Essential Food Allergy Management Guide
Essential Food Allergy Management Guide
Table of Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
A Checklist for Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Managing Food Allergies: What You Need to Know. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Understanding Food Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Tips for Avoiding Your Allergen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
How to Avoid Cross-Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dining Out With Food Allergies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Preparing Others to Care for Children With Food Allergies. . . . . . . . . . . . . . . . . . . . . . 16
Food Allergies: Frequently Asked Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Glossary of Food Allergy Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
FARE Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
FARE Fundraising Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
More Food Allergy Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
[Link]
©2016, Food Allergy Research & Education (FARE) 2
Introduction
Thank you for downloading FARE’s Food Allergy Field Guide, a packet for individuals and
families who have been newly diagnosed with food allergies. FARE is the nation’s leading
organization working on behalf of the 15 million Americans with food allergy, including all those
at risk for life-threatening anaphylaxis. FARE is committed to providing all those affected by
food allergies with the resources and tools they need to live well with food allergies.
Within this packet, you’ll find content from our “Managing Food Allergies: What You Need to
Know” brochure, a checklist for getting started, information on food labels, tips for avoiding
allergens and cross-contact, advice about dining out with food allergies, frequently asked
questions and much more.
A food allergy diagnosis is life-altering. We are here to help. These educational materials, along
with the extensive resources on our website, [Link], are designed to equip you
with the knowledge you need to effectively manage food allergies.
The information provided here is designed to support, not replace, the relationship that exists
between a patient and his/her existing physician. Always be sure to consult your doctor for
specific questions.
[Link]
©2016, Food Allergy Research & Education (FARE) 3
A Checklist for Getting Started
Your Food Allergy Field Guide is a resource created and provided by Food Allergy Research & Education (FARE). FARE is
a national non-profit organization, whose mission is to improve the quality of life and the health of individuals with food
allergies, and to provide them hope through the promise of new treatments. More general resources on food allergies,
including articles, support groups, and webinars, can be found on our website at [Link]. For questions
related to your specific food allergy care plan, please consult your doctor.
A food allergy diagnosis is life-altering. There is a lot to learn, and it can be tough to know where to start. This field guide
checklist can help point you toward important information and resources that will help you learn more about managing
food allergies.
Educate Yourself
¨¨ FIRST STEP: Read all of the information in this Food Allergy Field Guide, starting with the Managing Food Allergies
section.
¨¨ Carry the Tips for Avoiding Your Allergen sheet with you to help with reading labels or asking about ingredients.
¨¨ Visit the FARE website at [Link] to learn more about food allergies and strategies for staying safe.
¨¨ FOR PARENTS: Know your child’s food allergies inside and out so you can communicate their needs to caregivers.
Be Prepared
¨¨ FIRST STEP: Fill your prescription for epinephrine auto-injectors. Learn how to use an epinephrine auto-injector and
practice by using a trainer. Teach family members and friends how to use the auto-injector.
¨¨ Put a reminder on your calendar about refilling your prescription before the epinephrine auto-injector’s expiration
date.
¨¨ FOR PARENTS: Help your child understand their allergies and teach them to ask questions about ingredients and
any food being served.
Have a Plan
¨¨ FIRST STEP: Fill out the enclosed Food Allergy & Anaphylaxis Emergency Care Plan with your doctor.
¨¨ Order medical identification to make emergency responders aware of your or your child’s food allergies.
¨¨ FOR PARENTS: Make sure your child has a food allergy management plan in place at their school or child care
facility.
[Link]
©2016, Food Allergy Research & Education (FARE) 4
Managing Food Allergies:
What You Need to Know
Food allergies are serious, but you can manage them with help from your allergist and others. This packet will help you
learn more about the disease so that you can be prepared, stay safe and live well with food allergies.
The food you are allergic to is called a “food allergen.” The response your body has to the food is called an “allergic
reaction.”
People can be allergic to any food, but eight foods cause most food allergy reactions in the U.S. They are: milk, egg,
peanuts, tree nuts (such as walnuts or pecans), wheat, soy, fish, and shellfish (such as lobster, shrimp or crab).
