ALLERGENS

Common Allergens

Although nearly any food can trigger an allergic reaction, there are nine foods that cause the majority of reactions.

MILK ALLERGY

AVOIDING MILK

To prevent a reaction, it is very important that you avoid cow’s milk and cow’s milk-containing food products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

If you are allergic to cow’s milk, your doctor may recommend you also avoid milk from other domestic animals. For example, goat’s milk protein is very similar to cow’s milk protein and may cause a reaction in people who have a milk allergy.

Milk is one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. This makes it easy to see if milk is present in a food item.

As a general tip, ingredients are listed on the package in order of their prevalence in the product. For those avoiding baked milk, make sure milk (or an milk-containing product) is listed as the 3rd ingredient or later in the list. When in doubt, it’s best to avoid

WHAT IS MILK ALLERGY

Cow’s milk allergy is the most common food allergy in infants and young children. Even though most children eventually outgrow their allergy to milk, milk allergy is also among the most common food allergies in adults.1

Approximately 70% of children with cow milk allergy tolerate baked cow milk.2 Baked milk can be defined as milk that has been extensively heated, which disrupts the structure of the proteins that cause cow milk allergy. Young children who are allergic to fresh milk but can eat baked milk without reacting may be more likely to outgrow their milk allergy at an earlier age than young children who react to baked milk.3

When a person with a milk allergy is exposed to milk, proteins in the milk bind to specific IgE antibodies made by the person’s immune system. This triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe.

Allergens are not always present in these food and products, but milk protein can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.

Milk in Kosher Foods

Kosher Dairy: A “D” or the word “dairy” following the circled K or U on a product label means the product contains or is contaminated with milk protein. Avoid these products if you have a milk allergy.

Kosher Pareve: A food product labeled “pareve” is considered milk-free under kosher dietary law. However, a product may be considered pareve even if it contains a very small amount of milk protein—possibly enough to cause an allergic reaction in certain people. Do not assume that these products will always be safe.

Do These Ingredients Contain Milk?

People allergic to milk often have questions about the following ingredients. These ingredients do not contain milk protein and are safe to eat.

Calcium lactate
Calcium stearoyl lactylate
Cocoa butter
Cream of tartar
Lactic acid (however, lactic acid starter culture may contain milk)
Oleoresin
Sodium lactate
Sodium stearoyl lactylate

Is the use of non-animal casein or whey ingredients in products safe for those with milk allergy? What are the labeling requirements?

Products with man-made casein or whey ingredients are not safe for individuals with milk allergy as they still contain milk protein.

The Food Allergy Labeling Consumer Protection Act (FALCPA) requires plain-English labeling of casein and whey as “milk,” regardless of whether extracted from cow’s milk or man-made, either in the ingredient list or with a “Contains: Milk” statement immediately following the list of ingredients.

ALLERGIC REACTIONS TO MILK

Cow milk allergy varies from person to person, and allergic reactions can be unpredictable. Symptoms of a milk allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis.

If you have a milk allergy, keep an epinephrine injection device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

Avoid foods that contain milk

Butter, butter fat, butter oil, butter acid, butter ester(s)
Buttermilk
Casein
Casein hydrolysate
Caseinates (in all forms)
Cheese
Cottage cheese
Cream
Curds
Custard
Ghee
Half-and-half
Lactalbumin, lactalbumin phosphate
Lactic acid starter culture
Lactoferrin
Lactoglobulin
Lactose
Lactulose
Milk (in all forms including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, non-fat, powder, protein, skimmed, solids, whole)
Milk protein hydrolysate
Pudding
Recaldent®
Rennet casein
Simplesse®
Sour cream, sour cream solids
Sour milk solids
Tagatose
Whey (in all forms)
Whey protein hydrolysate
Yogurt

Other Possible Sources of Milk:

