Food allergies are very common, but learning to live with the diagnosis is often a steep learning curve. This starter guide for parents gives a summary of the science behind allergic reactions plus tips for raising kids with food allergies. With knowledge, support, and an Allergy Action Plan, children and families can stay safe, healthy, and happy! Find the section that’s most relevant for now, and come back to other sections as needed.
How common are food allergies?
In the United States, around 1 in 13 children have a food allergy. This means that in a typical classroom, 2 students might have a food allergy. But a child’s individual experience with food allergies can be very different from each other.
Some children are allergic to one food, and others are allergic to several.
Most people have their first allergic reaction during the baby years when they first start to eat. Some develop food allergies when they’re older, and others outgrow them. Compared to peanuts and tree nuts, kids are more likely to outgrow allergies to dairy and egg.
What are the most common food allergies?
The 9 most common food allergies are peanuts, tree nuts, dairy, eggs, fish, shellfish, wheat, soy, and sesame.
How is a food allergy different from an intolerance or sensitivity?
Food allergies can be confusing, because even the same food can cause different types of reactions in other people. For example, lactose intolerance is different from a milk allergy, and gluten sensitivity is different from a wheat allergy. The differences are important, because the treatment depends on what’s happening inside the body.
When someone has a food allergy, their immune system is over-reacting to a food protein. In most people with food allergies, the immune system’s IgE antibodies are too sensitive.
Confused IgE antibodies can cause food allergies
In the immune system, antibodies are like soldiers who watch out for threats. Different antibodies have different jobs, and the army of IgE antibodies are supposed to fight off toxic parasites and prevent infection. Normally, since the body doesn’t have parasites, it should not make many IgE antibodies.
However, when someone has a food allergy, their immune system is confused. They make extra IgE antibodies to a certain food, because they think the food proteins are toxic. So they remember the food protein as an antigen that they need to attack.
If an allergic food is eaten, the food protein gets digested into little protein particles (antigens) that float around the blood. When the IgE antibodies see those food antigens, they might latch onto them.
Activated mast Cells cause allergy symptoms
IgE antibodies often sit on mast cells, similar to how soldiers may sit on a tank. After IgE binds to the food protein, it triggers the tank to start firing. The mast cell breaks down and lets out different types of chemicals that cause inflammation. Those chemicals tend to irritate the skin and cause hives. Sometimes, they can affect other organs like airway, heart, and digestive tract.
Scientists are constantly studying what causes food allergies. So far, research shows that food allergies tend to happen when a person has relatives with asthma, eczema, or environmental allergies. Also, when a baby explores different foods at a young age (around 4 to 6 months), they might be able to train their immune system to get used to those proteins. If they wait and put off trying a peanut until they are much older, they might develop an allergy to it.
Anaphylaxis is a potentially dangerous reaction that make breathing very difficult and send the body into shock. Anaphylaxis can also be a combination of symptoms in different organ systems, for example, vomiting plus hives.
How do doctors diagnose food allergies?
The only way to know if someone has a real food allergy is if a reaction happens from eating a certain food. If the cause of an allergic reaction is a mystery, skin and blood tests might be able to narrow down the cause.
The downside is that the tests are not perfect, so it’s best to do testing only with a doctor that specializes in food allergies. Sometimes, a person can have a “positive” allergy test, even though they can actually eat the food.
Skin prick testing
For this test, a tiny amount of the food is put on the skin of the arm or back. Then, the allergy doctor will check to see if a red itchy wheal shows up on the skin and measure the size.
Blood IgE antibody testing
Doctors can also see how many IgE antibodies are in the blood. For example, they can measure peanut IgE antibody levels and see if that number goes up or down as a child grows.
What’s the best way to treat allergic reactions?
Together with your allergy doctor, talk about what symptoms to look out for and fill out an Allergy Action Plan. The treatment depends on whether the reaction is mild or severe, and all of the common symptoms should be listed on the Allergy Action Plan. This plan can remind you to call 911 for emergencies and what medication to give, such as epinephrine for anaphylaxis.
Severe allergic reactions (anaphylaxis)
Epinephrine is a shot that should be given right away in the outer thigh when a severe allergic reaction is happening. When someone is having anaphylaxis, epinephrine helps opening up the airway, improve circulation, and calms the inflammation.
Epinephrine works best if it’s given within 15 minutes of the reaction, so don’t wait! Sometimes, the first shot isn’t enough, and a second shot is needed.
Epi-Pen and Avi-Q are popular brand-name versions of the epinephrine medication, and pharmacies also have generic versions.
When you get epinephrine from the pharmacy, each package of epinephrine should contain two devices. Be sure to keep both devices in a safe, easy-to-reach place at all times.
Also, the package should have a training device with no medication so that parents, teachers, children, and caregivers can practice.
Watch this informative video of a 5-year-old child getting an epinephrine shot for anaphylaxis. Note that specific instructions, such as how long to count, could be different from the video. Check your medication for specific instructions.
What about antihistamines?
Remember those mast cells that let out chemicals? Histamine was one of those chemicals, and it can be blocked by antihistamine medication. The problem is that antihistamine medication can take an hour to have effect, and there are a lot of other chemicals besides histamine that cause allergic symptoms. If someone is having a severe allergic reaction, that’s why epinephrine is top priority.
