Food Allergy Living Blog Tagged Results

allergic reaction

Hidden Allergens in Medications

Posted 9.16.10 | Sarah O'Brien

One more thing to watch out for – hidden allergens in medications!Yep, those medications that are supposed to help us feel better can also be harmful to those with food allergies.

Nita wrote a post about hidden allergens that could be lurking in vaccines, Christine wrote about hidden allergens in non-food related items and it led me to think of other places allergens could be lurking.We sometimes get questions about a sudden and mysterious onset of rashes or change in bowel movements or other types of allergy symptoms and after reviewing all the potential causes we often end up with a change in medication or a new medication as the culprit.

Corn and wheat are the two common allergens you’ll find in a variety of medications. But dairy, potatoes and coconut are also common. Lactose is used in more than 20% of prescription drugs and about 6% in over-the-counter medicines. Many inhalers, such as Advair® or Serevent® contain lactose which can affect someone with a milk allergy. Some medications used to treat asthma and/or allergies such as Claritin®, Benadryl® and Prednisone® can also contain lactose.

It’s good to be aware of FDA regulations for labeling food and medicine; they are not quite the same. For example “starch” on a food label means cornstarch.On a medicine label, it could mean potato, corn, tapioca or wheat starch.

Generic vs. Brand Name Drugs

Be careful when taking generic drugs vs brand name drugs. A generic drug must be chemically identical to its brand name equivalent and must pass through tests to prove its strength. However, the generic drug does not necessarily contain the same inactive ingredients. Kids with Food Allergies has more information about ingredient differences in generic vs brand name drugs on their website.

Even different dosages of the same medications can have varying ingredients.The 10 mg tablets of Singulair® also contains lactose, however the 4mg and 5mg versions do not.

As with foods, make sure you read the label for medications prior to purchase and watch out for hidden allergens.It’s always good practice to consult with your physician before starting or switching any medications.

Have you experienced an allergic reaction due to a hidden allergen in any medications?

- Sarah

[Image Source]

Toothpaste, flip flops, stickers and other unusual places where food allergens could be hiding

Posted 7.20.10 | Christine Graham-Garo

I have a friend whose daughter has severe gluten allergies. We often have long conversations about what it’s like to live with a child who has severe allergies, but one story she shared with me stands out. Her daughter was starting to get a horrible rash on her feet, and my friend could not understand what was causing it. After some investigative work, it turns out it was her daughter’s new flip flops! The sandals had gluten on them. She had found out by calling the manufacturer and was able to locate the culprit.

I was truly stunned by this! My friend works so hard at avoiding gluten by looking over all food labels and yet, there it was, in her daughters’ flip flops. This got me thinking; what other things are gluten and other allergens hiding in? Here is a list of some surprising hidden allergens in products other than food:


  • Adhesives on envelopes and stamps
  • Self-stick labels and stickers
  • Latex or rubber gloves for house cleaning
  • Art supplies like play dough, clay, glue
  • Hand lotion
  • Shampoos


  • Chewing gum
  • Toothpaste
  • Sunscreen
  • Clothing


  • Adhesives
  • Body lotions and creams
  • Fabrics
  • Paper
  • Printing Inks
  • Soaps

What are some weird and unusual places you have found an allergen? It always helps to discuss your findings with other families to help them in avoiding accidental exposure and frustrations! We’d also love to hear about any “safe” products you are using.



Accidental Injections of Epinephrine From An Epipen

Posted 7.8.10 | Mallory West

Self-administrated shots of epinephrine (often referred to by their brand names: EpiPen and Twinject) are life-saving devices which can halt an allergic reaction and give a patient time to get to a hospital. For children and adults who experience anaphylaxis, an epinephrine shot is a matter of life or death. But it’s important for patients and caregivers to know how to properly work an automatic epinephrine shot. An incorrect or accidental administration can have dangerous consequences.

Accidental Epipen Injections & the Consequences:

In order for epinephrine to work properly, it must be injected into the thigh muscle. The greatest risk of an accidental or an incorrect injection is that injecting the epinephrine elsewhere can delay or impair the effectiveness during a time-critical emergency.

