Description

Cow’s milk allergy is the most common food allergy in infants and young children.  It occurs more frequently in infants who are fed cow’s milk formula than in babies who are breast-fed or who are fed hypoallergenic or a less allergenic infant formula.  Sensitivity to cow’s milk varies greatly from person to person.  Some people have a severe reaction after exposure to a tiny amount of milk.  Others have only a mild reaction after ingesting a moderate amount of milk or dairy products. 

Most children outgrow eventually outgrow cow’s milk allergy.  The allergy is most likely to persist in children who have high levels of cow’s milk antibodies in their blood.  Blood tests that measure these antibodies can help your allergist determine whether or not your child is likely to outgrow a milk allergy.

Some people confuse milk allergy with lactose intolerance.  Unlike food allergies, food intolerances do not involve the immune system.  People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products.  As a result, lactose-intolerant patients are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating, and diarrhea. While lactose intolerance can cause great discomfort, it is not life-threatening.     

Hidden Sources

Deli meat slicers are frequently used for both meat and cheese products.

Some brands of canned tuna fish contain casein, a milk protein.

Many non-dairy products contain casein (a milk derivative), listed on the ingredient labels.

Some meats may contain casein as a binder. Check all labels carefully.

Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.

Found In

Milk protein is found in all dairy products, including milk, butter, cheese, cream, custard, yogurt, ice cream, and puddings.  The following ingredients indicate the presence of milk protein:
Artificial butter flavor, butter fat, and butter oil
Casein and caseinates (in all forms)
Cheese flavor
Curds
Ghee
Hydrolysates (casein, milk protein, protein, whey, whey protein)
Lactalbumin, lactalbumin phosphate, lactoglobulin, lactoferrin, lactulose
Nougat
Rennet, rennet casein
Recaldent™, used in tooth-whitening chewing gums
Simplesse®
Whey (in all forms)

• Milk protein may be found in numerous manufactured products, including many margarines, breads, cookies, cakes, chewing gum, cold cuts, crackers, cereals, non-dairy products, processed and canned meats, and frozen and refrigerated soy products.
• Many frozen and refrigerated soy-based products are manufactured on dairy equipment and run the risk of cross-contact with milk protein.
• Sheep’s and goat’s milk are not considered safe for people with cow’s milk allergy, as most cow’s milk-allergic individuals are also allergic to these milks.
• Shellfish is occasionally dipped in milk to reduce the fishy odor.   Please ask if there is any risk of milk contact when purchasing shellfish.
• Kosher Dairy:  A “D” or the word “dairy” following the circled K or U on a product label indicates the presence of milk protein or a risk of milk protein contamination.  These products should be avoided.
• Kosher Pareve:  A product labeled “pareve” is considered milk-free under kosher dietary law.  However, a food product may be considered pareve even if it contains a very small amount of milk protein—potentially enough to cause an allergic reaction in susceptible individuals.  Do not assume that pareve products are always safe.

Ingredients that do not contain Milk

Cocoabutter, coconut milk, calcium lactate, calcium stearoyl lactylate, oleoresein, cream of tartar, sodium stearoyl lactylate, and lactic acid (although lactic acid starter culture may contain milk).

Nutrition

Milk is an important dietary source of protein, calcium, vitamin D and vitamin B12.  Please discuss a safe dietary alternative to cow’s milk with your doctor or dietitian.

Description

Hen’s egg allergy is one of the most common allergies in children, second only to cow’s milk.  Most children eventually outgrow this allergy.

People who are allergic to hen’s eggs must completely avoid both the white and the yolk.  The white contains the allergenic proteins, but since it is impossible to separate it completely from the yolk, cross-contamination is likely to occur.  Even a small amount of egg may be enough to cause an allergic reaction.  Other bird eggs also are likely to cause a reaction, although limited research has been done on this topic.

If you are on an egg-restricted diet, your intake of grain may be limited because many commercially prepared grain products, such as breads and pastas, contain eggs.  A diet that is limited in eggs and grains may be low in some of the B vitamins and possibly iron.  Read ingredient labels to find egg-free pastas and grain products.  You can also substitute rice in some recipes that call for pasta and make your own homemade bread products. 

Found In

The following ingredients indicate the presence of egg protein:
Albumin
Egg (white, yolk, dried, powdered, solids)
Egg substitutes
Eggnog
Globulin
Lecithin
Lysozyme
Mayonnaise
Meringue
Ovalbumin
Ovovitellin

Egg protein may be found in numerous products, such as baked goods, breaded foods, cream fillings, custards, candies, canned soups, casseroles, frostings, ice creams, lollipops, marshmallows, marzipan, pastas, salad dressings, and meat-based dishes, such as meatballs or meatloaf. 