Social challenges: What’s it like to live with food allergies?
With a new food allergy diagnosis, there will be an adjustment period while figuring out new recipes, meal planning, social events, and holidays. Here’s a checklist of helpful habits and routines to incorporate over time.
Bring epinephrine medication everywhere
At least 2 autoinjectors should always be with the child. Keep the medication in an easy-to-access insulated medical case in your backpack, purse, and/or keychain.
Grocery shopping and cooking
- Check nutrition facts and ingredient list for food allergies and possible cross-contamination.
- Call or email companies to clarify ingredients, where the food was processed, and what other foods are processed in the factory.
- Explore brands that are dedicated to snacks free of the top 9 food allergens, such as Made Good, Enjoy Life, and Partake.
- Meet with teachers, school nurse, principal before a new school year.
- Renew epinephrine prescription and check expiration date
- Allergy Action Plan:
- Ask about first aid and epinephrine training, including substitute teachers. Confirm who has been trained, what their understanding is about treatment, and which epinephrine device they have practice with. Schedule an extra practice session with the school staff using expired epinephrine autoinjectors or training devices.
- Plan epinephrine pen storage location (unlocked and easily accessible).
- Meal Plan:
- Discuss where your child will sit at snack-time and lunch. Questions to consider:
- Where can the child safely sit with supervision?
- Does the child have friends who can pack snacks and lunch without certain allergens?
- Are other children discouraged from feeding, trading, or sharing food?
- Review policies for hand-washing before and after snacks and meals.
- Explain that hand-sanitizer does not wash off food protein, but wipes could be a back-up option.
- Discuss where your child will sit at snack-time and lunch. Questions to consider:
- Consider having your child wear a medical alert bracelet.
- Document everything in a written School Emergency Plan or a 504 Plan.
- Research restaurant reviews and menus for meals that do not contain your child’s food allergy.
- Call or email the restaurant’s chef to discuss allergy policies and confirm recipe ingredients.
- Write down or print out a list of food allergies and common dishes that contain the ingredient. Equal Eats offers wallet-sized allergy alert cards in 50 languages. (Use code DRBETTY for 10% off.)
- Before sitting, check the table and chairs for overlooked crumbs and food scraps.
- Bring wipes to clean the child’s eating area.
Playdates and parties
- Let the host know about food allergies. If you are hosting, tell your guests about any food restrictions in your home.
- Because non-allergic families may not know how to prepare food and prevent cross-contamination, packing your own special snacks is generally the safest option.
Preparing for travel
With food allergies, traveling can still be fun! Extra time is needed for planning though. Before road trips and air travel, keep these safety steps in mind.
- Check the expiration date of your epinephrine medication, and ask your doctor for refills if needed.
- As an extra precaution, bring two sets of two epinephrine devices (e.g., two packs of two EpiPen Jr. = four injectors)
Forms and paperwork
- Print and pack the Anaphylaxis Action Plan.
- Bring allergy alert cards. Equal Eats offers cards in 50 languages.
- Bring medical alert bracelets.
- If needed, bring written prescriptions and/or permission forms to carry medication. (E.g., Check current air travel requirements).
- Pack extra snacks, meals, dishware, and silverware.
- Hand-washing with soap and water is ideal, but if that’s not possible, wipes can be helpful for cleaning food off of hands, tables, and other surfaces.
- Research restaurants by reading reviews as well as emailing or calling chefs to discuss allergy policies and menu options.
- In case of emergencies, find out where the nearest hospital is located. Check if the hospital is familiar with pediatric care.
- Consider staying at a place with a refrigerator, microwave, and/or kitchen.
- Check for food crumbs and wrappers in the hotel room, parks, and other areas where your child is playing.
- If you’re staying with relatives or friends, talk to them about your family’s food allergies and safety precautions.
Print-friendly allergy travel checklist
Resources for children and families with food allergies
Books about kids with food allergies
Stories are a wonderful way for children to learn about people like them. They are also helpful for encouraging awareness and empathy to people who do not have food allergies. As with any book, the conversations between story characters are great opportunities for deeper family discussions and learning.
Food Allergy Counselor website and podcast
Tamara Hubbard, LCPC is a family therapy-trained counselor with special expertise in food allergies. On the Food Allergy Counselor website, you can find a directory of therapists who are knowledgeable about food allergies. She also shares advice on her podcast and printable therapeutic worksheets.
Food Allergy and Your Kiddo podcast
Dr. Alice Hoyt is board-certified in allergy and immunology, pediatrics, and internal medicine. The Food Allergy and Your Kiddo podcast is dedicated to giving clear, evidence-based information about food allergies. This includes symptoms, skin and blood testing, oral food challenges, epinephrine treatment, prevention, and mental health support for families.
Remember! Print these important allergy forms
- FARE Food Allergy Action Plan (available in English and Spanish)
- Equal Eats Food Allergy Alert Cards (available in 50 languages; use code DRBETTY for 10% off)
- Print-Friendly Allergy Travel Checklist