Aside from this, there are also risks of an accidental injection in and of itself. An accidental intravenous injection (which is very rare and would be fairly difficult to do on accident), is especially dangerous and can lead to hypertension and/or heart problems[1]. Most accidental injections (an estimated 94%) occur when a patient or someone trying to help them accidentally jabs their finger or thumb[2]. An accidental injection to the hands or feet can impair blood flow to these areas and can potentially cause tissue death. This however, is the worst-case scenario.

Symptoms of an accidental injection are not usually so severe and may include temporary numbness or tingling, pain and swelling at the injection site, elevated heart rate and/or heart palpations. Regardless, you should always seek medical attention in the event of an accidental injection; it’s better safe than sorry!

Know How To Use the Epipen:

It never hurts to refresh your memory on how to use your child’s epinephrine shot. You may even want to print out the instructions and keep them in a handy place (for example, fold it up and keep it with the epinephrine shot). Both EpiPen and Twinject have several resources to teach patients about the proper use of epinephrine shots.

For best results, ask your child’s health care provider to demonstrate how to properly use an epinephrine shot[3]. Research shows that parents who receive hands-on training are better able to properly demonstrate how to use their child’s epinephrine shot[4]. Remind them to be careful! An ironic side note: An estimated 10% of accidental epinephrine injections occur in health care providers when demonstrating to their patients how to use it!

How many of you carry Twinject or EpiPens for your children? Have you ever had to deal with an accidental epinephrine injection?


[1] Epinephrine. Drug Facts and Comparisons. Efacts [online]. 2008. Available from Wolters Kluwer Health, Inc.
Accidental EpiPen injections becoming more common. Annals of Allergy, Asthma and Immunology, April 2009.
Pediatr Pharm.2008;14(5)©2008Children's Medical Center, University of Virginia.
" [4] Arkwright PD, Farragher AJ. Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Pediatr Allergy Immunol 2006;17:227-9.

What does Hypoallergenic Mean?

Posted 3.30.17 | Nutrition Specialist

Most consumers today believe that a product labeled as hypoallergenic will not cause an allergic reaction, but is this really true?

Let’s start with the basics. The technical definition of “hypoallergenic” is that a product is less likely to cause an allergic reaction, or will cause fewer allergic reactions. There are few federal standards that regulate the use of this term for consumer goods. For many products, like cosmetics, the term “hypoallergenic” may be used without ANY evidence or support. Some companies will use certain tests for a product to support that it’s hypoallergenic.

For infant formulas, however, you can rest assured that the term “hypoallergenic” can ONLY be used when certain criteria are met.

What is a Hypoallergenic Infant Formula?

When it comes to infant formulas, based on calls our nutrition specialists receive on a regular basis, many people think the term hypoallergenic means the product is totally void of any and all things that could trigger an allergic reaction. The reality is a bit more complex.

For an infant formula to claim hypoallergenicity it needs to go through study in a clinical trial. The requirements have been based on recommendations by the According to the American Academy of Pediatrics (AAP). According to the AAP, a hypoallergenic infant formula must:

  • Be studied in a clinical trial
  • Be studied in patients with documented cow milk allergy
  • Have been shown to be tolerated by at least 90% of the patients

“Tolerated” means that the formula did not cause an allergic reaction, or that those with cow milk allergy did not have defined symptoms, such as hives, anaphylaxis, or other symptoms of a food allergy.  Only infant formulas made with free amino acids – like Neocate – or extensively hydrolyzed protein, also called peptides, have met the necessary criteria in these studies and can be classified as hypoallergenic. 

Other infant formulas are NOT hypoallergenic. These include formulas made with whole dairy protein, formulas made with soy protein, and formulas made with partially hydrolyzed protein. (Hydrolyzed protein comes from dairy protein, but partially hydrolyzed protein is not broken down as much as extensively hydrolyzed protein.)