A food intolerance is when your body has trouble digesting a food. It can make you feel badly, usually with an upset
stomach or gassiness, but it is not life-threatening. The most common intolerance is to lactose, which is a natural sugar
found in milk.
Anaphylaxis can affect several areas of the body. It can make it hard to breathe and make it hard for your body to
circulate blood. The first-line treatment for anaphylaxis is a medicine called epinephrine.
Carefully avoiding problem foods is the only way to prevent allergic reactions.
[Link]
©2016, Food Allergy Research & Education (FARE) 5
Managing Food Allergies: What You Need to Know
• Read every label, every time. Ingredients in 1. Always carry your epinephrine auto-injector.
packaged foods may change without warning. Epinephrine is the only medicine that can stop
Check ingredient statements every time you life-threatening reactions. Carry your
shop. Even the same product from the same epinephrine auto-injector with you at all times
company can have different warning labels. If and check to make sure it has not expired, is
you have questions, call the manufacturer. kept at a safe temperature, and that it has not
been damaged.
Federal law requires packaged food labels to
list when one of the top eight food allergens 2. Fill out a Food Allergy & Anaphylaxis
is an intended ingredient. The top eight food Emergency Care Plan with your allergist.
allergens are: milk, egg, peanuts, tree nuts, These plans tell you and/or those who care
wheat, soy, fish, and shellfish. Read more for your child how to recognize and respond
about this law and tips for avoiding unintended to an allergic reaction. Sample plans can
ingredients at [Link]/food-labels. be downloaded from FARE’s website in both
English and Spanish ([Link]/
• Be mindful of cross-contact. Cross-contact downloads).
happens when a food that is an allergen comes
into contact with a safe food and their proteins 3. Know your plan and share it with others. Make
mix. As a result, each food contains small sure everyone who knows you understands what
amounts of the other food. These amounts are to do in case of an emergency. Keep your Food
so small that they usually can’t be seen. One Allergy & Anaphylaxis Emergency Care Plan in
example of cross-contact is when the same a place where others can find it. For parents,
utensil is used to serve a food that contains an give your child’s plan and medicines to their
allergen and a safe food. school or preschool as soon as possible.
Cross-contact can happen in restaurants, 4. Wear medical identification. Medical IDs will
school cafeterias, home kitchens, or anywhere help protect you or your loved one—at home or
that an allergen may be present. Get more tips wherever you may be during an emergency.
for avoiding cross-contact at
[Link]/cross-contact.
Safety First!
Never take a chance by trying “just a bite” of a food that
may contain your allergen. Even a tiny amount can put your
life at risk.
[Link]
©2016, Food Allergy Research & Education (FARE) 6
Managing Food Allergies: What You Need to Know
[Link]
©2016, Food Allergy Research & Education (FARE) 7
Managing Food Allergies: What You Need to Know
1. Call 911 immediately! An epinephrine auto-injector buys time, but it is important to receive follow-up
treatment as soon as possible. An ambulance can provide treatment on the way to the hospital.
3. Lay the person flat and raise their legs. If their breathing is difficult or they are vomiting, have them sit up or
lie on their side.
4. If symptoms do not get better, or symptoms return, more doses of epinephrine can be given about 5 minutes or
more after the last dose.
5. Have the ambulance take the person to the Emergency Room. They should stay there for at least 4 hours to
make sure symptoms do not return.
You will also need to make a follow-up appointment with an allergist as soon as possible. Be sure to:
2) It’s vital to always carry your epinephrine auto-injector with you. In the case of severe reaction,
minutes can make a difference.
3) Know the possible symptoms of an allergic reaction, and know how and when to use your
epinephrine auto-injector.
[Link]
©2016, Food Allergy Research & Education (FARE) 8
Understanding Food Labels
The only way to prevent a serious allergic reaction is to avoid the food allergen.
Reading every food label, every time is one of the best ways to keep you or your loved one safe. Many people who are
managing food allergies use the “Rule of 3” for reading ingredient labels—read the label at the store, when unloading
your groceries, and before serving the food—to triple-check that a food is safe. Others use a system of colored stickers on
foods in the pantry or refrigerator to indicate that an adult has read the ingredient label and determined whether the food
is safe or contains the allergen.