Egg whites and shells also may be used as a clarifying agent in soup stocks, consommés, wine, and alcohol-based and coffee drinks.

Substitute In Recipes

For each egg, one of the following may be substituted in recipes:
1 tsp. baking powder, 1T. water, and 1 T vinegar
1 tsp. yeast dissolved in ¼ cup warm water
1½ T. water, 1½ T. oil, and 1 tsp. baking powder
1 packet gelatin and 2 T warm water (mix just prior to use)
2 T. fruit puree may be used for binding, but not leavening.

Hidden Sources

Eggs have been used to create the foam or milk topping on specialty coffee drinks and are used in some bar drinks.

Some commercial brands of egg substitutes contain egg whites.

Most commercially processed cooked pastas (including those used in prepared foods such as soup) contain egg or are processed on equipment shared with egg-containing pastas. Boxed, dry pastas are usually egg-free, but may be processed on equipment that is also used for egg-containing products. Fresh pasta is sometimes egg-free, too. Read the label or ask about ingredients before eating pasta.

Description

Peanut allergy is one of the most common food allergies.  Unfortunately, it also is one of the most dangerous, since peanuts tend to cause particularly severe reactions (anaphylaxis).   Some people are very sensitive and have reactions from eating trace amounts of peanut.  Non-ingestion contact (touching peanuts or inhaling airborne peanut allergens, such as dust from the shells) is less likely to trigger a severe reaction.

Peanut allergies seem to be on the rise in children.  In the United States, the number of children with peanut allergy doubled between 1997 and 2002.  Subsequent studies in the United Kingdom and Canada also showed a high prevalence of peanut allergy in schoolchildren.  Unlike egg and cow’s milk allergies, which most children outgrow, peanut allergies tend to be life-long. Recent studies, however, indicate that approximately 20% of peanut-allergic children do eventually outgrow their allergy.   

The peanut (Arachis hypogaea) is not really a nut, but a kind of legume. It is related to other beans, such as peas, lentils, and soybeans.  People with peanut allergy are not necessarily allergic to other legumes (even soy, another of the “big eight” food allergens), so be sure to speak with your doctor before assuming that you have to avoid these protein-rich foods. A person with a peanut allergy may also be allergic to tree nuts (almonds, walnuts, hazelnuts, cashews, etc.).  In fact, some 30-40% of people who have peanut allergy also are allergic to tree nuts. Not surprisingly, allergists usually tell their peanut-allergic patients to avoid tree nuts. 

Researchers have isolated three major peanut allergens.  They are trying to learn why peanuts cause such severe reactions and why the number of people who suffer from peanut allergy is increasing.  Investigators also are trying to develop therapies that would prevent anaphylaxis in people with peanut allergies.  

Hidden Sources

• Artificial nuts can be peanuts that have been deflavored and reflavored with a nut, such as pecan or walnut. Mandelonas are peanuts soaked in almond flavoring.
• Arachis oil is peanut oil.
• African, Chinese, Indonesian, Mexican, Thai, and Vietnamese dishes often contain peanuts or are contaminated with peanuts during the preparation process. Additionally, foods sold in bakeries and ice cream shops are often in contact with peanuts.
• Many brands of sunflower seeds are produced on equipment shared with peanuts.
• The following ingredients indicate the presence of peanut protein: Beer nuts, ground nuts, mixed nuts, and peanut (including peanut flour and peanut butter).
• Peanut protein is found in Arachis oil, and in cold pressed, expressed, expelled, and extruded peanut oils.   Highly processed peanut oil has been shown to be safe for the vast majority of people individuals allergic to peanut.  As the degree of processing of commercial peanut oil may be difficult to determine, avoidance is prudent.
• Nu-Nuts® and other artificial flavored nuts contain peanut protein.
• Ethnic restaurants (such as Chinese, African, Indonesian, Thai, and Vietnamese), bakeries, and ice cream parlors are considered high-risk for individuals with peanut allergy due to the common use of peanut and the risk of cross contamination—even if you order a peanut-free item.
• Peanut butter and/or peanut flour have been used in chili and spaghetti sauce as thickeners.  Always ask if peanut was in the recipe.
• Many candies and chocolates contain peanut or run the risk of cross contact with peanut protein.
• Lupine or lupin is a legume that may cause an allergic reaction in those with peanut allergy.  Lupine is used in this country in many gluten-free and high-protein products.  In many European countries, particularly Italy and France, lupine flour and/or peanut flour may be mixed with wheat flour in baked goods.
• Many tree nuts are processed with peanuts and therefore may contain trace amounts of peanut protein.  Extreme caution is advised.