Difference Between a Hydrolyzed Formula and Amino Acid-Based Formula

Hydrolyzed formulas are made using protein from dairy, but the milk proteins in those formulas have been broken down into smaller fragments. The body’s immune system may not detect the smaller protein fragments as being an allergen. In some patients with a cow milk allergy, the body still reacts to the protein fragments in extensively hydrolyzed formula, resulting in allergic reactions.

Amino acid-based formulas, which used to be called elemental formulas, use only amino acids as the source of protein. Amino acids are the building blocks of protein, and are too small for the body to recognize as being foreign. They are the least allergenic form of protein.

To help you visualize the difference between these two types of formulas, picture a pearl necklace. In this example our necklace represents the strand of amino acids that make a protein.  If you take the necklace and break it into smaller length strands where several pearls are connected, this would look like the peptides used in partially-hydrolyzed formulas. Even shorter strands of a few pearls will look like the smaller peptides used in an extensively hydrolyzed formula.

If you start with individual pearls, then you have a visual example of an amino acid-based formula. In an amino acid-based formula like Neocate, none of the amino acids are attached to each other. In Neocate, the amino acids are NOT derived from dairy protein. The amino acids in Neocate are synthetic, meaning they’re not derived from meat. Most of them are made from plant sugars, and some are completely synthetic.

Here’s another way to look at infant formulas and their potential for triggering an allergic reaction:

Can a Child React to a Hypoallergenic Infant Formula?

It is possible for a child with food allergies react to formulas made with hydrolyzed protein, or peptides. Amino acid-based formulas, on the other hand, are the least allergenic type of formula, meaning they’re least likely to cause a food allergy reaction.

While two types of infant formulas can claim to be hypoallergenic, based on the information above you can see that the term alone doesn’t guarantee that there will NOT be an allergic reaction. It’s important to look at your child’s individual case and discuss with your healthcare professional the type of hypoallergenic formula – amino acid-based or extensively hydrolyzed - that would best fit your needs.

Here are some additional resources that can be helpful if you are currently evaluating various formula types

EpiPen Safety: How to Keep a Child Safe at School

Posted 2.25.10 | Nutrition Specialist

EpiPens, for any child with allergies, can be a huge life saver. However, sending your little one to school with their EpiPen can be rather stressful for a parent. There are a thousand questions that might go through your mind, “Will they be safe even with the EpiPen?” or “Will someone know how to use the EpiPen?”.

EpiPen and Anaphylactic Shock Basics

For those of you who don’t know, anaphylaxis or anaphylactic shock can be a life-threatening allergic reaction to specific triggers, such as food proteins and medication. This results in hives or swelling of the throat or tongue, which can lead to constricted airways and/or a dramatic drop in blood pressure.

An injection from an EpiPen is imperative when anaphylactic shock occurs and can save a person’s life. An EpiPen is a premeasured dose of epinephrine, which is injected into someone’s body during a severe allergic reaction to avoid or treat the onset and symptoms of anaphylactic shock, which provides a window of time to seek further medical attention. 1

EpiPens at Schools

If you are a parent of a child who is at risk for anaphylactic shock, you probably carry his or her EpiPen with you at all times, in case they are exposed to an allergen to which they are allergic. This is excellent for when you are with your child; however, your child could be exposed to many more allergens at school when you and your EpiPen aren’t there!

In fact, one study of children and adolescents found that 10 out of 13 fatal or near fatal anaphylactic reactions occurred outside the home. All the fatalities did not have an EpiPen and those who survived received an EpiPen shot before or within 5 minutes of developing severe symptoms.2

So, what does this mean? EpiPens can save lives! You need to ensure that the other adults who spend time with your child are trained and able to assist in any situation if you’re not around.

Don’t worry, this isn’t as difficult as it sounds! I suggest sitting down with your child’s teacher in the beginning of the school year to set up a 504 plan. This will ensure he or she receives proper care and attention when you aren’t there and that all adults that are around your child have the proper training to use an EpiPen if an emergency situation arises.

