove cooking, while two tween girls sit at the table looking in her direction.

    Food allergy management support for families

    For many families, food allergy and food insecurity are of special concern. Support is necessary for good nutrition, health and safety.

    Food insecurity is when you don’t have enough food or the right kinds of food to eat. It may occur due to not having enough money. Or you may not have access to a grocery store with fresh foods.

    People with food allergies, Celiac disease and other chronic diseases are at risk for food insecurity. This is because they may need special foods (dairy-free, gluten-free, etc.) for their diet. Sometimes it can be a challenge to find these special foods.

    Many people with food allergies tend to spend more for groceries than those without food allergies. Allergy-friendly foods are often classified as specialty items and may cost more than similar foods. They may be too costly for many households already struggling to afford the cost of groceries. Read about ways to afford allergen free foods.

    What to do if you cannot afford epinephrine? These resources can help!

    Woman's hands holding an empty bowl with a spoon in it.

    Stress, mental health impact, and managing a food allergy diagnosis

    Managing food allergies is a daily challenge. It involves uncertainty and unpredictability. It requires finding a balance between vigilance and preparedness. So, it’s not a surprise that people with food allergies may feel overwhelmed. Anxiety and stress are common.

    Anxiety from a food allergy diagnosis is different among age groups:

    • Young children may feel distress about safe foods to eat, especially when not around their parents.
    • Adolescents and teens are more likely to feel general anxiety, low self-esteem and depression. They may even avoid eating.
    • Adults may worry about eating out at restaurants. They may worry about affording epinephrine for severe food allergies.
    • Parents and caregivers say they are often fearful for their child’s safety around food.
    • All age groups may experience post-traumatic stress following an anaphylaxis episode.

    Anxiety is a normal human emotion. Most people consider anxiety to be a negative emotion to be avoided. But even though anxiety feels uncomfortable, it can be useful. It encourages people to plan and prepare. These are key aspects of staying safe.

    Managing a food allergy successfully is a life skill. When we are developing a new skill, there’s usually discomfort. Allergic conditions can be demanding because of their life-impacting and life-threatening nature. But at the core, we’re still just building life skills like we do in other areas of our lives. You don’t need to take a major leap outside of your comfort zone (unless you feel ready to). Start small and build over time.

    When stress and anxiety start impacting day-to-day life, that’s when you may need help. Talk with a board-certified allergist or your healthcare team about:

    • managing food allergy on a day-to-day basis;
    • understanding and learning how to evaluate risks;
    • navigating food allergy anxiety;
    • identifying knowledge you need but don’t have;
    • identifying reliable sources of food allergy information online.

    Your allergist may recommend a mental health professional who can also help with:

    • learning how to manage food allergy anxiety;
    • living with or adjusting to food allergies;
    • what to do if food allergy anxiety won’t go away;
    • engaging in avoidance to calm anxiety and fear.

     

    Other resources for living with food allergies

    Below is a resource list for living or working with food allergies.

    Downloadable Resources for the Food Allergy Community: A rich source of resources in both English and Spanish, including:

    • FAQs on food allergies
    • Prepping for others to care for children with food allergies
    • Cleaning methods
    • Dining out
    • Avoiding cross contact
    • Understanding food labels
    • and much more!

    Resources for consumers and staff of food assistance programs: Resources to help families navigate some of the challenges of using food assistance programs, and teach staff to prevent cross contact and respond to anaphylaxis.

    School Tools – Anaphylaxis & Food Allergy Resources for Professionals: A website of resources for children with asthma and food allergies or anaphylaxis.

    Safe Food Substitutions

    If you have food allergies, it can be hard to prepare some of your favorite foods. Food allergy columnist Erin Malawer offers a list of safe food substitutions for some of the most common allergens.

    AllergySubstitution

    Icon of milk cartonDairy

    Rice milk; soy milk; almond milk; coconut milk

    Notes: Dairy refers to milk, cream, butter, cheese, ice cream, sherbet, yogurt and other milk- based derivatives. Before substituting soy, coconut or almond milk, make sure there’s no allergy to soy, coconut or tree nuts.

    Icon of eggEggs

    Unsweetened applesauce (plus 1⁄2 teaspoon of baking soda for baking)


    Notes:
    Eggs are often used as binders (they’re in meatballs and meatloaf) as well as for glazes on breads. Most of time you can just omit egg from a recipe, but to make baked dishes and desserts rise, you’ll need an egg substitute.

    Icon of a peanutPeanut

    Sunflower-based butter (if used for flavor)


    Notes:
    Sunflower butters behave just like peanut butter. You can also offer to use a tree nut as a substitute for whole peanut; cashews have a similar texture and flavor. But keep in mind many people allergic to peanut may also have an allergy to tree nuts..

    Icon of a tree nutTree Nuts

    Sunflower or pumpkin seeds; roasted chickpeas for salads


    Notes:
    When substituting for tree nuts, you’ll need to consider replacing both for taste as well as texture.

    Icon of soySoy

    Canola or olive oil


    Notes:
    Soy is in many processed foods, including margarine and vegetable oil. Read labels care- fully for those with an allergy to soybeans.

    Icon of wheatWheat

    Gluten-free flour blends; corn flakes for breading


    Notes:
    Avoid barley, rye and sometimes oats. Keep gluten-free pasta, bread and a supply of rice.

    Icon of sesameSesame

    Sunflower butter; safflower oil


    Notes:
    Sesame seed allergies are on the rise and can cause severe reactions similar to nut aller- gies. In addition, those who are allergic can react to sesame oil. There isn’t an easy substitute for the whole seed, but safflower oil offers a very similar flavor to sesame oil and can be cooked at high heat..

    Icon of cornCorn

    Canola; olive oils; honey; agave nectar


    Notes:
    Most commercial baking powder contains cornstarch. Make a safe version by combining 1 teaspoon of baking soda with 1⁄2 teaspoon of cream of tartar (a dairy-free product). And, watch for processed food with vanilla extract and corn syrup – both could cause a reaction.

    Other conditions that may look like food allergies or co-exist with food allergies?

    There are other conditions that are different than food allergies but the symptoms, diagnosis and treatment vary depending upon the condition. Here are some of them.

    Food Intolerance

    Oral Allergy
    Syndrome (OAS)

    Celiac Disease

    Eosinophilic
    Esophagitis (EOE)

    FPIES

    GERD

    Reviewed by:

    Purvi Parikh, MD, FACAAI, is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill in New York City. She is on faculty as Clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.

    Stanley Fineman, MD, FACAAI, is a board-certified allergist and immunologist with Atlanta Allergy and Asthma. He earned his medical degree from Emory University School of Medicine. He is Past President of the American College of Allergy, Asthma and Immunology (ACAAI).

    Michael Pistiner, MD, MMSc, FACAAI, is a board-certified pediatric allergist and immunologist. He serves as the Director of Food Allergy Advocacy, Education and Prevention of the Food Allergy Center at MassGeneral Hospital for Children in Boston. He is the co-creator of the allergy educational website AllergyHome.org.