“Big 8” Top Food Allergens
Eight foods, or “The Big 8”, account for 90 percent of all food-allergic reactions in the U.S.: peanuts, tree nuts (e.g., walnuts, almonds, cashews, pistachios, pecans), milk, egg, wheat, soy, fish, and shellfish. Here is further information on these allergens:
Allergy to peanuts appears to be on the rise. One study showed that from 1997 to 2002, the incidence of peanut allergy doubled in children. Peanuts can trigger a severe reaction. The severity of a reaction depends on how sensitive an individual is and the quantity consumed.
Unexpected Sources of Peanuts:
- Sauces such as chili sauce, hot sauce, pesto, gravy, mole sauce, and salad dressing
- Cookies, and hot cocoa
- Egg rolls
- Potato pancakes
- Pet foods
- Gourmet pizzas
- Asian and Mexican dishes
- Vegetarian meat substitute products
- Glazes and marinades
- Some alternative nut butters, such as soy nut butter or sunflower seed butter, are produced on equipment shared with other tree nuts and, in some cases, peanuts. Contact the manufacturer before eating these products.
- Discuss with your primary doctor or allergist whether to avoid tree nuts. People allergic to peanuts may develop allergies to other foods, including tree nuts. In addition, the chance of a reaction due to cross-contact between peanut and tree nuts during the manufacturing process will be lowered if you avoid them altogether.
- Ice cream served in ice cream parlors should be avoided; cross-contact occurs frequently because of shared scoops.
- Sometimes, foods that are supposed to contain almonds or other tree nuts contain peanuts instead.
- Peanuts go by many names, such as ground nuts, beer nuts, or monkey nuts. Use caution if you are unsure!
- Studies show that most allergic individuals can safely eat peanut oil (not cold pressed, expelled, or extruded peanut oil – sometimes represented as gourmet oils). If you are allergic to peanuts, ask your doctor whether or not you should avoid peanut oil.
- Younger siblings of children allergic to peanuts may be at increased risk for allergy to peanuts. Your doctor can provide guidance about testing for siblings.
- Peanuts can be found in many foods and candies, especially chocolate candy. Check all labels carefully. Contact the manufacturer if you have questions.
- Peanuts can cause severe allergic reactions. If prescribed, carry TWO auto-injectors at all times.
- Some companies use peanut hulls in compost, which can be added as top-dressing on lawns. Before you hire a contractor, inquire about the use of peanut hulls in compost so that you can make an informed decision.
Tree Nut Allergy
An estimated 1.8 million Americans have an allergy to tree nuts. Allergic reactions to tree nuts are among the leading causes of fatal and near-fatal reactions to foods. Tree nuts include, but are not limited to, walnut, almond, hazelnut, coconut, cashew, pistachio, and Brazil nuts. These are not to be confused or grouped together with peanut, which is a legume, or seeds, such as sunflower or sesame.
Like those with peanut allergies, most individuals who are diagnosed with an allergy to tree nuts tend to have a lifelong allergy. As you’ll see below, tree nuts can be found as ingredients in many unexpected places.
Unexpected Sources of Tree Nuts:
- Many experts advise patients allergic to tree nuts to avoid peanuts and other tree nuts because of the high likelihood of cross-contact at processing facilities, which process peanuts and different tree nuts on the same equipment. Further, a person with an allergy to one type of tree nut has a higher chance of being allergic to other types. Discuss with your doctor whether to avoid other tree nuts.
- Tree nuts may be found in a wide range of unexpected foods for flavor or consistency. If ingredient information is not provided for a particular food or you question its accuracy, avoid the food completely.
- Younger siblings of children allergic to tree nuts may be at increased risk for allergy to tree nuts. Your doctor can provide guidance about testing for siblings.
- Tree nuts can cause severe allergic reactions. If your doctor has prescribed epinephrine, be sure to always carry it with you. Learn more about anaphylaxis.
- Most experts advise patients who have been diagnosed with an allergy to specific tree nuts to avoid all tree nuts.
Approximately 2.5% of children younger than 3 years of age are allergic to milk. Nearly all infants who develop an allergy to milk do so in their first year of life. Most children who have milk allergy will outgrow it in the first few years of life.
Unexpected Sources of Milk:
- 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.
- Baby formulas
Egg allergy is estimated to affect approximately 1.5% of young children. But it’s also a food allergy that is one of the most likely to be outgrown over time.
Most allergic reactions associated with egg involve the skin, but anaphylaxis also can occur. Allergic reactions to egg are mostly IgE-mediated (involving IgE antibodies).
Unexpected Sources of Egg:
- 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.
- Egg wash is sometimes used on pretzels before they are dipped in salt.
Wheat allergy is primarily common in children, and is usually outgrown before reaching adulthood. Wheat allergy is sometimes confused with celiac disease, which is a digestive disorder that creates an adverse reaction to gluten. Individuals with celiac disease must avoid gluten, found in wheat, rye, barley, and sometimes oats. People who are allergic to wheat have an IgE-mediated response to wheat protein and may tolerate other grains. Symptoms of a wheat allergy reaction can range from mild to severe.
A wheat allergy can present a challenge for the diet as well as for baking, because wheat is the nation’s predominant grain product. Someone on a wheat-restricted diet can eat a wide variety of foods, but the grain source must be something other than wheat. In planning a wheat-free diet, look for alternate grains such as amaranth, barley, corn, oat, quinoa, rice, rye, and tapioca.
Unexpected Sources of Wheat:
- Read food labels carefully, even if you would not expect the product to contain wheat. Wheat has been found in some brands of ice cream, marinara sauce, play dough, potato chips, rice cakes, and turkey patties, and at least one brand of hot dogs.
