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Food allergy

A food allergy is when the body's immune system reacts unusually to specific foods. Allergic reactions are often mild, but they can sometimes be very serious.

A food allergy is when the body's immune system reacts unusually to specific foods.

Allergic reactions are often mild, but they can sometimes be very serious.

In young children, common food allergies include milk and eggs. In adults, allergies to fruit and vegetables are more common. Nut allergies, including peanuts, are relatively common in both school-age children and adults.

Symptoms of a food allergy can affect different areas of the body at the same time. Some common symptoms include:

  • an itchy sensation inside the mouth, throat or ears
  • a raised itchy red rash (known as urticaria or hives)
  • swelling of the face, around the eyes, lips, tongue and roof of the mouth (known as angioedema)
  • vomiting

Read more about the symptoms of food allergies.

Anaphylaxis

In the most serious cases, a person has a severe allergic reaction (anaphylaxis), which can be life-threatening.

If you think someone has the symptoms of anaphylaxis – such as breathing difficulties, lightheadedness and feeling like they are going to faint or lose consciousness – call 999, ask for an ambulance and tell the operator you think the person has anaphylaxis or "anaphylactic shock".

What causes food allergies?

Food allergies happen when the immune system (the body’s defence against infection) mistakenly treats proteins found in food as a threat.

As a result, a number of chemicals are released. It is these chemicals that cause the symptoms of an allergic reaction.

Almost any food can cause an allergic reaction, but there are certain foods that are responsible for most food allergies.

In children, the foods that most commonly cause an allergic reaction are:

  • milk
  • eggs
  • peanuts
  • tree nuts
  • fish
  • shellfish

Most children that have a food allergy will have experienced eczema during infancy. The worse the child's eczema and the earlier it started, the more likely they are to have a food allergy.

In adults, the foods that most commonly cause an allergic reaction are:

  • peanuts
  • tree nuts  such as walnuts, brazil nuts, almonds and pistachios
  • fish
  • crustaceans (shellfish)  such as crab, lobster and prawns

It's still unknown why people develop allergies to food, although they often have other allergic conditions, such as asthma, hay fever and eczema.

Read more information about the causes and risk factors for food allergies.

Types of food allergies

Food allergies are divided into three types, depending on symptoms and when they occur.

  • IgE-mediated food allergy  the most common type, triggered by the immune system producing an antibody called immunoglobulin E (IgE). Symptoms occur a few seconds or minutes after eating. There is a greater risk of anaphylaxis with this type of allergy.
  • non-IgE-mediated food allergy  these allergic reactions are not caused by immunoglobulin E, but by other cells in the immune system. This type of allergy is often difficult to diagnose as symptoms take much longer to develop (up to several hours).
  • mixed IgE and non-IgE-mediated food allergies  some people may experience symptoms from both types.

Read more information about the symptoms of a food allergy.

Oral allergy syndrome

Some people experience itchiness in their mouth and throat (sometimes with mild swelling) immediately after eating fresh fruit or vegetables. This is known as oral allergy syndrome.

Oral allergy syndrome is not a true food allergy. It is caused by allergy antibodies mistaking certain proteins in fresh fruits, nuts or vegetables for pollen.

Oral allergy syndrome generally does not cause severe symptoms, and it is possible to deactivate the allergens by thoroughly cooking any fruit and vegetables.

Allergy UK has more information on oral allergy syndrome.

Treatment

There is no treatment to cure a food allergy. The best way of preventing an allergic reaction is to identify the food that causes the allergy and then avoid it.

Read more about identifying foods that cause allergies (these are known as allergens).

However, avoid making any radical changes to your or your child’s diet, such as cutting dairy products, without first talking to your GP. You should speak to a dietician before making any changes.

A type of medication called an antihistamine can help relieve the symptoms of a mild or moderate allergic reaction. A higher dose of antihistamines is often needed to control symptoms.

Adrenaline is also an effective treatment for anaphylaxis.

People with a food allergy are often given a device, known as an auto-injector pen, which contains doses of adrenaline that can be used in emergencies.