There are a variety of approaches that can work, and laws like the Food Allergy Labeling and Consumer Protection Act
(FALCPA) help make it easier to understand food labels so that you can safely manage your or your child’s food allergies.
What is FALCPA?
This law requires that food labels show in plain English when a “major food allergen” or any ingredient that contains
protein from a major food allergen is added as an ingredient in that product.
Example 1: Ingredients: Whey protein (milk), lecithin (soy), cherry, sugar, natural flavors (almond), salt.
Example 2:
Ingredients: Whey protein, lecithin, cherry, sugar, natural flavors, salt.
Contains: Milk, soy, and almond.
Does the label have to include the “Contains” statement at the end with the major allergens bolded?
No. The “Contains” statement is one of two options that food manufacturers have for listing the presence of major food
allergens.
[Link]
©2016, Food Allergy Research & Education (FARE) 9
Understanding Food Labels
Does the label have to declare “traces” of Do the specific types of nuts, fish or shellfish
peanut, milk or other allergen that have come have to be indicated on the label?
about through processing? Yes. The specific type of fish (e.g., tuna, salmon),
No. FALCPA applies to ingredients that are intentionally crustacean shellfish (e.g., shrimp, crab) or tree nut (e.g.,
added to processed food products. Precautionary cashew, walnut) must be declared.
warnings or advisory statements (e.g., “May contain…”,
“Processed in a facility with…”) are voluntary. A Do all foods need to be declared on food labels?
manufacturer does not have to warn you that there may No. The only foods that have to be declared are those the
be unintentional traces of an allergen due to cross- FDA considers major food allergens: milk, wheat, egg,
contact during processing. peanuts, tree nuts, fish, crustacean shellfish, and soy, or
ingredients that contain proteins from these foods.
Should we avoid products with precautionary
warnings (e.g., May contain…)? Do major food allergens contained in dyes
Most allergists recommend avoiding these products. (food coloring), spices, flavorings, additives and
Studies have shown that some of the products actually do processing aids have to be listed on labels?
contain allergens in amounts significant enough to cause Yes. If these ingredients contain a major food allergen,
an allergic reaction. the allergen must be indicated on the label.
If a product does not have a precautionary What about food from bakeries, delis, etc.?
warning, does that mean the product is safe to FALCPA does not apply to foods placed in a container or
consume? wrapper for a customer’s individual order, such as food
Not necessarily. Manufacturers are not required to warn from a bakery or a sandwich from a restaurant.
you if the product is processed on lines or in a facility
with any other food. How can consumers find out about other
allergens such as sesame, kiwi, mustard and
What foods are not covered by FALCPA? others?
FALCPA does not apply to fresh meats, fresh fruits and Other food ingredients may or may not be declared on the
vegetables. Restaurant foods that are placed in a wrapper label. Consumers can call the manufacturer and ask if a
or carry out box for an individual customer order are product contains their allergen(s). In some cases, food
exempt. Highly refined oils (even if they are derived from manufactures may prefer not to disclose their ingredients
a major allergen, such as peanut or tree nut) are also or recipes.
exempt.
[Link]
©2016, Food Allergy Research & Education (FARE) 10
Tips for Avoiding Your Allergen
• All FDA-regulated manufactured food products that contain a “major food allergen” (milk, wheat, egg, peanuts, tree
nuts, fish, crustacean shellfish, and soy) as an ingredient are required by U.S. law to list that allergen on the product
label. For tree nuts, fish and crustacean shellfish, the specific type of nut or fish must be listed.
• Read all product labels carefully before purchasing and consuming any item.
• Be aware of unexpected sources of allergens, such as the ingredients listed below.
• *Note: This list does not imply that the allergen is always present in these foods; it is intended to serve as a reminder
to always read the label and ask questions about ingredients.
[Link]
©2016, Food Allergy Research & Education (FARE) 11
Tips for Avoiding Your Allergen
[Link]
©2016, Food Allergy Research & Education (FARE) 12
How to Avoid Cross-Contact
What is cross-contact?
Cross-contact happens when one food comes into contact with another food and their proteins mix. As a result, each food
then contains small amounts of the other food. These amounts are so small that they usually can’t be seen.