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.
Symptoms of soy allergy are typically mild, although anaphylaxis is possible. Soybean allergy is one of the more common food allergies, especially among babies and children.
Unexpected Sources of Soy:
- Soybeans and soy products are found in baked goods, canned tuna, cereals, crackers, infant formulas, sauces, and soups.
- Peanut butter (!)
An estimated 2.3% of Americans – almost 7 million people – report allergy to seafood, including fish and shellfish. Salmon, tuna, and halibut (these are known as “vertebrae” or “finned” fish) are the most common kinds of fish to which people are allergic.
It is generally recommended that individuals who are allergic to one species of fish avoid all fish. 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.
Fish allergy is considered lifelong; once a person develops the allergy, it is very unlikely that they will lose it.
Approximately 40% of those with fish allergy first experienced an allergic reaction as an adult. To avoid a reaction, strict avoidance of seafood and seafood products is essential. Always read ingredient labels to identify fish ingredients. In addition, avoid touching fish, going to the fish market, and being in an area where fish is being cooked (the protein in the steam may present a risk).
Unexpected Sources of Fish:
- Salad dressings
- Worcestershire sauce
- Bouillabaisse / Soup stocks
- Imitation fish or shellfish
- Steaks / Burgers / Meatloaf
- Barbecue sauce
- Asian Foods
An estimated 2.3% of Americans – almost 7 million people – are allergic to seafood, including fish and shellfish. Shrimp, crab, and lobster cause most shellfish allergies.
Allergy to shellfish is considered lifelong; once a person develops the allergy, it is unlikely that they will lose it.
Approximately 60% of those with shellfish allergy first experienced an allergic reaction as an adult. To avoid a reaction, strict avoidance of seafood and seafood products is essential. Always read ingredient labels to identify shellfish ingredients. In addition, avoid touching shellfish, going to the fish market, and being in an area where shellfish are being cooked (the protein in the steam may present a risk).
Other Common Allergies:
Anaphylactic reactions to medication typically occur within an hour after taking the drug but may occur several hours later. It is estimated that up to 1 percent of the population may be at risk for allergic reactions to medications.
According to literature from the American Academy of Allergy, Asthma & Immunology, “The chances of developing an allergic reaction may be increased if the drug is given frequently, or by skin application or injection rather than by mouth. Inherited genetic tendencies of the immune system to develop allergies may also be important. Contrary to popular myth, however, a family history of reaction to a specific drug does not mean that a patient has an increased chance of reacting to the same drug.”
Recent research indicates that 90 percent of patients who have a history of allergic reactions to penicillin will be able tolerate the drug. Patients who need penicillin may be able to undergo a physician-supervised desensitization procedure in an effort to change their immune system response to the antibiotic. Those who are allergic to any antibiotic are more likely to react to other drugs than are patients who have no medication allergies.
If you experience symptoms of an allergic reaction after taking medication, speak to your doctor. If symptoms are severe, or if they resemble those of anaphylaxis, get emergency medical help immediately.
Latex allergy is most commonly diagnosed in individuals who are exposed to latex frequently, such as those employed in the health care or rubber industry. An estimated 1 percent of the U.S. population has latex allergy, but the figure is much higher – between 10 percent and 17 percent – among those employed in health care occupations.
Some individuals with latex allergy will also develop reactions when eating foods that cross-react with latex, such as bananas, kiwi, avocados, European chestnuts, and, less commonly, potatoes, tomatoes, and peaches, plums, cherries, and other pitted fruits.
Bee / Wasp / Insect Sting
Honeybees, bumblebees, yellow jackets, hornets, wasps, and fire ants are the most common sources of insect stings in the United States. The symptoms of anaphylactic reactions to insect stings usually occur within minutes of the sting.
Insect sting reactions can range from local and mild to life-threatening. Local reactions can involve swelling of an area larger than the sting site (i.e., the entire arm can be swollen after a sting on the hand). This type of reaction may also include nausea and low-grade fever. Insect stings account for about 50 deaths each year in the U.S.
In some instances, insect sting allergy can be cured with immunotherapy, a process in which the doctor gradually administers stronger and stronger doses of the venom over a period of time.
To minimize the risk of an insect sting, avoid brightly colored clothing and scented cosmetics, perfumes, and so forth; avoid walking barefoot; use caution when cooking outdoors; avoid areas where stinging insects congregate; and keep insecticide handy when working outdoors.
Food intolerances differ from a food allergy, as the immune system is not involved when a person is intolerant to a food. Two common intolerances, lactose intolerance and Celiac disease are discussed here.
- Lactose Intolerance
Lactose intolerance occurs when an individual’s small intestine does not produce enough of the lactase enzyme. Therefore, affected individuals are not able to digest lactose, a type of sugar found in dairy products.
The symptoms of lactose intolerance typically occur within 30 minutes to 2 hours after ingesting dairy products. Large doses of dairy may cause increased symptoms.
- Celiac Disease
This is an auto-immune disorder sometimes also called “celiac sprue”. This disease requires a lifelong restriction of gluten, which is found in wheat, rye, and barley, and perhaps oats. These grains and their by-products must be strictly avoided by people with celiac disease.
Celiac disease causes damage to the lining of the small intestine, which prevents the proper absorption of nutrients in foods. This is turn can cause a person with Celiac disease to become malnourished.
Celiac disease can cause many symptoms, including bloating and gas, diarrhea, constipation, headaches, itchy skin rash, and pale mouth sores, to name a few. The symptoms may vary amongst affected individuals.
(Celiac Disease is not the same as a Wheat Allergy – more information about Celiac disease is available through the Celiac Disease Foundation)