Read more about the treatment of food allergies

When to seek medical advice

If you think you or your child may have a food allergy, it's very important to ask for a professional diagnosis from your GP. They can then refer you to an allergy clinic.

The National Institute for Health and Care Excellence (NICE) has also released a short guide for parents (PDF, 104kb) who think their child may have a food allergy.

Many parents mistakenly assume their child has a food allergy, when their symptoms are actually due to a completely different condition.

Commercial allergy-testing kits are available, but their use is not recommended. Many kits are based on unsound scientific principles. Even if they are reliable, you should have the results looked at by a health professional.

Read more about diagnosing food allergies.

Who is affected

Most food allergies affect younger children aged under the age of three. It is estimated that around one in every 14 children of this age has at least one food allergy.

Most children who have food allergies to milk, eggs, soya and wheat in early life will "outgrow" this allergy by the time they start school.

Peanut and tree-nut allergies are usually more persistent. An estimated four out of five children with peanut allergies remain allergic to peanuts for the rest of their lives.

Food allergies that develop during adulthood, or persist into adulthood, are likely to be lifelong allergies.

For reasons that are unclear, rates of food allergies have risen sharply in the last 20 years.

However, deaths from anaphylaxis-related food reactions are now very rare. There are around 10 deaths related to food allergies in England and Wales each year.



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Food allergy

Symptoms of a food allergy include a raised, itchy red rash, swelling of the face, eyes, lips, tongue, and a shortness of breath.

The symptoms of a food allergy almost always develop a few seconds or minutes after eating the food.

Some people may develop a severe allergic reaction (anaphylaxis), which can be life-threatening.

The most common type of allergic reaction to food is known as an IgE-mediated food allergy.

Symptoms include:

  • tingling or itching in the mouth
  • a raised, itchy red rash (urticaria) – in some cases, the skin can turn red and itchy, but without a raised rash
  • swelling of the face, mouth (angioedema) or other areas of the body
  • difficulty swallowing
  • wheezing or shortness of breath
  • feeling dizzy and lightheaded
  • feeling sick (nausea) or vomiting
  • abdominal pain or diarrhoea
  • hay fever-like symptoms, such as sneezing or itchy eyes (allergic conjunctivitis)

Anaphylaxis

The symptoms of a severe allergic reaction (anaphylaxis) can be sudden and get worse very quickly.

Initial symptoms of anaphylaxis are often the same as those listed above and can lead to:

  • increased breathing difficulties  such as wheezing and a cough
  • a sudden and intense feeling of anxiety and fear
  • a rapid heartbeat (tachycardia)
  • a sharp and sudden drop in your blood pressure, which can make you feel light-headed and confused
  • unconsciousness

Anaphylaxis is a medical emergency. Without quick treatment, it can be life-threatening. If you think you or someone you know is experiencing anaphylaxis, dial 999 and ask for an ambulance as soon as possible.

Non-IgE-mediated food allergy

Another type of allergic reaction is a non-IgE-mediated food allergy. The symptoms of this type of allergy can take much longer to develop – sometimes up to several days.

Some symptoms of a non IgE-mediated food allergy may be what you would expect to see in an allergic reaction, such as:

  • redness and itchiness of the skin  although not a raised, itchy red rash (urticaria)
  • the skin becomes itchy, red, dry and cracked (atopic eczema)

Other symptoms can be much less obvious and are sometimes thought of as being caused by something other than an allergy. They include:

  • heartburn and indigestion that is caused by stomach acid leaking up out of the stomach (gastro-oesophageal reflux disease)
  • stools (poo) becoming much more frequent or loose (though not necessarily diarrhoea)
  • blood and mucus in the stools
  • in babies: excessive and inconsolable crying, even though the baby is well-fed and doesn't need a nappy change (colic)
  • constipation 
  • redness around the anus, rectum and genitals
  • unusually pale skin
  • failure to grow at the expected rate

Mixed reaction

Some children can have a mixed reaction where they experience both "IgE" symptoms, such as swelling, and "non-IgE" symptoms, such as constipation.