Even this tiny amount of food protein has caused reactions in people with food allergies!
The term “cross-contact” is fairly new. Some people may call this “cross-contamination.”
This is not the same with food allergies and cross-contact. Cooking does not remove an allergen from a food!
The only way to stop you from having a reaction is to avoid the food and carefully clean anything that came in contact
with it using soap and water.
Examples of cross-contact
Peeling cheese off a cheeseburger to make it a Using the same spatula that flipped a
hamburger cheeseburger to flip a hamburger
Scraping peanut butter off a piece of bread and Wiping off—not properly cleaning—a knife used to
using it to make a different sandwich spread peanut butter before using it to spread jelly
[Link]
©2016, Food Allergy Research & Education (FARE) 13
Dining Out with Food Allergies
When you are dining out with food allergies, planning ahead is important. Follow these tips on what to do before you go
out and when you are at the restaurant to have a better dining experience.
Before You Go
Restaurant Selection
• Ask around. Your allergist and other individuals and families who manage food allergies may have recommendations.
To see if a particular restaurant may be a good choice, check out the website and review the menu in advance.
Some restaurants who have completed food allergy safety training also choose to be listed on SafeFARE. Check
[Link] to see which restaurants in your area have registered.
• Pick a restaurant that best fits what you can eat. Avoid riskier choices, which could include:
–– Buffets. With a wide variety of foods so close to one another, the risk for accidental exposure and cross-contact is
high.
–– Bakeries. There is a high risk of cross-contact, since many items are made with common allergens and many are
not packaged.
–– Restaurants that serve pre-made foods. The staff may not have an accurate list of the ingredients in a pre-made
item. Since the dishes are not prepared from scratch, you can’t ask the chef to remove the problem ingredient
from an item that would otherwise be safe to eat.
–– Restaurants that are known to use allergens in many dishes. For instance, peanuts and other nuts are used
frequently in Asian cuisines. In ice cream shops, shared scoops increase the risk of cross-contact. If you have a
fish or shellfish allergy, it’s a good idea to avoid seafood restaurants.
• Consider chain restaurants, especially when you’re traveling. Each restaurant is likely to use the same ingredients
and prepare foods the same way, and a growing number are allergy-aware.
• Know your options. If you plan to attend a catered event where the food will be prepared in advance, ask if it’s
possible to provide an allergy-friendly option.
[Link]
©2016, Food Allergy Research & Education (FARE) 14
Dining Out with Food Allergies
At the Restaurant
• Talk to everyone. The restaurant manager and wait staff should know about your food allergy. Remind a manager or
the head waiter about your allergies before you are seated. Present your chef card and ask that it be shown to the
chef.
• Ask what is in your dish and how it is prepared. Make sure your server understands what you are allergic to, and
explain that cross-contact must be avoided. Consider speaking to the manager and the chef, just to be sure. Know
what procedures a restaurant should follow to keep your food safe.
• Never be embarrassed if you feel you’re not communicating well. If the wait staff doesn’t seem to understand your
situation, always trust your gut and seek out another staff member or manager. Sometimes, the safest choice is to
avoid eating, enjoy the company of your friends, and find a safe meal somewhere else afterwards.
• Reward excellent service and build a relationship. If you have a good experience at a restaurant, tell the staff about it
and go back.
Meal Selection
• Keep it simple. If you have to ask a lot of complicated questions about the items on a menu, ordering more simple
fare—like a baked potato, broiled chicken or steamed vegetables—may be the safest way to go.
• Avoid fried foods. Both the grill and the frying oil are ripe for cross-contact; it’s best to avoid fried foods unless you
know for sure that they are prepared safely.
• Be very careful when ordering desserts. Desserts are often a source of unexpected allergens. Since many restaurants
order their desserts from specialty shops, the staff may not be able to provide a complete list of ingredients. If in
doubt, wait and have a safe dessert at home.
More information on dining out with food allergies is available on the FARE website at
[Link]/SafeFARE.
