What Are The Most Common Food Allergies?
6/15/2023
Written by Manisha Relan, MD Pediatric Allergist, Clinical Immunologist
If you are reading this, it means your baby has already or is about to move on to solid foods - yay! Introducing new foods and flavors to your baby is such a fun and exciting time, yet this is also when we as parents have to be on alert for any possible reactions.
What are food allergies, and how do we recognize them?
There are two major forms of food allergies (not the same as an intolerance): immediate and delayed. Studies show that unfortunately food allergies in people of all ages are on the rise. In fact, it is estimated that 1 in 13 school aged children may suffer from one or more food allergies. So what is a parent to do about this? Based on the latest research and recommendations, introduce allergenic foods early to your infant and keep the foods in rotation in their diet.
This blog post will be breaking down the IgE-mediated food allergies, which is a type of immediate hypersensitivity reaction. These types of allergies can cause anaphylaxis, which can be life-threatening. Although anaphylaxis is uncommon overall in infants (the exact rate varies based on the population looked at), it is not infrequent.
Examples of immediate hypersensitivity reactions could include, but are not limited to:
Hives, itchy skin, and/or swelling
Nausea, vomiting, abdominal pain
Itching, redness, watery eyes
Shortness of breath, fast breathing, coughing, wheezing
Trouble breathing, trouble speaking, drooling, weak pulse
Extreme fussiness, inconsolability
In some/most of these instances, you may have to seek immediate medical attention.
The top 9 causes of food allergies and therefore the common culprits (aka ‘allergens’) to pay particular attention to include: cow’s milk, egg, soy, wheat, peanut, tree nuts, sesame seed, fish and shellfish. Let us take a closer look at each of these food allergens, and break it down a little!
The Top Nine Food Allergens in the US as of 2023
1.) Cow’s Milk
A milk allergy is a reaction which occurs after consuming milk or products containing cow’s milk. In America, the most common form of milk (aside from human breast milk) ingested is from cows; other cultures around the world often drink other mammalian milks (ie, goat, buffalo) as well. Milk allergy may be confused with lactose intolerance. However, lactose intolerance is not the same as a milk allergy. Lactose intolerance means a person lacks or is low on the enzyme (lactase) that breaks down the sugar in milk. This is rare in babies as even breast milk contains lactose. Another common misconception involves the diagnosis of cow’s milk protein intolerance (CMPI). With CMPI, an infant’s lower intestine is unable to digest the milk protein but symptoms are limited to mostly intestinal ones; they are not due to an IgE mediated immediate hypersensitivity reaction. In the case of a true milk allergy, the immune system gets involved and the reactions are unpredictable versus in CMPI the reactions are often reproducible/predictable. In neither case are they uncomfortable! Please talk to your child’s doctor about any concerns.
2.) Egg
With eggs, it is not necessarily the whole food that is the issue but rather the culprit is typically the egg white, where the protein actually resides. Since it is difficult to remove all traces of the egg white (protein) from the yolk, if a child has an egg allergy most doctors recommend avoiding the whole egg until further evaluation by an allergist. Oftentimes, this allergy is outgrown and lots of children can tolerate the egg baked into foods (but clear it with your doctor first, please!). Side note: we do encourage flu shots even in the case of an egg allergy! That recommendation has been updated in the US by the CDC for many years now.
3.) Soy
Soy is a type of legume. The legume family includes peanuts, green peas, and lentils. However, being allergic to soy does not automatically mean you are allergic to all legumes! The chances are quite low, actually. The tricky part with soy is to study those labels. Soybean oil (highly refined is generally tolerated well), soybean lecithin (contains traces of protein), and soy sauce (contains soy plus a lot of sodium) could be lurking within certain products.
4.) Wheat
Wheat allergy often gets confused with celiac disease. The difference is that again a wheat allergy is immune mediated and would trigger an immediate reaction that can be severe and life threatening. Celiac disease is an autoimmune condition that can take hours or weeks to occur. Gluten sensitivity is a different entity altogether. This typically involves stomach pains, gas, bloating, change in bowel patterns, fogginess and fatigue… all thanks to difficulty digesting wheat. Symptoms can start within a few hours so they are often mistaken for a wheat allergy, but history and testing by your doctor can help clarify the reaction.
5.) Peanut
Again, this is another legume. It is one of the most common food allergens amongst children. Peanuts are specific to just peanuts - not all nuts are the same! Keep an eye out for the lupin (or sometimes spelled ‘lupine’) bean; a common cross-reactivity for peanuts. Check in with your allergist specifically about avoidance, repeat testing, trying other nuts as this is case-by-case. Some good news though – about 20% of children with peanut allergy have a chance of outgrowing this allergy by late their teens!
6.) Tree nuts
As mentioned above, an allergy to peanuts does not necessarily include the realm of tree nuts. In this case, tree nuts are foods such as almond, hazelnut, cashew, pistachio, walnut, pecan, Brazil nut, and macadamia. The name itself is self-explanatory: these foods all come from trees, but are not in the same family as coconut. Most people are allergic to one or a subfamily (example, cashew and pistachio) but not all nuts under this umbrella (some exceptions do exist). However, it is generally suggested to avoid all tree nuts while dining out due to the risk of cross-contamination. Tree nuts are full of nutrition, and can be found in so many cultural/ethnic cuisines. We want you, as a family, to decide what works best for you!
7.) Sesame
Welcome to our newest member in the Top 9 family: sesame seed. Researchers have found a protein in the seeds that cross reacts with peanut and cashew (random, right?). Sesame seeds have been hidden ingredients in the past but with the new labeling law of 2023, they have to be declared on packages. Currently it is estimated about 20 to 30% of patients may outgrow this food allergy but time will tell if this remains true.
8.) Fish
Fish in this case is defined as the “finned” variety – salmon, cod, tuna, catfish, haddock, bass and tilapia. This allergy can be really sneaky: you would be surprised how often it turns up in Caesar salad or Caesar dressing, imitation or artificial fish (or even shellfish!), and worcestershire sauce. Just keep reading those labels!
9.) Shellfish
The most common adult food allergy is shellfish. This category includes crustaceans (ie, shrimp, lobster, crab) and mollusks (ie, clam, oyster, scallops). Again, a food allergy occurs because of a reaction to the protein component of the food. A common misconception is that the problem lies in iodine or radiocontrast dye (spoiler alert, neither has shrimp protein in it!). Myth busted!
Keep feeding those babies good, wholesome foods
It remains unclear exactly why at this point food allergies are still on the rise but there are many theories. With this information in this blog post, we hope you feel more informed and empowered to feed your babies new, healthy foods including the top 9 food allergens, and handle any reactions along the way!
We would love to hear from you! If you found this article helpful, please give us a follow, leave a comment, or share with friends! If you have a favorite recipe or dish involving the top 9 food allergens your little one loves, let us know! If you have specific medical questions, please reach out to your medical provider or board-certified pediatric allergist directly.
Bon appetit!
Dr. Relan
Ready to learn more about starting solids?
If you found this post helpful, we share more evidence-based best practices for starting solids inside our 101 before one program.
We have very detailed instructions on introducing the Top 9 allergens to your baby through real food inside our program (Book, App, and PDF Guides), written and approved by Dr. Relan.
At 101 before one, we believe babies who eat Family Meals from the Start™ will be happy, healthy eaters for life. Starting solids can be intimidating, but we show you how to introduce 101 different foods to your baby before their first birthday, all through simple, easy-to-follow recipes that the whole family can enjoy.