Also, there is good news for all you Massachusetts residents! Thanks to your persistent neighbors, starting March 2010, all newly hired school bus drivers in the state of Massachusetts will be required to have EpiPen training. Unfortunately, the law doesn’t mandate the existing school bus drivers to be trained; however, it’s a step in the right direction. Hopefully the other 49 states will follow suit. Good work Massachusetts!

How have you been able to ensure that your child is safe and can receive the proper care if they go into anaphylactic shock? Did it involve a 504 plan or EpiPen training?

- Nita


2. Sampson H, Mendelson L, Rosen J. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.

Safe and Spooky Halloween Tips

Posted 10.13.09 | Mallory West

Halloween With Halloween just a few weeks away, your little ones are probably getting excited about their costumes, class parties and trick-or-treating. And while these can be fun experiences for children, they can be potentially dangerous for those with food allergies.

Fortunately, with a little advance planning, you and your little ones can have a safe and spooky Halloween without the risk of an allergic reaction. Here are some tips and safe treats to help you prepare:

Halloween Parties

For Halloween parties (especially at school), it always helps to be involved in the planning process and to attend. You can also volunteer to bring your child’s favorite sweet treat for everyone to try. Some safe options include this recipe for Dairy Free Caramel Apples or these delicious dairy and gluten-free Chocolate Chip Cookies.


Most important when trick-or-treating is to examine your children’s candy before they eat any of it. Depending on the severity of their allergy, you may want to have them avoid putting their hands into candy bowls (since candy wrappers could be contaminated with allergens like nuts or dairy). Have neighbors drop the candies into their bags directly, or incorporate gloves into their costume design.

Consider creating a “swap-out” bag of allergy-safe treats, DVDs or books that they can enjoy at home. Divvies Chocolate Ghosts and Bats are delicious gluten, dairy, nut and egg-free treats. If there are other children in your neighborhood with food allergies, you can set an example by handing out non-food goodies like stickers.

What tips do you follow for a safe Halloween?


EpiPen Safety and Accidental Injection

Posted 5.12.09 | Nutrition Specialist

Knowing when, how and where to use an EpiPen safely and correctly is of the utmost importance when you have a child with food allergies. What you’re probably not thinking of when you pick up the EpiPen, however, is your own safety. This is when accidents can -- and unfortunately do -- happen.  Check out this blog entry from the Consumer Reports health blog. Nicole A. Sarrubbo, editorial associate at Consumer Reports, wrote about an experience she had going to babysit a 7-year old boy with severe allergies to a number of foods, including milk, eggs and nuts. As practice, Nicole injected an orange with an EpiPen so that she would know what to do in case the boy had an allergic reaction. However, while the boy’s mother was teaching Nicole how to use the EpiPen, she accidentally injected herself with it!
Fortunately, this particular mom only felt a bit jittery after the accidental injection, but in some cases it can cause extreme discomfort. According to a review of 26 studies in the Annals of Allergy, Asthma, and Immunology, there were nearly 70 incidents of unintentional EpiPen injections over the course of 20 years. However, it is believed that the accidental injection rates are highly underreported.
As Nicole suggests in her blog, practicing using an EpiPen is important so that if an allergic reaction was to occur, you feel prepared. However, it’s a good idea to always be prepared by keeping extra supplies on hand, incase you accidentally inject yourself. And remember to handle the EpiPen with care, even if you are only demonstrating how to use it.
- Nita

Can my child have an allergic reaction from a medicine or vaccine?

Posted 2.18.09 | Nutrition Specialist

Unfortunately, the answer might be yes. Recently, Kids with Food Allergies dedicated part of their monthly e-newsletter to articles and resources on potential food allergens in medication and vaccines. The information was very informative and is something I encourage all allergy parents to read and be aware of.

Prescription and over-the-counter medications, as well as vaccines, can contain food allergens as inactive ingredients. While a generic form of a drug must be chemically equivalent to its brand name counterpart — and therefore have the same active ingredients — it does not have to contain the same inactive ingredients as its brand name equivalent. Some of these inactive ingredients may be derived from potential food allergens.