[Link]
©2016, Food Allergy Research & Education (FARE) 15
Preparing Others to Care for Children
with Food Allergies
1. Educate Yourself
Before planning for your child’s care at school, you need to learn everything you can about your child’s food allergies, the
policies at your child’s school and what accommodations you are seeking.
A 504 Plan (named for Section 504 of the Rehabilitation Act of 1973) is a plan that outlines the accommodations, aids
or services that a student with a disability needs in order to use, and fully participate in, a free and appropriate public
education.
Children whose food allergy may result in severe, life-threatening reactions (in the opinion of the child’s doctor) meet the
definition of disability under Section 504.
504 Plans are a legal right in schools that receive federal funding. This includes many private schools. Students who go
to private schools that do not take federal monies are covered under the Americans with Disabilities Act and can work
with their schools to set up similar plans. Religious schools may be exempt from Section 504, but state laws may apply.
Each school should have a 504 Coordinator who can help.
3. Visit Our Website—[Link]—For More Information About Managing Food Allergies at School.
[Link]
©2016, Food Allergy Research & Education (FARE) 16
Preparing Others to Care for Children
with Food Allergies
Talking to Caregivers
Managing food allergies is a team effort, and babysitters, extended family members and other caregivers are often
important members of that team. Educating caregivers and planning ahead will help ensure that your child is safe
and included while you are gone. Here are some important steps you can take to prepare caregivers:
• Explain the allergy, which foods to avoid, and the safety precautions you follow at home. Be sure to provide
enough time for the caregiver to absorb the information. You may want to set up a meeting in the days or week
prior to when they will be caring for your child to ensure you have enough time to review everything and they have
enough time to ask questions.
• Carefully explain to the caregiver the symptoms of a food allergy reaction and what to do if a reaction occurs.
Refer them to the food allergy reaction symptoms as described in your Food Allergy & Anaphylaxis Emergency
Care Plan (FAAECP). A magnet listing common symptoms that can be used as a reference on your fridge or
another easy-to-access location is available for purchase from FARE’s Online Store.
• Show the babysitter how to use an epinephrine auto-injector, and make sure the sitter is comfortable using it.
Using expired pens or trainers, let the sitter practice on an orange to get a feel for it. Instructional videos for
a variety of epinephrine auto-injectors can be found on the FARE website at [Link]/treating-an-
allergic-reaction/epinephrine.
• Tell the caregiver to act first and call you later. Let the caregiver know that the most important thing they need
to do in case of a severe reaction is to inject epinephrine and call 911. Let them know that, when in doubt, they
should choose to use epinephrine and that you will not be upset at their decision.
• Make it easy to reach you. Leave your cell phone number with the caregiver, as well as the number of at least one
other person in case you are away from the phone.
• Explain the dangers of cross-contact and how to avoid it. Have them read the How to Avoid Cross-Contact sheet in
this guide.
• Teach the caregiver how to read labels. Make a copy of the Tips for Avoiding Your Allergen sheet in this packet
and keep it in the kitchen or in another easily accessible location. Practice reading a few labels with the
caregiver.
• Leave a tray of safe foods that they can give your child while you are out.
• Have the caregiver arrive after your child has eaten and is ready for bed. This strategy is probably the least
stressful until you feel comfortable leaving your child with someone else.
• Put it all in writing. Keep all important information and instructions together in an easily accessible place, such
as a brightly colored binder in the kitchen, and make sure to update it as needed.
[Link]
©2016, Food Allergy Research & Education (FARE) 17
Food Allergies: Frequently Asked Questions
What is anaphylaxis?
Anaphylaxis is a serious allergic reaction that comes on quickly and may cause death. Early use of an epinephrine
auto-injector is the primary treatment for anaphylaxis. A complete list of the symptoms of anaphylaxis and more
information are available at [Link]/anaphylaxis.
How long does it take for a reaction to start after eating a food?
Symptoms usually start as soon as a few minutes after eating a food and as long as two hours after. In some cases,
after the first symptoms go away, a second wave of symptoms comes back one to four hours later (or sometimes even
longer). This second wave is called a biphasic reaction. The risk of a biphasic reaction is why patients who have a
severe reaction should stay at a hospital for four to six hours for observation.
