Food allergies are a very serious issue. Thirty-two million Americans have food allergies (I’m one of them). That equates to 1 in 10 adults and 1 in 13 children -- and the numbers of people appear to be increasing. That's why people with food allergies should read labels to avoid food allergens. 

Food Allergy & Food Intolerance

Food intolerances are often confused with food allergies. These intolerances, or sensitivities, don't involve the immune system are not typically life-threatening.

On the other hand, true food allergies are caused by your immune system wrongly recognizing some of the proteins in food as harmful. These allergies can be significant, possibly requiring hospitalization, and sometimes can be fatal. Unfortunately, there is no cure for this. 

The only way to avoid an allergic reaction is to avoid the item. This can be difficult to do with some food allergens as they are used as ingredients in other foods, beverages, or supplements.

That’s why food allergen labeling is so important when purchasing prepared items. For those with a food allergy it’s critical to tell people what your allergies are so they can let you know if they make something with one of those ingredients.

Latest News on Food Allergen Labeling

On April 24, 2021, the president signed legislation making sesame the 9th identified food allergen. Because of lead times required to change packaging and labeling, companies are being given until January 1, 2023, to comply with mandatory labeling for sesame. 

Even after sesame appears on the label as an identified allergen, those 1.5 million Americans who struggle with the allergy need to be aware of foods that may contain sesame or sesame-derived products.

Sesame derived products include:

• Sesame oil
• Tahini - sesame seed paste
• Falafel - may contain sesame seeds and tahini
• Hummus - may contain tahini
• Sushi - the oil and seeds may be used in this
• Halva - sesame based Middle Eastern/Mediterranean sweet
• Chikki - an Indian sweet
• Sesame seeds also feature in several dry condiments such as furikake or gomashio
• Cosmetics (found in many lip balms, ointments, eye products, soaps, oils, creams)
• Pharmaceutical products (check the package insert)

Top Eight Food Allergens

While over 160 foods can cause allergic reactions in people with food allergies, the law identifies the eight most common allergenic foods. 

Milk/Dairy

Allergy to cow’s milk affects 2.5% of toddlers under the age of 3. Most of these children develop allergies when exposed to cow’s milk protein in their first year of life.

However, about 90% of them can outgrow this allergy when they turn three, making it less common in adults. 

Lactose intolerance is commonly confused with milk allergy, but this condition is not an allergy. 

Dairy products can be a source of protein, calcium, vitamin D, and vitamin B12. Here are some safe food sources to replace these dietary needs: 

• Protein - meat
• Calcium - leafy green vegetables, broccoli, collards, kale
• Vitamin D - fatty fish or supplements (It is recommended to speak with a board-certified allergist before adding this to your diet)
• Vitamin B12 - Organ meat, poultry, meat, fortified foods (Read the label)

Cow’s milk in unexpected places: 

• Chewing gum
• Cold cuts
• Cereal
• Non-dairy products
• Processed and canned meats
• Frozen and refrigerated soy products
• Sheep & goat’s milk
• Deli meats (due to cross-contact from slicing cheese)
• Cosmetics
• Supplements & medicines

Eggs

Egg allergy is among the most common causes of food allergies in children. About 68% of them can outgrow this allergy when they turn 16. 

Most allergenic proteins are found in egg whites, but it is recommended to avoid egg whites and egg yolks.  

An egg is an excellent source of dietary fat and protein. Here are some alternatives: 

• Protein: meat
• Fat - avocado, meat, vegetable oils

Eggs in unexpected places: 

• Shiny coats/glazes on pastries/candies. These may be egg washes. 
• Many egg substitutes may contain eggs.
• Pasta sold in stores may contain eggs.
• Marshmallows, marzipan, and nougat may contain eggs.
• Foams on coffee drinks may also contain eggs.

Peanuts 

Allergy to peanuts is one of the leading causes of fatal food allergies in the United States. Peanut allergies affect around 4–8% of children and 1–2% of adults. However, only about 20% of children with this allergy may outgrow it. Therefore, the treatment is lifelong and requires complete avoidance of peanuts and peanut-containing products. 

Here are some foods that may contain peanut as an unexpected ingredient:

• Egg roll (used binding agent)
• Pet food
• Bird Seed
• Crepe filling
• Mole Sauce
• Glazes and marinades
• Graham cracker crusts
• Chili & hot sauces
• Pesto
• Gravy

Tree Nuts

This is one of the most common food allergies in adults and children. Around 1% of the US population is affected by tree nuts allergy. Approximately 9% of patients outgrow this allergy.