Artificial butter flavor
Baked goods and desserts
Breakfast foods (e.g. cereals, pancakes, waffles)
Caramel candies
Chocolate
Lactic acid starter culture and other bacterial cultures
Luncheon meat, hot dogs and sausages, which may use the milk protein casein as a binder. Also, deli meat slicers are often used for both meat and cheese products, leading to cross-contact.
Margarine
Nisin
Non-dairy products, as many contain casein
Nougat
Pantry Staples (e.g. breads, pasta, tortillas)
Shellfish is sometimes dipped in milk to reduce the fishy odor. Ask questions when buying shellfish.
Sherbert
Snack foods (e.g. chips, crackers, pretzels)
Tuna fish, as some brands contain casein
Some specialty beverages (e.g. smoothies, lattes) made with milk substitutes (i.e., soy-, nut- or rice-based dairy products) are manufactured on equipment shared with milk.
Many restaurants put butter on grilled steaks to add extra flavor. You can’t see the butter after it melts.
Some medications (e.g., psyllium, Advair diskus, Flovent diskus, some probiotics) contain milk protein.

EGG ALLERGY

AVOIDING EGGS

To prevent a reaction, it is very important that you avoid eggs and egg products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

The whites of an egg contain the proteins that most commonly cause allergic reactions to egg. If you have an egg allergy, you must avoid eggs completely (both the egg white and the egg yolk). Even if you aren’t allergic to egg yolk proteins, it is impossible to separate the egg white completely from the yolk. Cross-contact will always be a concern.

If you are allergic to chicken eggs, your doctor may recommend you also avoid eggs from other domestic animals. Eggs from birds such as ducks, geese, turkeys and quails can cause a cross-reaction.

WHAT IS EGG ALLERGY

Hen’s egg allergy is among the most common food allergies in infants and young children, but is less common in older children and adults. Most children eventually outgrow their allergy to egg (71% by 6 years of age),1 although some individuals remain allergic to egg throughout their lives.

When a person with an egg allergy is exposed to egg, proteins in the egg bind to specific IgE antibodies made by the person’s immune system. This triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe.

Approximately 70% of children with egg allergy tolerate baked egg.2 Heating disrupts the protein responsible for egg allergy. The safe and regular ingestion of baked egg foods can lead to tolerance or resolution of egg allergy over time.3 Speak to your allergist before trialing baked egg products at home.

Allergens are not always present in these foods and products, but egg protein can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.

ALLERGIC REACTIONS TO EGGS

Symptoms of an egg allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. Allergic reactions can be unpredictable, and even very small amounts of egg can cause one.

If you have an egg allergy, keep an epinephrine injection device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

Avoid foods that contain EGGS

Baked goods (although some people can tolerate these foods—consult with your allergist)
Breakfast foods (e.g. pancakes, waffles)
Breads (may be coated with an egg wash)
Cake decorations or fillings (e.g. buttercream, frosting, mousse)
Chips
Crackers
Egg substitutes
Hollandaise
Ice cream, custard, sorbet
Lecithin
Marzipan
Marshmallows
Nougat
Pasta: Most commercially made cooked pastas (including those in prepared foods such as soup) contain egg. Boxed, dry pastas are usually egg-free. But these types of pasta 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 any pasta.
Pretzels (sometimes covered in egg wash before they are dipped in salt)
Salad dressings
Souffle Specialty coffee drinks and bar drinks (eggs can be used in the foam or topping)
Tortillas

SHELLFISH ALLERGY

AVOIDING SHELFISH

To prevent a reaction, it is very important to avoid all shellfish and shellfish products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

Most people who are allergic to one group of shellfish are allergic to other types. Your allergist will usually recommend you avoid all kinds of shellfish. If you are allergic to a specific type of shellfish but want to eat other shellfish, talk to your doctor about further allergy testing.

Steer clear of seafood restaurants, where there is a high risk of food cross-contact. You should also avoid touching shellfish and going to fish markets. Being in any area where shellfish are being cooked can put you at risk, as shellfish protein could be in the steam.

Crustacean shellfish are one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. For crustacean shellfish, the specific variety must also be identified on the package such as crab or shrimp.