All the more reason to read all food labels and packaging inserts carefully. And speak with your child’s allergist regarding the safety of vaccines and medications to ensure your child doesn’t have a surprise reaction.

To read the entire e-newsletter, click here.

And to see a list of e-newsletter topics from Kids with Food Allergies, click here.

I encourage you to check them out!

- Nita

Would you like to share your allergy story?

Posted 2.2.09 | Nutrition Specialist

ABC News is planning a television segment on food allergy labeling and advisory labeling laws and would like to speak with allergy families. Specifically, the network would like to interview families who have a child who has had an allergic reaction from mis-labeled or non-labeled packaged food items since 2006.

The segment will air in March, in conjunction with the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

If you are interested, please send a brief description of your family’s experience and your contact information (email, phone number, address) to Barbara Rosenstein, director of communications for the Food Allergy Initiative (FAI) at or 212-207-1998 by tomorrow, February 3rd.

- Nita

The Coolest New Accessory for Allergy Kids is…

Posted 11.25.08 | Nutrition Specialist

The EpiPen. According to an article on, doctors prescribed 1.9 million EpiPens in 2007, a 36 percent increase from 2003, when 1.4 million were prescribed. Since food allergies are on the rise, this comes as no surprise.

The pocket-sized, life-saving EpiPen has cultivated quite a following. It “auto injects a pre-measured dose of epinephrine to someone experiencing anaphylaxis, a severe whole-body allergic reaction.” Some parents have 10 or more EpiPens around the house at all times, as well as at school, in the car and on their allergy-prone little one.

Stylish EpiPen carriers and portable pouches have even emerged. There are carriers covered in cartoon characters for the younger kids and discreet leg straps for the older kids that might be a bit self-conscience.

For many years, the EpiPen was one-of-a-kind. Currently, there is another company that makes a similar product, but the EpiPen has maintained 97 percent of the market.

For the entire EpiPen article, click here.

- Nita

Allergy-Safe Classroom Parties For Kids

Posted 10.9.08 | Guest Blogger

Gina Clowes is the founder of We would like to thank her for guest blogging for us and sharing her family's allergy story. Note: This article was originally written for Health Central: My To view the article there, click here.

Although there is a lot of attention on peanut-free tables and banning peanut butter from school cafeterias, studies show that most food allergic reactions at school happen outside the cafeteria. Classroom parties and other situations out of the ordinary can put food allergic children at increased risk.

With Halloween parties around the corner, I thought I'd share my TREAT sheet (some tips) that has helped keep my son and other allergic children safe and included in classroom parties.

Start with your child's teacher.

In my experience, having the teacher communicate the "rules" for the party is the way to go. You and other parents of children with special dietary needs can provide the teacher with a list of safe treats and activities. Hopefully by this point, your child's teacher understands how dangerous food allergies can be. If not, now would be a great time to share this important information.

Set realistic expectations.

Even today there are many parents who are not aware of the dangers of food allergies. It is likely there will be mistakes. Sometimes the teacher may "catch" these, other times he or she may not. Remember that others are not as immersed in the food-allergy world as we are. Even with reminders sent home, there will always be a parent who "didn't get the memo." Take these oversights with a grain of salt and assume honest intent.

Eat only food with labels that have been double checked.

Your child will be tempted but it's important to remember that ingredients change. Different sizes of the same candy or cookies can have different ingredients as well. Homemade treats are likely to be on the scene and these can contain any number of questionable ingredients and may have been cross-contaminated by an innocent parent who is not accustomed to baking for a food allergic child. Also, don't use common sense (or common assumptions) to determine if a food is safe. Jelly beans can contain peanut flour. Taffy, chewy candies and lollipops can contain milk or egg. Cherries can contain almonds! This is not the time for you to let your guard down.

Attend the party.

You will be amazed at what you will find. My son attended a "peanut-free" preschool and received a full-sized Snickers bar in his treat bag! (I confiscated it and enjoyed it later that evening!)