This often happens to children who have a milk allergy.

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Food allergy

A food allergy is caused when your immune system mistakenly treats harmless proteins found in certain foods as a threat. It releases a number of chemicals, which then triggers an allergic reaction.

A food allergy is caused when your immune system mistakenly treats harmless proteins found in certain foods as a threat. It releases a number of chemicals, which then triggers an allergic reaction.

The immune system

The immune system protects the body by producing specialised proteins called antibodies.

Antibodies identify potential threats to your body, such as bacteria and viruses. They then signal to your immune system to release chemicals to kill the threat and prevent the spread of infection.

In the most common type of food allergy, an antibody known as immunoglobulin E (IgE) mistakenly targets a certain protein found in food as a threat. IgE can cause several chemicals to be released, the most important being histamine.

Histamine

Histamine causes most of the typical symptoms that occur during an allergic reaction. For example, histamine:

  • causes small blood vessels to expand and the surrounding skin to become red and swell up
  • affects nerves in the skin, causing itchiness
  • increases the amount of mucus produced in your nose lining, which causes itching and a burning sensation

In most food allergies, the release of histamine is limited to certain parts of the body, such as your mouth, throat or skin.

In anaphylaxis, the immune system goes into overdrive and releases massive amounts of histamine and many other chemicals into your blood. This causes the wide range of symptoms associated with anaphylaxis.

Non-IgE-mediated food allergy

There is another type of food allergy, known as a non-IgE-mediated food allergy, caused by different cells in the immune system. This is much harder to diagnose as there is no test to accurately confirm non-IgE-mediated food allergy.

This type of reaction is largely confined to the skin and digestive system, causing symptoms such as heartburn, indigestion and eczema.

In babies, a non-IgE-mediated food allergy can also cause diarrhoea and reflux (stomach acid leaks up into the throat).

Foods

In children, the foods that most commonly cause an allergic reaction are:

  • eggs
  • milk  if a child has an allergy to cow's milk, they are probably allergic to all types of milk, as well as infants' and follow-on formula
  • soya
  • wheat
  • peanuts

In adults, the foods that most commonly cause an allergic reaction are:

  • peanuts
  • tree nuts – such as walnuts, brazil nuts, almonds and pistachios
  • fish
  • crustaceans (shellfish) – such as crab, lobster and prawns

However, any type of food can potentially cause an allergy.

Allergic reactions have been reported in association with:

  • celery or celeriac – this can sometimes cause anaphylactic shock
  • gluten – a type of protein found in cereals
  • mustard
  • sesame seeds
  • fruit and vegetables  these usually only cause symptoms affecting the mouth, lips and throat (oral allergy syndrome)
  • pine nuts (a type of seed)
  • meat  some people are allergic to just one type of meat, while others are allergic to a range of meats; a common symptom is skin irritation

Who is at risk?

Exactly what causes the immune system to mistake harmless proteins as a threat is unclear. However, a number of risk factors for food allergies have been identified, which are outlined below.

Family history

If you have a parent, brother or sister with an allergic condition – such as asthma, eczema or a food allergy – you have a slightly higher risk of developing a food allergy. However, you may not develop the same food allergy as your family members.

Other allergic conditions

Children who have atopic dermatitis (eczema) in early life are more likely to develop a food allergy.

The rise in food allergy cases

The number of people with food allergies has risen sharply over the past few decades, although the reason is unclear. For example, the number of children admitted to hospital for food-related anaphylaxis since 1990 has risen seven-fold.

One theory behind the rise is that a typical child’s diet has changed considerably over the last 30 to 40 years.

Another theory is that children are increasingly growing up in "germ-free" environments. This means that their immune systems may not receive sufficient early exposure to the germs needed to develop properly. This is known as the hygiene hypothesis.

Food additives

It is rare for someone to have an allergic reaction to food additives. However, certain additives may cause a flare-up of symptoms in people with pre-existing conditions.