Description

Tree nut allergy is one of the most common food allergies in children and adults.  Like peanuts, tree nuts (almonds, cashews, walnuts, etc.) tend to cause particularly severe reactions, even if a person is exposed to only a tiny amount. 

In a registry of 5,149 people who had peanut or tree nut allergy, the median age of reaction to tree nuts was 36 months.  Sixty-eight percent of the tree nut-allergic participants were not aware of any previous exposure to tree nuts before their first reaction.  This allergy tends to be life-long; recent studies have shown that approximately 9% of tree nut-allergic children eventually outgrow their allergy.  

People seldom are allergic to just one type of tree nut, so allergists usually will tell patients to avoid all tree nuts.

Hidden Sources

Artificial nuts can be peanuts that have been deflavoured and reflavoured with a nut, such as pecan or walnut. Mandelonas are peanuts soaked in almond flavoring.

Mortadella may contain pistachios.

Tree nuts have been used in many foods, including barbecue sauce, cereals, crackers, and ice cream.

Kick sacks, or hacky sacks, bean bags, and draftdodgers are sometimes filled with crushed nut shells.

Found In

The following common nuts are considered tree nuts under U.S. law:  almond; Brazil nut; cashew; chestnut; filbert/hazelnut; macadamia nut; pecan; pine nut (pignolia nut); pistachio; walnut.

The following are uncommon, additional tree nuts that require disclosure by U.S. law.  However, the risk of an allergic reaction to these nuts is unknown: beechnut; ginkgo; shea nut; butternut; hickory; chinquapin; lychee nut; coconut; pili nut.

• Tree nut proteins may be found in cereals, crackers, cookies, candy, chocolates, energy bars, flavored coffee, frozen desserts, marinades, barbeque sauces, and some cold cuts, such as mortadella. 
• Tree nut protein will be found in foods such as gianduja (a creamy mixture of chocolate and chopped almonds and hazelnuts, although other nuts may be used); marzipan (almond paste); nougat; Nu-Nuts® artificial nuts; pesto; and nut meal.
• Tree nut oils may contain nut protein and should be avoided.
• Ethnic restaurants (e.g., Chinese, African, Indian, Thai, and Vietnamese), ice cream parlors, and bakeries are considered high-risk for people with tree nut allergy due to the common use of nuts and the possibility of cross contamination, even if you order a tree-nut-free item.
• Avoid natural extracts, such as pure almond extract and natural wintergreen extract (for the filbert/hazelnut allergy).  Imitation or artificially flavored extracts generally are safe.
• The following are not considered nuts:  nutmeg, water chestnuts, and butternut squash.
• Tree nut oils are sometimes used in lotions and soaps.  Shea nut, although not usually found in food products, is often used in lotions.
• Some alcoholic beverages may contain nut flavoring and should be avoided.  Since these beverages are not currently regulated by FALCPA, you may need to call the manufacturer to determine the safety of ingredients such as natural flavoring.

Description

Sesame seed allergy appears to be on the rise in many countries, including the United States.  These seeds are capable of causing severe allergic reactions.  Canada and the European Commission have added sesame to the list of ingredients that must be reported on food labels, although the U.S. has not yet done so.

The more widely an allergenic food is consumed in a particular country, the more likely the population is to report an allergy to that food. In the Middle East, where sesame seeds and oil are dietary staples, the incidence of sesame seed allergy is very high.  In fact, sesame is the third most common allergy in Israeli children, after cow’s milk allergy and egg allergy. Researchers theorize that the growing popularity of snacks and ethnic foods that contain sesame in Europe, North America, Australia, and New Zealand accounts for the increase in sesame seed allergy in these parts of the world.

Allergies to other seeds (e.g., poppy, sunflower, pumpkin, rapeseed, and flaxseed, also known as linseed) are much less common, so they are not discussed in detail here.  People who are allergic to one type of seed don’t necessarily have to avoid all others, so you should discuss this matter with your doctor.

Found In

The following ingredients and foods indicate the presence of sesame seed protein:
Benne/benne seed/benniseed
Gomasio (sesame salt)
Halvah
Hummus
Tahini
Seeds
Sesame oil (also known as gingelly or til oil)
Sesamol/sesamolina
Sesamum indicum
Sim sim
Vegetable oil

• Baked goods (breads, buns, rolls, crackers, cookies, pastries, bagels, etc.) and certain cereals (e.g., muesli) often contain sesame and other seeds (e.g., poppy, sunflower).
• Many snack foods (e.g., trail mix, granola bars, protein bars, candy, rice cakes, pretzels, bagel chips or pita chips) contain sesame seeds.
• Sesame seeds may be found in a wide variety of other foods, including margarine, sauces, dips, soups, salad dressing, processed meats, and vegetarian burgers.  
• Bakeries and ethnic restaurants (such as Middle Eastern and Asian) are considered high-risk for people with sesame allergy due to the common use of sesame and the risk of cross-contamination, even if a sesame-free item is ordered. 