Even when you think you have the party food covered, other parents may use food in their party games or for prizes, not thinking of food allergies. Parties are hectic so it is always helpful to have an extra set of eyes on your child to make sure that he does not consume an unsafe treat.

Treats served should be safe for all of the students in the classroom. This is not only more inclusive but it keeps the learning environment safe. Even with multiple food allergies, there are a wide variety of snacks and treats that can be served safely. Offer to bring safe foods to share. Prepare a specific list of safe snack ideas to keep other parents involved. This will give other parents an opportunity to bring food to share as well. Be there to double check what shows up because there are always surprises. I thought all lemonade was safe for my son until one parent brought kiwi-flavored lemonade to a party!

So always have safe treats and a drink for your child as back up.

Remember the power of "Thank you."

And last but not least, remember to thank those who have helped kept keep your child safe and included. People may not realize how hard it is for us to ask for accommodations for our child or how scared we are when we have to depend on others to prepare or serve food for our kids. Those who "get it" make our lives so much easier, so each and every time you come across one of these angels, let them know how much it means to you and your child.

- Gina Clowes

Ask the Nutritionist – Immediate and Delayed Allergic Reactions

Posted 1.30.11 | Nutrition Specialist

Question: What is the difference between immediate and delayed allergic reactions? We are trying to get to the bottom of what foods are causing my son’s allergic reactions and I think that he may be having a delayed reaction to something.

Answer: Immediate allergic reactions, also known as IgE reactions, occur within a few moments of exposure to an allergen to up to two hours, so it is easy to identify which food is causing the reaction.

Delayed allergic reactions (which are non-IgE) can happen anywhere from two to 72 hours after exposure to an allergen, or longer. This can make it difficult to pinpoint what is causing a reaction. Plus, there are no specific lab tests to identify non-IgE allergies so the only way to know if a food is safe or not is through trial and error. It might be helpful to keep a food journal of exactly what your son eats and when. Then you can look for patterns over time, and hopefully figure it all out!

If you’re still having trouble identifying the problem foods, your doctor may recommend an elimination diet. With an elimination diet, all foods are taken out of the diet and an elemental formula, such as Neocate and/or E028 Splash, is the sole source of nutrition. This period allows the symptoms to resolve and sets up your “baseline”. After a few weeks, foods are added back to the diet one at a time. Since the reactions are delayed, you should wait a few days after each food introduction to see if symptoms return. If no symptoms occur, you move on to the next food. If symptoms do occur, you can add this food to the no-no list and continue with this process (remember that there may be multiple foods responsible so you have to contrinue with the process of trying foods one at a time).


allergic reaction  |  IgE  |  symptoms

Ear Piercing and Nickel Allergy

Posted 9.20.12 | Rob McCandlish, RDN

When it comes to allergies, most everyone knows about seasonal allergies. Our readers, mostly Neocate families, are also very familiar with food allergies.  But maybe you’ve met someone who can’t wear certain types of jewelry because of a metal allergy? It sounds strange, but you may be interested to know that jewelry can pose a problem, and ear piercing may be a culprit! If you’re thinking of piercing your little one’s ears, consider this scientific publication that I came across recently. You really do learn something new every day!

Recent Research

As I was reading a medical journal, I came across an interesting case study. As we’ve discussed before, a case study is a report of one or several patients who have something unusual about their diagnosis or treatment. Medical teams write them when they feel their experience in caring for these patients can help other medical teams who see the same thing.

The article, which you can find a copy of here, presented one boy’s experience after he swallowed a coin. It was written by Dr. Elaine Kaye and several of her colleagues from both Harvard Medical School in Boston, MA and the University of Calgary in Alberta, Canada. Within a day of swallowing a Canadian quarter that was mostly made of nickel*, the child developed a very severe skin rash and fever. The team discovered that he’d swallowed the coin by accident in an x-ray. The mother recalled he’d reacted to metal snaps in clothing as a baby. The boy’s skin gradually improved after the coin was removed.