[Link]
©2016, Food Allergy Research & Education (FARE) 18
Food Allergies: Frequently Asked Questions
Can the severity of a person’s allergic reactions to food be predicted from his or her previous
reactions?
No. Someone whose reactions have been mild in the past may suddenly experience severe reactions that could be
deadly.
If I think I or my child has outgrown an allergy to a food, is it okay to try a small amount of that
food?
No. Only your allergist can test for this. For more information on tests for food allergies, visit
[Link]/diagnosis-and-testing.
[Link]
©2016, Food Allergy Research & Education (FARE) 19
Glossary of Food Allergy Terms
The following words and phrases are often used to talk about food allergies.
A
Acute symptoms – Physical signs that begin suddenly or last only a short amount of time.
Adrenaline – A hormone made by the body (also known as epinephrine).
Adverse reactions – An unwanted response to a food (such as a rash, vomiting, etc.).
Allergen – Anything that causes an allergic reaction.
Allergic reaction – An immune system response to something that the body mistakes as a threat.
Anaphylaxis – A serious allergic reaction that comes on quickly and may cause death.
Anaphylactic shock – A symptom of anaphylaxis where there is a severe drop in blood pressure.
Angiodema (or edema) – Swelling of a part of the body.
Antibody – A protein in the blood that is meant to identify and attack foreign objects like bacteria or viruses. In food
allergies, these antibodies mistake some food proteins as a foreign object.
Antigen – Anything that causes the immune system to react when it enters the body.
Antihistamine – A medicine used to block the effects of histamine, a chemical that is released during an allergic
reaction. Antihistamines do not stop anaphylaxis.
Asthma – A chronic disease of the lungs in which the airways become blocked or narrowed. This blockage can make it
hard to breathe. Many people with food allergies also have asthma. Those with both asthma and food allergies are at a
higher risk for a severe allergic reaction.
B
Biphasic reaction – An allergic reaction that has two stages. After the first wave of symptoms goes away, a second wave
of symptoms comes back one to four hours later. Because of the risk of biphasic reactions, patients who have a reaction
requiring epinephrine should stay at a hospital for four to six hours after the initial reaction for observation.
C
Chronic – Happening often or lasting a long time.
Cross-contact – When one food comes into contact with another food and their proteins mix. As a result, each food then
contains small amounts of the other food. These amounts are so small that they usually can’t be seen. Even this tiny
amount of food protein has caused reactions in people with food allergies.
E
Eczema – Also called atopic dermatitis. It is an itchy, red rash usually found at the folds of the elbows and behind the
knees. It can cause so much itching that the person may scratch until the skin bleeds. In young children, eczema is
sometimes caused by a food allergy.
Eosinophilic Esophagitis (EoE) – A disorder that causes large numbers of eosinophils, a type of white blood cell, to gather
in the esophagus (the tube that connects the mouth to the stomach). As a result, the lining of the esophagus becomes
inflamed, making it difficult for food to go down. EoE can be triggered by certain foods.
Epinephrine – Also called adrenaline. It is a self-injectable medicine and is the first-line treatment for a severe or
life-threatening allergic reaction (anaphylaxis). Epinephrine is a highly effective medicine that can reverse severe
symptoms. It must be given quickly when anaphylaxis occurs to be most effective. Delayed use of epinephrine during an
anaphylactic reaction has been associated with deaths.
[Link]
©2016, Food Allergy Research & Education (FARE) 20
Glossary of Food Allergy Terms
F
FALCPA (Food Allergy Labeling and Consumer Protection Act) – A federal law that took effect January 1, 2006. It
requires that the labels of foods containing major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree
nuts, wheat and soy) note the allergen in plain language.
Food allergy – When the immune system mistakes a food protein as a threat and creates an antibody to that food
protein. When the food is eaten again, the immune system releases histamine and other chemicals that cause an
allergic reaction.
Food Allergy & Anaphylaxis Emergency Care Plan – A document that outlines the recommended treatment in case of
an allergic reaction. It is signed by a physician and includes emergency contact information. It should be on file at
school for every student with food allergies, and it is also useful at home, when traveling and for educating caregivers
what to do in an emergency.
