Raising Kids With IgE-Mediated Food Allergies: Starter Guide for Parents

Food allergies are common, but learning to live with the diagnosis is often a steep learning curve. This starter guide for parents summarizes 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!

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How common are food allergies in kids?

Around 1 in 13 children in the United States have a food allergy. This means 2 students might have a food allergy in a typical classroom. However, 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 children 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 eggs.

What are the most common food allergies?

The 9 most common food allergies in kids are peanuts, tree nuts, dairy, eggs, fish, shellfish, wheat, soy, and sesame.

Tree nuts (almonds, pecans, walnuts, cashews, pistachios, brazil nuts)
Dairy products (milk, cheese, yogurt, cream)
Eggs (hard-boiled, scrambled, sunny-side up, baked)
Wheat (bread, pasta, cereal, noodles)
Soy (milk, tofu, edamame)
Shellfish (crab, lobster, mussels, clams, oysters)
Fish (steamed, baked, fried, boiled, raw sashimi)
Sesame seeds and tahini are common food allergies

How is a food allergy different from an intolerance or sensitivity?

The definition of food allergies, intolerances, and sensitivities can be confusing for many people. One type of food can cause different 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 a child has a food allergy, their immune system overreacts to a protein. In most people with food allergies, the immune system’s IgE antibodies are too sensitive.

What Happens During An Allergic Reaction - Antibodies Mast Cell Degranulation

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 is supposed to fight off toxic parasites and prevent infection. 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 they need to attack.

If a kid eats an allergic food, the protein gets digested into little protein particles (antigens) floating 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, the tank starts firing. The mast cell breaks down and lets out different chemicals that cause inflammation. Those chemicals tend to irritate the skin and cause hives. Sometimes, they can affect other organs like the 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 kid has relatives with asthma, eczema, or environmental allergies.

Also, when babies explore 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.

Common signs and symptoms of a food allergy reaction

Food allergies are tricky because sometimes a kid might have only one symptom. But the next time the food is eaten, they could have more symptoms.

  • SKIN – Hives (itchy red bumps or wheals)
  • MOUTH – Itching, lip swelling, tongue swelling
  • NOSE – Congestion, runny nose
  • THROAT – Tightness, voice changes, trouble with swallowing
  • LUNGS – Coughing, wheezing, difficulty breathing
  • STOMACH – Cramping, nausea, vomiting, diarrhea (sometimes later)
  • HEART & CIRCULATION – Weak pulse, low blood pressure, pale skin
  • BRAIN – Dizziness, fainting, anxiety, agitation

Anaphylaxis is a potentially dangerous reaction that makes breathing very difficult and sends 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 who specializes in food allergies. Sometimes, a kid can have a “positive” allergy test to a specific food, even though they can eat it.

skin prick food allergy testing on a child's back

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 if a red, itchy wheal appears on the skin.

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?

Talk to your allergy doctor about the symptoms to look for. Create an Allergy Action Plan together.

The treatment depends on whether the reaction is mild or severe, and 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 has anaphylaxis, epinephrine helps open the airway, improves circulation, and calms inflammation.

Epinephrine works best 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.

epinephrine autoinjectors: Epi Pen Jr, Teva, Auvi-Q for Human Body Learning

Each epinephrine package should contain two devices when you get it from the pharmacy. Always keep both devices in a safe, easy-to-reach place.

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 vary from the video. Check your medication container for specific instructions.

What about antihistamines?

Remember those mast cells that let out chemicals? Histamine is one of those chemicals that can be blocked by antihistamine medication. The problem is that antihistamine medication can take an hour to have an effect, and there are a lot of other chemicals besides histamine that cause allergic symptoms.

That’s why epinephrine is the top priority when a person has a bad allergic reaction.

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.

Kids with food allergies always need at least two autoinjectors on hand. Keep the medication in an easy-to-access insulated medical case in your backpack, purse, or keychain.

Grocery shopping and cooking

  • Check nutrition facts and ingredients 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 dedicated to snacks free of the top 9 food allergens, such as Made Good, Enjoy Life, and Partake.

School planning

  • Meet with teachers, school nurses, and principals before a new school year.
  • Renew your epinephrine prescription and check the expiration date.
  • Allergy Action Plan:
    • Ask about first aid and epinephrine training, including substitute teachers. Confirm who has been trained, their understanding of treatment, and which epinephrine device they practiced with. Schedule an extra practice session using expired epinephrine autoinjectors or training devices.
    • Plan epinephrine pen storage location (unlocked and easily accessible).
Epi pen jr injectors and medical alert bracelet / Human Body Learning
  • 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 backup option.
  • Consider having your child wear a medical alert bracelet.
    • OpalStock offers adjustable bands with buckles for older kids and adults.
    • Road ID offers slide-on silicone bands in different sizes for toddlers and kids.
  • 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 ingredients. 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.
Equal Eats Food Allergy Alert Card

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 safe and special snacks is generally the safest option.

Preparing for travel

Kids with food allergies can have fun traveling! Extra time is needed for planning, though. Before road trips and air travel, keep these safety steps in mind.

Travel Checklist and Tips for Families with Food Allergies


  • 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.
  • Bring written prescriptions and permission forms to carry medication if needed. (E.g., Check current air travel requirements).


  • Pack extra snacks, meals, dishware, and silverware.
  • Hand washing with soap and water is ideal. Wipes can help clean food from hands, tables, and other surfaces if washing is impossible.
  • Research restaurants by reading reviews and 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 or kitchen.
  • Check for food crumbs and wrappers in the hotel room, parks, and other areas where your child plays.
  • 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

Best Food Allergy Books for Kids and Parents

Stories are a wonderful way for children to learn about people like them. They are also helpful for encouraging awareness and empathy in 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 dedicated to supporting kids with 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 for kids. This includes symptoms, skin and blood testing, oral food challenges, epinephrine treatment, prevention, and mental health support for families.

How can communities support children with food allergies?

  • Ask about food allergies before parties and other events
  • Brainstorm alternatives to food for school activities such as crafts, holidays, and birthdays
  • Train schools and restaurants on anaphylaxis prevention and treatment

Remember! Print these important allergy forms

More ways for kids to learn about eating

Human Body Learning has strict sourcing guidelines and relies on information from peer-reviewed research studies, academic institutions, and medical associations.

Published on March 1, 2022. Updated on January 23, 2024 by Betty Choi, MD

Published on March 1, 2022. Updated on January 23, 2024 by Betty Choi, MD

Dr. Betty Choi pediatrician

Betty Choi, MD

Dr. Betty Choi is a Harvard-trained pediatrician who makes learning fun and doable. She created the kids’ anatomy book Human Body Learning Lab, which Science Magazine recommended as a “notable standout in the genre.”