Nickel Allergy

An allergy to nickel can develop when the skin comes in contact with nickel. This can be skin on the surface (from a watch band), or it can happen when something metal containing nickel is swallowed or inhaled. Not everyone will develop a nickel allergy, but nickel is the most common allergen in patients who undergo skin patch testing, especially children. The effects of a nickel allergy can include eczema and/or redness of the skin. In rare cases of nickel allergy, anaphylaxis can occur after exposure to nickel.

Ear Piercing and Nickel Allergy

One of the most interesting points that the doctors made in their case study was that ear piercing is a very common risk factor for developing a nickel allergy. It seems that if the posts or other parts of the earrings that come into contact with skin contain nickel, they can act as the “first exposure” to nickel that then sets the stage for nickel allergy. If a nickel allergy already exists, the earrings could cause an allergic reaction.

If you’re considering piercing your little one’s ears, it may be a good idea to check with the healthcare team to see what their thoughts are or if they would recommend any testing. And if you do decide to pierce, it may be best to try to find earrings that do not contain nickel. This website has some helpful information on where you can find nickel-free jewelry.

Have you had any experience with a nickel allergy, or do you have problems wearing some jewelry?

- Rob

*Most of the coins in the United States that are silver in color contain some nickel.

Which Came First: Eczema and Food Allergy?

Posted 11.5.13 | Mallory West

You might have heard that eczema can be a sign of a food allergy or sensitivity in infants. The link between food allergies and eczema has been known for many years. It is typically assumed that the eczema is a symptom of the underlying food allergy. In other words, the eczema is triggered by the food allergy. However, a new study suggests just the opposite.

An article published in the July issue of the Journal of Investigative Dermatology found evidence that it’s actually eczema which triggers the food allergy, rather than the other way around. The authors suggested that the breakdown of the skin barrier and inflammation in the skin that occurs in eczema could play a key role in triggering food sensitivity in babies. These findings might indicate that immune cells in the skin, rather than the gut, play a major role in the development of food allergies. The authors theorize that the breakdown of the skin barrier seen with eczema exposes immune cells in the skin to environmental allergens – For example, food proteins in this case -- which then triggers an allergic reaction to foods.

So what does this mean for individuals with eczema and food allergies? Nothing yet, but these findings may help researchers develop better treatments or prevention tactics for food allergies in the future. If eczema and an exposed skin barrier lead to the development of food allergies, then perhaps repairing the skin barrier can help prevent or resolve food allergies.



King's College London. "Eczema may play a key role in the development of food allergy in infants, study suggests." ScienceDaily, 19 Jul. 2013. Web. 5 Nov. 2013


Food Allergies and Cross-Reactivity – Do You Have to Avoid Related Foods?

Posted 6.8.17 | Nutrition Specialist


Learning that you or your loved one has an allergy to a food often sparks a long list of questions. One common question that many families have is “If my child is allergic to one item, what else are they allergic to?” Another common question is “Where should I start when either trying new food items or adding foods back into my diet?” If you are facing these questions, you are not alone!! Before we tackle some of these questions, remember: Each of us is unique and there is no substitute for individualized guidance and recommendations from your healthcare team. Now, let’s take a look at something called cross-reactivity to help you get the conversation started with your healthcare team if you are facing these questions.

Finding the Food Allergy?

An allergy to food is allergic reaction, or overreaction by your immune system, to the proteins in the food. For example, many children have a milk allergy, which more specifically is a cow milk protein allergy. The body's immune system "recognizes" that the protein in the food is not the same as the protein in our own body. For most people the immune system is able to ignore these "foreign" proteins. But for people with a food allergy, their immune system mounts a response to that protein.

The proteins found in one food item can be similar to the proteins in other foods, especially related foods. Sometimes the body's immune system cannot tell the difference between the proteins in two foods and has an allergic reaction to both of them. The question becomes, If you are allergic to one food item, will you also be allergic to the protein in a related food? This concept is called “Cross-Reactivity”.  But what does this mean for you?