As you know, tree nuts are not the same as peanuts. Tree nuts grow on trees, while peanuts grow underground and are part of the legume family. 

Tree nuts in unexpected places: 

• Cereals
• Crackers & cookies
• Trail mixes
• Candy
• Flavored coffee
• Frozen desserts
• Marinades
• Nutritional supplements
• Medications
• Cold cuts like Mortadella

Shellfish 

About 60% of people with this allergy experience their first allergic reaction as adults. 

Allergy to crustacean-type shellfish (shrimp, crab, and lobster) is more common than allergy to mollusks (clams, mussels, oysters, scallops, and octopuses). 

Shellfish in unexpected places: 

• Asian dishes and in stuffing (i.e., oyster stuffing)
• Pet food (for those that may have problems even touching it)
• Nutritional supplements
• Fertilizers
• Imitation shellfish (surimi) may contain shellfish or used shellfish as a flavoring. 

Wheat 

Two-thirds of children with this allergy outgrow the wheat allergy by age 12. Unfortunately, some individuals remain allergic to wheat throughout their lives.

Wheat allergy is often confused with Celiac disease since both involve a reaction to gluten. However, a wheat allergy causes an immune response to one of the hundreds of proteins found in wheat. In contrast, Celiac disease is caused by an abnormal immune reaction to gluten and is not life-threatening.

Wheat in unexpected places:

• Ale & Beer
• Candies
• Cereals
• Crackers
• Gravy or roux (often thickened with flour)
• Ice cream products
• Hot dogs and processed meats
• Salad dressings, sauces, and soups (usually thicker soups)
• Soy sauce
• Surimi (a paste made from fish or other meats) 

Soy

Soy allergies are common in infants and young children. Although it occurs in roughly 0.5% of children under three, around 70% of them outgrow the allergy.

Like peanuts, soybeans are a member of the legume family. Being allergic to soy does not necessarily mean that you are also allergic to another legume. 

Where to find soy: 

• Asian cuisine
• Baked goods
• Canned meats, including canned tuna
• Processed meats
• High protein energy bars
• Infant formulas
• Protein shakes

Fish

Allergy to finned fish (cod, flounder, salmon, tilapia, tuna, etc.) affects nearly 1% of the population and is more common in adults. 

Since shellfish and fish with fins have different proteins, people who are allergic to shellfish may not be allergic to fish.

Finned fish in unexpected places: 

• Caesar dressing
• Caesar salad
• Bouillabaisse
• Imitation crab
• Fish stock
• Seafood flavorings
• Worcestershire sauce

Always read labels closely, communicate with foodservice professionals clearly, and constantly carry at least two (2) epinephrine auto-injectors.

Checking for Food Allergens

While some of the body's responses to food allergies can be similar to food intolerances, with allergies the response can, over time, become more severe.  This makes knowing whether it is an intolerance or a true food allergy important.  Because the body mechanism for food allergies is different than food sensitivities it’s best to see a board-certified Allergist and have proper testing.  

The testing usually starts with Skin Prick Testing. Depending on the results your doctor may also decide to do a blood test to confirm the findings of the skin prick test.  

[expand title="Sources"] 

"With The Stroke Of President Biden’S Pen, FASTER Act For Sesame Labeling Becomes Law". Food Allergy Research & Education, 2021, foodallergy.org/media-room/stroke-president-bidens-pen-faster-act-sesame-labeling-becomes-law. 

"Facts And Statistics." Food Allergy Research & Education, 2021,  foodallergy.org/resources/facts-and-statistics. 

"Skin Prick Tests". Food Allergy Research & Education, 2021, foodallergy.org/resources/skin-prick-tests.

"Sesame | Description, Uses, & Facts". Encyclopedia Britannica, 2021, britannica.com/plant/sesame-plant. 

“US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.” The Journal of Allergy and Clinical Immunology, 2010  jacionline.org/article/S0091-6749%2810%2900575-0/abstract. 

“Common Food Allergens.” Food Allergy and Anaphylaxis Connection Team, 2021  foodallergyawareness.org/food-allergy-and-anaphylaxis/food-allergens/the-top-8-food-allergens/. 

“Common Allergens.” Food Allergy Research and Education.  foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens. 

“The 8 Most Common Food Allergies” Healthline, 2017. healthline.com/nutrition/common-food-allergies. 

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