H
Histamine – One of several chemicals released by the body that causes many of the symptoms of an allergic reaction.
Hives – Mosquito-bite-like bumps that are very itchy and can appear anywhere on the body. Many different things can
cause hives, including allergic reactions to food.
I
Immunoglobulin E (IgE) – An antibody created by the immune system that triggers food allergy symptoms.
Intolerance – A reaction to a food that does not involve the immune system. For example, people with lactose
intolerance lack an enzyme needed to digest milk sugar. When they eat milk products, they may have symptoms such
as gas, bloating and abdominal pain.
O
Oral food challenge – A test used in a clinical setting to confirm or rule out a suspected food allergy by feeding the
patient, under an allergist’s supervision, very small but increasing amounts of a possible allergen.
R
RAST (radioallergosorbent tests) – A blood test that measures the presence of IgE antibodies to specific foods. The
term is antiquated because modern tests are not “RAST” tests. See “Serum test for food-specific IgE.” Negative
tests usually (not always) indicate that there is no immediate type of allergy, but positive tests do not necessarily
indicate an allergy. Tests must be interpreted by your doctor taking into consideration your medical history.
S
Skin prick test (SPT) – A test that measures the presence of IgE antibodies for a suspect food. SPTs are inexpensive,
produce immediate results, and can be performed in the doctor’s office. Negative tests usually (not always) indicate
that there is no immediate type of allergy, but positive tests do not necessarily indicate an allergy. Tests must be
interpreted by your doctor taking into consideration your medical history.
U
Urticaria – A medical term for itchy rash or hives.
W
Wheal – A raised white bump surrounded by a small circle of itchy red skin.
[Link]
©2016, Food Allergy Research & Education (FARE) 21
FARE Offices
FARE’s mission is to improve the quality of life and the health of individuals with food allergies, and to provide them
hope through the promise of new treatments. Support our mission!
Donate today! Your tax-deductible donation to FARE can make a difference in the lives of up to 15 million Americans
with food allergies. Contribute online ([Link]/donate), by phone (703-691-3179) or by mail (7925 Jones
Branch Drive, Suite 1100, McLean, VA 22102).
Become a member! Advance FARE’s mission and enjoy great benefits, including the latest food allergy news and
discounts on conferences and products. Complete the enclosed membership response card or visit
[Link]/membership to get started.
Shop for food allergy resources! Visit [Link] to check out our FARE merchandise and education
materials.
[Link]
©2016, Food Allergy Research & Education (FARE) 22
Get Involved: FARE Fundraising Events
Please consider joining us in our quest to raise valuable funds for food allergy education programs, advocacy initiatives,
awareness efforts and research projects by participating in one of the below events.
Team FARE
Team FARE partners your passion for supporting food allergy research, education and advocacy with
your own personal fundraising coach, campaign and website. The fundraising options are endless,
but the goal is the same: raising money to support FARE and its mission. Become a member of
Team FARE and create your own campaign today! Visit [Link] for more details.
Special Events
FARE’s special events—such as our galas and luncheons—let you raise urgently needed funds while
enjoying the company of other supporters who share your commitment to the cause. These events
attract corporate and individual donations to advance FARE’s mission. To find an event near you, or to
start a new event, please reach out to your regional office.
[Link]
©2016, Food Allergy Research & Education (FARE) 23
More Food Allergy Resources
When you are new to food allergies, there is a lot to learn. FARE can help! Check out these key resources on our website
to learn more about living well with food allergies and the latest advancements in food allergy research.
Visit [Link]/managing-food-allergies.
Become an Advocate
The FARE Advocacy Network helps you make your
Resources for… voice heard. Keep informed about important legislative
developments and show your legislators you support life-
FARE has a variety of resources designed to help individuals,
saving initiatives at the federal, state and local levels.
families and communities stay safe and live well with food
allergies. In our Resources For… section, you can find tips
Sign up at [Link].
for:
• Newly Diagnosed • Healthcare Providers
• Parents • Schools, Camps and
• Kids Child Care Facilities Advancing a Cure
• Teens • Colleges & Universities FARE invests in world-class research that focuses on
• College Students • Restaurants and Food increasing our understanding of food allergies and developing
• Adults Manufacturers therapies that can protect against life-threatening reactions.