Sulphites

Sulphur dioxide (E220) and other sulphites (E221, E222, E223, E224, E226, E227 and E228) are used as preservatives in a wide range of foods, especially soft drinks, sausages, burgers, and dried fruits and vegetables.

Sulphur dioxide is produced naturally when wine and beer are made. It is often added to wine to stop it from continuing to ferment in the bottle. Usually, most of the "head space" in a bottle of wine (the part of the bottle not filled with wine) is sulphur dioxide.

Anyone who has asthma or allergic rhinitis may react to inhaling sulphur dioxide. A few people with asthma have had an attack after drinking acidic drinks containing sulphites, but this is not thought to be very common.

Food labelling rules require pre-packed food sold in the UK, and the rest of the European Union, to show clearly on the label if it contains sulphur dioxide or sulphites at levels above 10mg per kg or per litre.

Benzoates

Benzoic acid (E210) and other benzoates (E211, E212, E213, E214, E215, E218 and E219) are used as food preservatives to prevent yeasts and moulds from growing, most commonly in soft drinks. They occur naturally in fruit and honey.

Benzoates could make the symptoms of asthma and eczema worse in children who already have these conditions.

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Food allergy

There is no cure for food allergies, although many children will grow out of certain ones, such as allergies to milk and eggs. The most effective way you can prevent symptoms is to remove the offending food (known as an allergen) from their diet.

The advice here is primarily written for parents of a child with a food allergy. However, most of it is also relevant if you are an adult with a food allergy.

Your child’s diet

There is no cure for food allergies, although many children will grow out of certain ones, such as allergies to milk and eggs. The most effective way you can prevent symptoms is to remove the offending food (known as an allergen) from their diet.

However, it's important to check with your GP or the doctor in charge of your child’s care first before eliminating certain foods.

Removing eggs or peanuts from a child's diet is not going to have much of an impact on their nutrition. Both types of these are a good source of protein, but can be replaced by other alternative sources.

A milk allergy can have more of an impact as milk is a good source of calcium, but there are many other ways you can include calcium in your child’s diet, including green leafy vegetables.

Many foods and drinks are fortified with extra calcium.

If you are concerned that your child’s allergy is affecting their growth and development, see your GP.

Reading labels

It's very important to check the label of any pre-packed food or drinks your child has, in case it contains ingredients they are allergic to.

Under EU law, any pre-packed food or drink sold in the UK must clearly state on the label if it contains the following ingredients:

  • celery
  • cereals that contain gluten (including wheat, rye, barley and oats)
  • crustaceans (including prawns, crabs and lobsters)
  • eggs
  • fish
  • lupin (lupins are common garden plants, and the seeds from some varieties are sometimes used to make flour)
  • milk
  • molluscs (including mussels and oysters)
  • mustard
  • tree nuts  such as almonds, hazelnuts, walnuts, brazil nuts, cashews, pecans, pistachios and macadamia nuts
  • peanuts
  • sesame seeds
  • soybeans
  • sulphur dioxide and sulphites (preservatives that are used in some foods and drinks) at levels above 10mg per kg or per litre

Some food manufacturers also choose to put allergy advice warning labels (for example, "contains nuts") on their pre-packed foods if they contain an ingredient that is known to commonly cause an allergic reaction, such as peanuts, eggs or milk.

However, these are not compulsory. If there is no allergy advice box or "contains" statement on a product, it could still have any of the 14 specified allergens in it.

Look out for "may contain" labels, such as "may contain traces of peanut". Manufacturers sometimes put this label on their products to warn consumers that they may have become contaminated with another food product when being made.

Read more detailed information about allergen labelling on the Food Standards Agency website.

Some non-food products contain allergy-causing food:

  • Some soaps and shampoos contain soy, egg and tree nut oil.
  • Some pet foods contain milk and peanuts.
  • Some glues and adhesive labels used on envelopes and stamps contain traces of wheat.

Again, read the labels of any non-food products that your child may come into close physical contact with.

