How to manage food allergy with confidence

Probably up to 10% of the population have true food allergy, but as many as 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 way I explore the “heart of health” is attending CME -continuing medical education- conferences. All physicians do, to stay current on medical information and maintain licensure and board certification.

One of the most informative lectures I heard recently was about food allergy, a topic often discussed in the lay literature and media. Much of that discussion is based on personal experiences and opinions which, while interesting, may not be scientifically valid.

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 counselling 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 that the difference between food allergy and food intolerance. (The other two will not be discussed here)

Allergy– immune mediated, that is it involves the immune system with the production of 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
Mil 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 food allergy.

Probably up to 10% of the population have true food allergy, but as many as 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 needed, 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. Anaphylaxis

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

a heart monitor showing a heart tracing EKG
Minutes matter with heart 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-

an individualized Health Care Plan  – which includes strategies for food avoidance

Create and Maintain an Emergency Plan
Food Allergy Emergency Action Plan -Include specific actions to be taken in the event of accidental or purposeful ingestion of the allergenic food

Maintain a current and back-up supply of emergency medication

Specific instruction on transport to ER/ED (emergency room) for follow up care
Emergency medications and plan need to be with child/adult

a speed limit sign with an H for hospital , 5 miles
  • in school
  • at work
  • sporting events
  • field trips

“Eating a little bit won’t hurt.” “Childhood allergies last for life.” True or false? Find out at this link.

Food Allergy Myths and Misconceptions 

from Food

exploring the HEART of food allergy

Dr Aletha

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