How to manage food allergy with confidence

Up to 10% of the population have true food allergy, while 50-90% of people who believe they have food allergy may not. An accurate diagnosis is important so the condition can be managed properly when appropriate, but not needlessly..

One of the most informative lectures I heard recently was about food allergy, a common problem that patients and even physicians don’t always understand.

I welcomed the chance to hear from an expert to help me counsel my patients. I also have a personal interest since my grandson has food allergies; when he visits me, I have to be careful not to feed him foods he may react to.

The speaker, Kirsten Bennett, Ph.D. is a registered dietitian (RD) who specializes in counseling patients with food allergies. She presented data from research studies as well as from her clinical practice, and I’m sharing some of what she said with you.

How to manage food allergy with


What is food allergy?

You may assume that any symptom due to eating a food is an allergy but there are many ways food can make us sick, including allergy, intolerance, toxic effects, and infection.

Dr. Bennett explained the difference between food allergy and food intolerance. (The other two will not be discussed here)

Allergy– is immune-mediated, meaning the immune system produces and releases antibodies after exposure to a food; celiac disease is due to food allergy.

Intolerance– does not involve the immune system, no antibodies are produced; this occurs in lactose intolerance.

Some foods such as wheat and milk can cause both allergy and intolerance.

cup of milk, plate of bread
Milk and wheat can cause allergy and intolerance.

So how do you know the difference? You can’t, without an appropriate medical evaluation, so it is important to see a physician if you suspect a food allergy.

Up to 10% of the population have true food allergy, while 50-90% of people who believe they have food allergy may not. An accurate diagnosis is important so the condition can be managed properly when appropriate, but not needlessly.

What causes food allergy?

The BIG 8 cause 90% of food allergy. These are

  1. Milk
  2. egg
  3. peanut
  4. fish
  5. shellfish
  6. soy
  7. wheat
  8. tree nut






Symptoms of food allergy

Almost any symptom can occur with allergy but the most common are

  • Rash with or without itching
  • Swelling of the face, lips, eyes
  • Watery, itchy eyes
  • Nasal drainage and/or congestion
  • Hoarse voice
  • Cough, wheezing, difficulty breathing
  • Nausea, vomiting, diarrhea
  • Dizziness, fainting
  • Low blood pressure, fast heart beat
  • Feeling of “impending doom”





How to diagnose food allergy

Although blood and skin testing may be helpful, the history is the first and most important step to identify food allergy. The evaluation may start with the answers to these 9 questions-

  • What are the symptoms?
  • What food was eaten that may have caused the symptoms and was it eaten before?
  • How much of the food was eaten?
  • Was the suspect food cooked or raw?
  • Has the food ever been eaten without symptoms?
  • Was else was the person doing or ingesting at the same time, such as exercise, medications, etc.?
  • Have the symptoms occurred without eating the food?
  • How were the symptoms treated and how long did they last?

What You Need to Know About Diagnostic Allergy Testing

by David Stukus, MD,Assistant Professor of Pediatrics in the Section of Allergy/Immunology at Nationwide Children’s Hospital, in Columbus Ohio.



Goals in  managing food allergies

Allow the child (or adult) to live as normal a life as possible while avoiding foods that might cause allergic symptoms.

The fear of a serious food allergic reaction can cause a family to forgo normal activities and keep a child isolated. Dr. Bennett suggested these tactics to minimize food allergy anxiety.

Family of 4 sitting at a dining table.
Read food labels carefully to avoid inadvertently eating foods that cause allergy.

At home 

  • Cook as a family ; Learn how to cook meat and other protein foods
  • Take children grocery shopping and engage them in food selection
  • Use at least 3 elements of the plate model for meal planning
  • Gather together and celebrate food and eating together
  • Practice manners and table talk
  • Make the home kitchen a safe sanctuary
  • Enjoy the food journey


  • Take foods along that are safe
  • Identify possible allergy risks in travel itinerary -Restaurants

At school 

  • What does the school staff and administration know about food allergies?
  • Start a conversation Provide reference materials or community resources
  • Create a plan for inclusion
  • Partner with the school
  • Universal supports for all children

Find more Tips for Maintaining a Healthy Lifestyle from Kids With Food


Be prepared for an emergency allergic reaction.


The greatest danger of any allergy is anaphylaxis, a life-threatening allergic reaction that impairs breathing and heart function.

a heart monitor showing a heart tracing EKG
Minutes matter with allergy emergencies

Anyone who cares for a person with food allergy needs to know what to do in case of a reaction. Schools and work places should have a plan for dealing with such emergencies.

Create and Maintain an Action Plan for school/work-

Develop an individualized Health Care Plan  – which includes strategies for food avoidance as well as an Emergency Action Plan with specific actions to be taken in the event of accidental or purposeful ingestion of the allergenic food.

Maintain a current and backup supply of emergency medication

  • Epinephrine (Injectable)
  • antihistamine

Document specific instruction on transport to ER/ED (emergency room) for follow-up care
Emergency medications and plan need to be accessible at all times.

exploring the HEART of food allergy

I also addressed food allergy in this book review post.

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