Food allergies can involve many types of responses; you may get a rash when eating a certain food or it could be life threatening, like anaphylaxis.  The most common immune response in a food allergy is when your body makes something called IgE (immunoglobulin E) antibodies to the protein of the food allergen. This results in a variety of physical reactions or symptoms such as skin itching, hives, nausea, vomiting, diarrhea, breathing difficulty such as wheezing or coughing, or the life-threatening reaction called anaphylaxis. 

As you likely well know, diagnosis of food allergies is not an easy process. Experts at the Jaffe Food Allergy Institute in New York recommend that diagnosis of food allergies include careful interpretation of a variety of factors including physical examination, skin test or RASTs, detailed patient history, and oral food challenges or elimination diets. No single test on it's own is a perfect predictor of an allergy to a given food. This extensive testing and the possible conflicting results are just one of many reasons why individualized treatment and recommendations are needed, and why there is no substitute for the individual guidance you will receive from your healthcare team.

What is Cross-Reactivity?

So where should you start when either trying new foods or adding foods back into your diet? To help allergists identify related foods of concern, research was conducted into how likely people with a given food allergy are to react to other related foods. This was done using tests that are predictive, but not 100% accurate, so they're just indicators. Family allergists may use this data to help determine what advice to give their patients about where to start when either trying new foods or adding food items back into the diet. (If you really want to read the review of the clinical data, the full reference is noted below.)

In some cases, the data reveals a significant chance of having an allergic reaction (or at least a strongly positive allergy test) to a new food when the protein is related. For example, if you are allergic to cashews, you have a pretty high likelihood to also be allergic to pistachios and/or mango.1 There are many families of foods that may be linked, so it is best to consult with your healthcare provider to determine the extent of your food allergy and the potential for cross-reactivity. As noted above, your healthcare team will offer guidance for you specifically after all the information has been collected and evaluated.

How to Spot Foods That Might Cause Cross-Reactivity?

The table below shows some of the potential cross-reactivity revealed by this research review, and was developed by an allergist at the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York. Clinicians might use a table like this when determining where you might start when either trying new foods or adding food items back into your diet.

A clinician would look for your known food allergen in the left column. The column on the right gives an indication of the risk that there will be an allergic reaction to one of the foods that are listed in the center column. For example, for a patient allergic to cow milk, the available research shows there is a 92% chance the patient will have a positive allergy test to goat milk, but only a 4% chance of a positive allergy test to mare (horse) milk and a 10% chance of a positive allergy test to beef and beef products. Remember, a positive allergy test is NOT the same as an allergic reaction, but it can help the allergist gauge how likely an allergic reaction is. Depending on the results of the test, the allergist might recommend avoiding the food, may suggest having an in-office food challenge, or they may say that an allergic reaction is very unlikely.

What is the best way to introduce new foods to the diet?

Once your healthcare team has a plan for you, the next step is trying the food items suggested. Again, your healthcare team will likely have a very specific plan for you.  They may say to just introduce the food normally. They may suggest that you try foods at home, starting with a small amount and then waiting a few days before trying the food item again or even moving on to the next food item.

If you have had sever food reactions in the past and/or a test result in the middle of the range, then they may only recommend new foods be tried as an oral food challenge. This should only be done under strict medical supervision (e.g. in a doctor’s office) and involves trials with small amounts of the food causing the allergy or a potential cross-reactive food.  Depending on your results, the healthcare team will guide as you continue to explore and try new food items.

In closing, it's very important to discuss any questions with your healthcare team. A lot of the latest research in food allergies suggests that, for some people, avoiding foods in early childhood may actually INCREASE the likelihood of developing an allergy to that food. So don't make these decisions on your own, but be prepared to ask your healthcare team the questions you have about introducing new foods so that you're prepared with the knowledge you need!

Oringally published  12/22/15 by Ellen Avery, MS, RD, CNSC2.
Updated 6/8/17 by Kristin Crosby MS, RDN, LDN.

Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. 2001;108(6):881-90.




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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.