Mollusks are not required to be labeled in the U.S. at this time and may be present in a food item unexpectedly.

WHAT IS SHELFISH ALLERGY?

Shellfish allergies are the most common food allergies in adults and among the most common food allergies in children. Approximately 2% of the U.S. population reports an allergy to shellfish.1 Shellfish allergies are usually lifelong.

When a person with an allergy to a particular shellfish is exposed to that shellfish, proteins in the shellfish bind to specific IgE antibodies made by the person’s immune system. This triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe.

There are two groups of shellfish: crustaceans (such as shrimp, prawns, crab and lobster) and mollusks/bivalves (such as clams, mussels, oysters, scallops, octopus, squid, abalone, snail). Allergy to crustaceans is more common than allergy to mollusks, with shrimp being the most common shellfish allergen for both children and adults.

Finned fish and shellfish are not closely related. Being allergic to one does not always mean that you must avoid both, though care is needed to prevent cross-contact between fish and shellfish. Discuss this issue in detail with your allergist to make sure the appropriate food restrictions are implemented.

Note: The federal government does not require mollusks to be fully disclosed on product labels.

Shellfish are sometimes found in the following:

Bouillabaisse
Cuttlefish ink
Glucosamine
Fish stock
Seafood flavoring (e.g., crab or clam extract)
Fish stock or fish sauce (sometimes made from krill)
Surimi

ALLERGIC REACTIONS TO SHELFISH

Shellfish can cause severe and potentially life-threatening allergic reactions (such as anaphylaxis). Allergic reactions can be unpredictable, and even very small amounts of shellfish can cause one.

If you have a shellfish allergy, keep an epinephrine injection device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

AVOID FOOD THAT CONATAIN SHELFISH

Barnacle
Crab
Crawfish (crawdad, crayfish, ecrevisse)
Krill
Lobster (langouste, langoustine, Moreton bay bugs, scampi, tomalley)
Prawns
Shrimp (crevette, scampi)
Your doctor may advise you to avoid mollusks* or these ingredients:
Abalone
Clams (cherrystone, geoduck, littleneck, pismo, quahog)
Cockle
Cuttlefish
Limpet (lapas, opihi)
Mussels
Octopus
Oysters
Periwinkle
Sea cucumber
Sea urchin
Scallops
Snails (escargot)
Squid (calamari)
Whelk (Turban shell)

FISH ALLERY

AVOIDING FISH

To prevent a reaction, it is very important to avoid all fish and fish products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

Steer clear of seafood restaurants, where there is a high risk of food cross-contact. You should also avoid touching fish and going to fish markets. Being in any area where fish are being cooked can put you at risk, as fish protein could be in the steam.

More than half of people who are allergic to one type of fish are also allergic to other fish. Your allergist will usually recommend you avoid all fish. If you are allergic to a specific type of fish but want to eat other fish, talk to your doctor about further allergy testing and recommendations.

Finned fish is one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. This makes it easy to see if finned fish is present in a food item.

WHAT IS FISH ALLERGY?

Finned fish is one of the most common food allergies with a prevalence of 1% in the U.S. population. In one study, salmon, tuna, catfish and cod were the fish to which people most commonly reported allergic reactions.

When a person with an allergy to a particular fish is exposed to that fish, proteins in the fish bind to specific IgE antibodies made by the person’s immune system. This triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe.

Allergens are not always present in these food and products, but fish can appear in surprising places. Again, read food labels and ask questions if you’re ever unsure about an item’s ingredients.