Unpackaged food

Currently, unpackaged food doesn't need to be labelled in the same way as packaged food. This can make it more difficult to know what ingredients are in a particular dish.

Examples of unpackaged food include food sold from:

  • bakeries (including in-store bakeries in supermarkets)
  • delis
  • salad bars
  • "ready-to-eat" sandwich shops
  • takeaways
  • restaurants

If you or your child have a severe food allergy, you need to be careful when you eat out.

The following advice should help:

  • Let the staff know. When booking a table at a restaurant, make sure the staff know about your child’s allergy. Ask for a firm guarantee that the food you or your child is allergic to won't be in any of the dishes served. The Food Standards Agency (FSA) offers chef cards that provide information about your child’s food allergy, which you can give to restaurant staff. As well as informing the chef and kitchen staff involved in cooking your food, let waiters and waitresses know so they understand the importance of avoiding cross-contamination when serving you.
  • Read the menu carefully and check for "hidden ingredients". Some food types contain other foods that can trigger allergies, which restaurant staff may have overlooked. Some desserts contain nuts (such as a cheesecake base) and some sauces contain wheat and peanuts.
  • Prepare for the worst. It's a good idea to prepare for any eventuality. Always take your child’s anti-allergy medication with you when eating out, particularly if they have been given an auto-injector of adrenalin (read more about treating food allergies with a auto-injector).
  • In older children, you can use what is known as a "taste-test". Before your child begins to eat, ask them to take a tiny portion of the food and rub it against their lips to see if they experience a tingling or burning sensation. If they do, it suggests that the food will cause them to have an allergic reaction. However, the "taste-test" doesn't work for all foods, so it shouldn't be used as a substitute for the above advice.

The FSA has produced a factsheet about buying food and eating out with a food allergy (PDF, 220kb).

Further advice

Here is some more advice for parents: 

  • Notify your child's school about their allergy. Depending on how severe your child’s allergy is, it may be necessary to give the staff at their school an emergency action plan in case of accidental exposure. Arrange for the school nurse or another staff member to hold a supply of adrenalin. Food allergy bracelets are also available, which explain how other people can help your child in an emergency.
  • Let other parents know. Young children may easily forget about their food allergy and accept food that they shouldn't have when visiting other children. Telling the parents of your child’s friends about their allergy should help prevent this.
  • Educate your child. Once your child is old enough to understand their allergy, it's important to give them clear, simple instructions about what foods to avoid and what they should do if they accidentally eat them. 


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Food allergy

Once you have been diagnosed as having a food allergy, you will receive advice about antihistamines, adrenaline and using an auto-injector.

There are two main types of medication that can be used to relieve the symptoms of an allergic reaction to foods:

  • antihistamines, which can be used to treat mild to moderate allergic reaction
  • adrenaline, which can be used to treat severe allergic reactions (anaphylaxis)

Antihistamines

Antihistamines work by blocking the effects of histamine, which is responsible for many of the symptoms of an allergic reaction.

Many antihistamines are available from your pharmacist without prescription  stock up in case of an emergency. Non-drowsy antihistamines are preferred.

Some antihistamines, such as alimemazine and promethazine, aren't suitable for children under two years old. If you have a younger child with a food allergy, ask your GP about what types of antihistamines may be suitable.

Avoid drinking alcohol after taking an antihistamine as this can make you feel drowsy.

Adrenaline

Adrenaline works by narrowing the blood vessels to counteract the effects of low blood pressure, and by opening up the airways to help ease breathing difficulties.

If you or your child is at risk of anaphylaxis or has had a previous episode of anaphylaxis, you will be given an auto-injector of adrenaline to use in case of emergencies.

Carefully read the manufacturer’s instructions that come with the auto-injector and when your child is old enough, train them how to use it (see below).

Using an auto-injector

If you suspect that somebody is experiencing the symptoms of anaphylaxis, call 999 and ask for an ambulance. Tell the operator that you think the person has anaphylaxis.

Older children and adults will probably have been trained to inject themselves. You may need to inject younger children, or older children and adults who are too sick to inject themselves.