Non-food sources of sesame seeds include health and beauty aids (cosmetics, soaps, hair care products, etc.), certain drugs and ointments, pet food, and livestock feed.

Description

Allergic reactions to fish and shellfish are commonly reported in both adults and children. It is generally recommended that individuals who have had an allergic reaction to one species of fish, or positive skin tests to fish, avoid all fish. The same rule applies to shellfish. If you have a fish allergy but would like to have fish in your diet, speak with your allergist about the possibility of being tested with various types of fish.

Shellfish allergy usually develops in young adults.  In fact, it is the most common significant food allergy reported by adults and is considered life-long.  Along with peanuts and tree nuts, shellfish are the most frequent triggers of anaphylactic reactions.    

There are two kinds of shellfish: crustacea (such as shrimp, crab, and lobster) and mollusks (such as clams, mussels, oysters, and scallops).  Reactions to crustacean shellfish tend to be particularly severe.  If you are allergic to one group of shellfish, you might be able to eat some varieties from the other group.  Since most people who are allergic to one kind of shellfish usually are allergic to other types, however, allergists usually advise their patients to avoid all varieties.  If you have been diagnosed with a shellfish allergy, never eat any kind of shellfish without consulting your doctor first.

When eating out, people with shellfish allergies should be particularly alert to cross-contamination.  Always check with the chef to make sure that shellfish are not cooked on the same skillet or in the same oil as other food.  You also should make sure that your dishes are not prepared with the same utensils or on the same work surfaces as shellfish.    

Crustaceans
Shrimp (prawns, crevette)
Crab
Crawfish (crayfish, ecrevisse)
Lobster (langouste, langoustine, scampo, coral, tomalley)

Mollusks
Abalone
Clam
Cockle
Mussel
Oyster
Octopus
Scallop
Snail (escargot)
Squid (calamari)

Found In

The following ingredients may indicate the presence of a shellfish protein:
Bouillabaisse
Fish stock
Flavoring
Seafood flavoring
Surimi

• Some sensitive individuals may react to aerosolized shellfish protein through cooking vapors. It is wise to stay away from steam tables or stovetops when shellfish are being cooked.
• Seafood restaurants are considered high-risk due to the possibility of cross-contamination, even if a non-shellfish item is ordered.
• Carrageen is a marine algae, not a fish, and is considered safe for those avoiding fish and shellfish.

Hidden Sources

• Caponata, a traditional sweet-and-sour Sicilian relish, can contain anchovies.
• Caesar salad dressings and steak or Worcestershire sauce often contain anchovies.
• Surimi (imitation crabmeat) contains fish.

Description

Finned fish can cause severe allergic reactions.  This allergy is usually life-long.  The protein in the flesh of fish most commonly causes the allergic reaction; however, it is also possible to have a reaction to fish gelatin, made from the skin and bones of fish.  Although fish oil does not contain protein from the fish from which it was extracted, it is likely to be contaminated with small molecules of protein and therefore should be avoided.

More than half of all people who are allergic to one type of fish also are allergic to other fish, so allergists often advise their patients to avoid all fish.  However, many people with fish allergies are able to eat canned tuna or salmon, which are less allergenic than fresh fish. Finned fish and shellfish do not come from related families of foods, so being allergic to one does not mean that you will not be able to tolerate the other.  Be sure to talk to your doctor about which kinds of fish you can eat and which to avoid.

When eating out, people with fish allergies should be particularly alert to cross-contamination.  Always check with the chef to make sure that the fish is not cooked on the same skillet or in the same oil as other food.  You also should make sure that your dishes are not prepared with the same utensils or on the same work surfaces as fish.

Includes

The term “fish” encompasses all species of finned fish, including (but not limited to):  anchovies; bass; catfish; cod; flounder; grouper; haddock; hake; herring; mahi mahi; perch; pike; pollock; salmon; scrod; sole; snapper; swordfish; tilapia; trout; and tuna.