ALLERGIC REACTIONS TO FISH

To prevent a reaction, it is very important to avoid all fish and fish products. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

AVOID FOOD THAT CONATAIN SHELFISH

Anchovies
Bass
Catfish
Cod
Flounder
Grouper
Haddock
Hake
Halibut
Herring
Mahi mahi
Perch
Pike
Pollock
Salmon
Scrod
Sole
Snapper
Swordfish
Tilapia
Trout
Tuna
Also avoid these fish products:
Fish Flavoring
Fish gelatin, made from the skin and bones of fish
Fish oil
Fish sticks (some people make the mistake of thinking these don’t contain real fish)
Some Unexpected Sources of Fish
Barbecue sauce
Bouillabaisse
Caesar salad and Caesar dressing
Caponata, a Sicilian eggplant relish
Imitation or artificial fish or shellfish (e.g., surimi, also known as “sea legs” or “sea sticks”)
Worcestershire sauce
Certain multicultural cuisines (especially African, Chinese, Indonesian, Thai and Vietnamese). Many contain hidden sources of fish (e.g., kimchi made with fish sauce) and —even if you order a fish-free dish, there is high risk of cross-contact.

GLUTEN ALLERGY

AVOIDING GLUTEN

To prevent a reaction, it is very important that you avoid wheat and wheat-containing foods. Always read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

Wheat is the most common grain product in the United States. Patients with wheat allergy rarely are allergic to other common grains except in some cases, barley. You can still eat a wide variety of foods, but the grain source must be something other than wheat. Look for other grains such as amaranth, barley, corn, oat, quinoa, rice, rye and tapioca.

A combination of wheat-free flours usually works best for baking. Experiment with different blends to find one that will give you the texture you desire.

Wheat is one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. This makes it easy to see if wheat is present in a food item.

WHAT IS GLUTEN ALLERGY?

Wheat allergy is most often reported in young children and may affect up to 1% of children in the U.S. One study found that two-thirds of children with a wheat allergy outgrow it by age 12.1 However, some individuals remain allergic to wheat throughout their lives.

When a person with a wheat allergy is exposed to wheat, proteins in the wheat bind to specific IgE antibodies made by the person’s immune system. This binding triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe.

Wheat allergy and celiac disease are both adverse food reactions, but their underlying causes are very different. Wheat allergy results from an adverse immunologic (IgE-mediated) reaction to proteins in wheat and reactions can cause typical allergy symptoms involving the skin, gastrointestinal tract, respiratory system, and anaphylaxis in some individuals.1

Celiac disease is an autoimmune disease. Antibodies are produced in response to the presence of gluten resulting in inflammation and damage to the lining of the small intestine. Many symptoms involve the gastrointestinal tract (e.g., diarrhea, constipation, weight loss, abdominal pain and bloating). Other symptoms can include skin rashes and disorders that result from nutrient deficiencies. The estimated global prevalence of celiac disease is 1%, similar to wheat allergy.2

It’s important to work with your physician to determine an accurate diagnosis to prevent short- and long-term complications.

Wheat is sometimes found in the following:

Glucose syrup
Soy sauce
Starch (gelatinized starch, modified starch, modified food starch, vegetable starch)

ALLERGIC REACTIONS TO GLUTEN

Symptoms of a wheat allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. Allergic reactions can be unpredictable, and even very small amounts of wheat can cause one.

If you have a wheat allergy, keep an epinephrine injection device you at all times. Epinephrine is the first-line treatment for anaphylaxis.

AVOID FOOD THAT CONATAIN GLUTEN

Bread crumbs
Bulgur
Cereal extract
Club wheat
Couscous
Cracker meal
Durum
Einkorn
Emmer
Farina
Farro
Flour (all-purpose, bread, cake, durum, enriched, graham, high-gluten, high-protein, instant, pastry, self-rising, soft wheat, steel ground, stone ground, whole wheat)
Freekeh
Hydrolyzed wheat protein
Kamut®
Matzoh, matzoh meal (also spelled as matzo, matzah or matza)
Pasta
Seitan
Semolina
Spelt
Sprouted wheat
Triticale
Vital wheat gluten
Wheat (bran, durum, germ, gluten, grass, malt, sprouts, starch)
Wheat bran hydrolysate
Wheat germ oil
Wheat grass
Wheat protein isolate
Whole wheat berries
Buckwheat is not related to wheat and is considered safe to eat.