[Link]
©2016, Food Allergy Research & Education (FARE) 24
Acknowledgements
This resource was developed by FARE staff and reviewed by members of FARE’s Education
Working Group:
Additionally, Chef Joel Schaefer, owner/president of Allergy Chefs, Inc., collaborated on the dining section of
this guide.
[Link]
©2016, Food Allergy Research & Education (FARE) 25
Creating a Food Allergy & Anaphylaxis Emergency Care Plan with your doctor is essential for emergency preparedness. This plan provides detailed instructions on recognizing and responding to an allergic reaction, including the use of epinephrine auto-injectors . Such a plan is crucial because allergic reactions can vary significantly in severity, and swift intervention can be lifesaving . It ensures that caregivers and family members are informed and prepared to act effectively during a reaction .
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires FDA-regulated food products containing major food allergens—such as milk, wheat, egg, peanuts, tree nuts, fish, crustacean shellfish, and soy—to list these allergens on product labels . The label must specify the specific type of tree nut, fish, or crustacean shellfish used . However, FALCPA does not cover fresh meats, fresh fruits, vegetables, highly refined oils, or restaurant foods prepared per individual order . Moreover, it does not require advisories for unintentional traces of allergens due to cross-contact in facilities .
Anaphylaxis is a serious allergic reaction that occurs quickly and can lead to death . The primary treatment is the early administration of an epinephrine auto-injector, as it effectively counteracts the severe, life-threatening symptoms. In contrast, antihistamines only alleviate mild symptoms like itchiness but cannot address the systemic effects of anaphylaxis .
Individuals with soy allergies should avoid foods containing soy and associated derivatives like soy cheese, soy flour, soy milk, etc. While highly refined soybean oil is generally safe for soy-allergic individuals, and many can consume soy lecithin without issue, it is essential to follow a healthcare provider's advice concerning these derivatives . Being vigilant about reading food labels and understanding food derivatives is crucial .
Food allergies involve the immune system and can be life-threatening, whereas food intolerances, such as lactose intolerance, involve digestive issues and are not life-threatening . This distinction is important because the management and risks associated with each are different. For food allergies, strict avoidance and an emergency care plan are required to prevent severe reactions .
Teens and young adults are at a higher risk of fatal outcomes from anaphylaxis because they are more likely to engage in risky behaviors, such as ignoring food allergy precautions or delaying treatment . This demographic may underestimate the severity or immediacy of allergic reactions, leading to dangerous outcomes if they do not administer epinephrine promptly or seek medical help .
Effective management of a food allergy involves several steps. Firstly, educating oneself about food allergies and their management is crucial. This includes reading the Food Allergy Field Guide and carrying with you a sheet with tips for avoiding allergens . Secondly, being prepared involves filling prescriptions for epinephrine auto-injectors, practicing their use, and ensuring family members know how to use them . Developing a comprehensive Food Allergy & Anaphylaxis Emergency Care Plan with a doctor is essential . Furthermore, staying connected and informed through resources such as FARE's website, support groups, and regular updates is crucial . Lastly, ensuring a management plan is in place at school or child care facilities and helping the child understand their allergies are important steps for parents .
Molluscan shellfish, like scallops, clams, mussels, and oysters, are not classified as major allergens under current food allergen labeling laws and therefore do not need to be indicated on food labels . Unlike crustacean shellfish, which require specific labeling, mollusks' presence is not mandated to be disclosed, potentially requiring additional vigilance by consumers of such allergens .
Most allergists recommend avoiding products with precautionary warnings such as "May contain…" because studies have shown these products can contain allergens in amounts significant enough to cause allergic reactions . These labels are voluntary, meaning that their absence does not necessarily indicate safety, as manufacturers are not required to disclose all potential cross-contact with allergens .
A biphasic reaction is when symptoms return one to four hours after the initial allergic reaction symptoms have subsided . Hospital observation is recommended after a severe reaction because this second wave can occur, sometimes even longer after the first, posing additional risks requiring medical intervention . Staying in a medical facility allows for monitoring and treatment if symptoms re-emerge .