There are three types of auto-injectors:

All three work in much the same way. If anaphylaxis is suspected, you should remove the safety cap from the injector, place it against your outer thigh (holding it at a right angle) and hold down the firing button at the end of the injector. The injections can be given through clothing.

This will send a needle into your thigh and deliver a dose of adrenaline. You need to hold down the button for 10 seconds.

If the person is unconscious, check their airways are open and clear, and check their breathing. Then put them in the recovery position (see below). Putting someone who is unconscious in the recovery position ensures they do not choke on their vomit.

Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin.

If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed.

Owning an auto-injector

As a precaution, the following advice should be taken: 

  • Carry the auto-injector at all times or encourage your child to do so if they are old enough. You may be recommended to carry multiple injectors  check with your GP or the doctor in charge of your care. You may also be given an emergency card or bracelet with full details of your child’s allergy and contact details of their doctor, to alert others. They should wear this at all times.
  • Extreme temperatures can make adrenaline less effective. Do not leave an auto-injector in places such as your fridge or the glove compartment of your car.
  • Check the expiry date regularly. EpiPen and Jext have a shelf life of 18 months after the date of manufacture, and Anapen has a shelf life of two years. An out-of-date injector will only offer limited protection.
  • The manufacturers offer a reminder service, where you can be contacted near the date of expiry. Check the information leaflet that comes with the medication for more information.
  • If your child has an auto-injector, they will need to change over to an adult dose once they reach a weight of 30 kilos (4.7 stone). Depending on the shape and size of your child’s body, this could be anywhere between the ages of 5 and 11 years old.
  • Do not delay injecting if you think you or your child may be experiencing the start of anaphylaxis, even if the initial symptoms are mild. It's better to use adrenaline early and find out it was a false alarm than delay treatment until you are sure your child is experiencing severe anaphylaxis. 
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Food allergy

Jane Bell is mother to Lilly, born in August 1997, who developed multiple allergies in her first few months of life. This is Jane and Lilly’s story.

Jane Bell is mother to Lilly, born in 1997, who developed multiple allergies in her first few months of life. This is Jane and Lilly’s story.

"Lilly had breathing and feeding difficulties as soon as she was born. She struggled to take anything in, brought up most of it and had extreme colic. Her bowel movements were very loose, yellow and pungent. She only gained 7oz in the first eight weeks. At 10 weeks, I took her to my GP because my instinct told me something was seriously wrong. Over the next 5 months, these visits became quite regular."

"Lilly was diagnosed with gastroenteritis 12 times and received replacement fluids, followed by a re-introduction of milk. When milk was re-introduced, it was barely a few hours before her symptoms re-emerged, each time becoming more aggressive."

"We were referred to the local hospital, where it was suggested that Lilly may be intolerant to milk. She was swapped to soya-based infant formula, but her symptoms didn't improve."

"At nine months, Lilly became seriously ill. Her faeces had turned to jelly, she was pale and clammy, and we couldn't wake her. We rushed her to hospital and the consultant told us our daughter was probably suffering from an allergy to her feed. Over the next few weeks, she was nasally fed with clear fluids and through a drip, until her symptoms subsided."

"Once she was stable, milk and soya were both re-introduced separately and Lilly reacted to both. At this point, she was started on Neocate, an amino-acid-based formula for highly allergic infants. Her gastroenterologist explained that her system would take some time to settle as it had taken so long to reach a diagnosis."

"Over the next three years, Lilly underwent vast amounts of tests, food challenges and scans. She spent long periods in hospital on drips and nasal feeding, as her system was too weak to cope with normal childhood illnesses. It took two years for her system to calm down, and she remains severely allergic to all milk products, soya, eggs, nuts, mango and some antibiotics."

"As she grows up, policing Lilly's every move becomes more difficult each year. We can only hope that, with guidance and an exact understanding of her allergies, she will stay safe."

"When asked now what parents should do if they think their child may have a food allergy, I always tell them to listen to their instincts and I refer them to Allergy UK, which has been an amazing source of support."

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