• Some sensitive individuals may react to aerosolized fish protein through cooking vapors.
• Seafood restaurants are considered high-risk due to the possibility of cross-contamination, even if you do not order fish.
• Ethnic restaurants (e.g., Chinese, African, Indonesian, Thai, and Vietnamese) are considered high-risk because of the common use of fish and fish ingredients and the possibility of cross-contamination, even if you do not order fish.
• Worcestershire sauce, Caesar salad, and Caesar dressing usually contain fish ingredients (anchovies).
• Caponata, a Sicilian eggplant relish, may contain anchovies.
• Surimi, an artificial crabmeat (also known as “sea legs” or “sea sticks”), is made from fish.
• Carrageen is a marine algae, not a fish, and is considered safe for those avoiding fish and shellfish.

Description

Like peanuts, soybeans are legumes.  In fact, soy and peanut proteins are similar in structure.  Nevertheless, a person who is allergic to soy won’t necessarily be allergic to peanuts, and vice versa.  Soy is widely used in many food products, so if you have a soy allergy, it is especially important to read ingredient labels with care.  

Comparatively little research has been done on soy allergy, but studies indicate that it generally occurs early in childhood and often is outgrown by age three. 

Soybeans have become a major part of processed food products in the United States. Avoiding products made with soybeans can be difficult. Soybeans alone are not a major food in the diet but, because they're in so many products, eliminating all those foods can result in an unbalanced diet. Consult with a dietitian to help you plan for proper nutrition.

Found In

• Soybeans and soy products are found in baked goods, canned tuna, cereals, crackers, infant formulas, sauces, and soups.
• At least one brand of peanut butter lists soy on the label.
• Studies show that most soy-allergic individuals may safely eat soybean oil (not cold pressed, expeller pressed, or extruded oil). If you are allergic to soy, ask your doctor whether or not you should avoid soy oil.

The following ingredients indicate the presence of soy protein:
Edamame
Miso
Natto
Shoyu sauce
Soy (fiber, flour, grits, nuts, sprouts)
Soy (milk, yogurt, ice cream, cheese)
Soy protein (concentrate, hydrolyzed, isolate)
Soy sauce
Tamari
Tempeh
Textured vegetable protein
Tofu

• Soy protein may be found in numerous products, such as breads, cookies, crackers, canned broth and soups, canned tuna and meat, breakfast cereals, high-protein energy bars and snacks, low-fat peanut butters, and processed meats.
• Asian cuisines are considered high-risk for people with soy allergy due to the common use of soy as an ingredient and the possibility of cross-contamination, even if a soy-free item is ordered.
• Studies show that most people with soy allergy may safely eat products containing soy oil and soy lecithin.   Soy oil is exempt from U.S. labeling laws.

Description

Wheat allergy most commonly affects children and often is outgrown by age three. Wheat, a type of grain, contains four major proteins that can cause an allergy: albumin, globulin, gliadin, and gluten.  Gluten is also found in barley, rye, and oats.  You or your child may not necessarily have to avoid foods that contain grains other than wheat.  However, about 20% of wheat-allergic children also are allergic to other grains.  Be sure to ask your doctor whether foods containing barley, rye, or oats are safe for you or your child to eat.

A wheat allergy should not be confused with “gluten intolerance” or celiac disease. Celiac disease (also known as celiac sprue), which affects the small intestine, is caused by an abnormal immune reaction to gluten. Usually diagnosed by a gastroenterologist, it is a digestive disease that can cause serious complications, including malnutrition and intestinal damage, if left untreated.

Found In

The following ingredients indicate the presence of wheat protein:
Bread crumbs
Bulgur
Cereal extract
Couscous
Durum, durum flour, durum wheat
Emmer
Einkorn
Farina
Flour (all wheat types, such as all-purpose, cake, enriched, graham, high protein or high gluten, pastry)
Kamut
Semolina
Spelt
Sprouted wheat
Triticale
Vital wheat gluten
Wheat (bran, germ, gluten, grass, malt, starch)
Whole-wheat berries

•  Wheat may be found in ale, baking mixes, baked products, batter-fried foods, beer, breaded foods, breakfast cereals, candy, crackers, frankfurters and processed meats, ice cream products, salad dressings, sauces, soups, soy sauce, and surimi.
• The following flour substitutes are available and may be used by people with wheat allergies if tolerated:  amaranth, arrowroot, buckwheat, corn, millet, oat, potato, rice, soybean, tapioca, and quinoa flour. Please check with your doctor before including these in your diet.

Recipe Substitute

When baking with wheat-free flours, a combination of flours usually works best. Experiment with different blends to find one that will give you the texture you are trying to achieve.

Try substituting 1 cup wheat flour with one of the following:

• 7/8 cup rice flour
• 5/8 cup potato starch flour
• 1 cup soy flour plus 1/4 cup potato starch flour
• 1 cup corn flour