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Feeding A Child With Food Allergies

WHAT ACTUALLY IS AN ALLERGY?  

  • A true allergic reaction is an immune system response. Immune systems normally fight disease, but in the case of allergies the reaction creates illness. The immune system of allergic people creates increased amounts of IgE, an antibody. When allergic people eat foods containing the allergen - peanut protein, for example - the IgE reaction is set into motion.

  • When we eat, small amounts of food proteins are rapdily circulated through the blood to our organs. But when a food-allergic person eats an allergen, the IgE antibodies recognize  the invader and histamine-producing blood cells called "mast" cells and basophils (part of the immune system that normally protects the body from infection) become "activated."

  • Whenever an allergic person eats, touches, or breathes (in extreme cases) the mast cells are waiting to react. The allergic reaction can be characterized by hives, swollen lips and tongue, asthma, vomiting and diarrhea, or any combination of these symptoms.

  • Mast cells are usually found where the body comes in contact with substances such as food, pollen or animal dander: normally the skin, mucous membranes, lungs and gastrointestinal tract.

  • Everyone has mast cells, but different groups of these cells are activated by different allergens. Only one thing is certain: wherever the mast cells are triggered is where the reaction will show up. So three different children, all allergic to peanuts, could all have different reactions. One may have the triggered mast cells in her lungs, therefore may have an asthma attack. One may have the triggered mast cells in his GI tract and therefore may vomit. And the last child may have the triggered mast cells in her skin and may get hives. Children frequently react in different ways to different foods.

 

WHY ALLERGIES?

There are three different theories for why food allergies have been on the rise. It's probably safe to say that not one of these theories is the culprit for making children allergic to food, but more likely a combination of all three.

  • Theory 1: Introduction: Leading allergists have determined a direct link between how early a food is introduced and how common the allergy to that food becomes. For example, a child can be passed peanut protein through breast milk. Exposing peanut protein to a child that early in life can be a direct link to allergies.

  • Theory 2: Hygiene: As our culture has become more and more germ phobic, we have come as close as humanly possible to sanitizing our young children's environments. There was a time when a pacifier dropped onto a clean kitchen floor was just popped back into the mouth. Now not only do we wash the pacifier in hot soapy water, we wash our hands with antibacterial soap just for good measure. The young immune system is born primed to ward off all the nasty little bacteria and viruses that have coexisted with humans for millennia. In fact, it's something we need to do to get our immune systems in fighting form. If there is nothing for the immune system to fight off, it acts like a bored-to-tears toddler in a neat-as-a-pin living room: it will turn destructive. The result for an allergic child is an immune system so ready to attack it sees milk, eggs, wheat and the rest as enemies.

  • Theory 3: Genetics: Some children are just genetically prone to developing food allergies. If either side of the child's family has a history of allergies - any kind of allergies including food allergies, eczema, asthma, hay fever and allergies to dust mites, feathers, and animal dander - it's probably best to assume that the child has inherited an immune system that is armed and ready to mount an allergic response.

 

SYMPTOMS

The symptoms of an allergic reaction can range from minimal (runny nose) to severe (anaphylactic shock). The most common symptoms are:

  • Diarrhea

  • Vomiting

  • Hives

  • Swelling

  • Rashes

  • Wheezing

  • Coughing

  • Headaches

  • Runny/Stuffy Nose

  • Irritability

  • Shock

  • Colic

 

ANAPHYLAXIS

Anaphylaxis literally means "against or without protection." Most doctors reserve the term for a reaction that affects two body systems - hives plus wheezing for example - or any reaction that could escalate into a life-threatening situation.

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Common symptoms of anaphylaxis include:

  • Itching and swelling of the lips, tongue, inside the mouth and pharynx (vocal cords). Children may report an itching, burning, or tingling sensation. When symptoms have progressed to include swelling inside the throat, the child's voice begins to grow hoarse and breathing is accompanied by an audible rasp.

  • Widespread hives and skin swelling.

  • Neausea, vomiting, abdominal pain and/or diarrhea.

  • An overall feeling of itchiness, in association with a rash, sneezing and itching runny nose.

  • Wheezing or a feeling of tightness in the chest.

  • An anxious, nervous feeling most adults would describe as a "sense of impending doom."

  • Weakness, fainting, or chest pains, accompanied by a rapid, weak or irregular pulse.

  • Shock and loss of consciousness.

 

Anaphylaxis progresses quickly usually within two hours of being exposed to the offending food. 

 

ANAPHYLAXIS ACTION PLAN

  1. Act as quickly as possible at the first symptoms of a reaction.

  2. Give the child a shot of epinephrine (The child will hopefully already have been diagnosed by the physician.) and a dose of liquid antihistamine as prescribed by a doctor.

  3. Call 9-1-1.

  4. Explain to the dispatcher that the child is experiencing an anaphylactic reaction to food. Quickly describe the symptoms. State that you already gave the child epinephrine and antihistime, but that you may need more epinephrine as a back up.

  5. Stay as calm as possible for the child's sake. If the child has a special toy, doll, or stuffed animal, make sure it's available for comfort.

  6. If your state does not authorize emergency personnel to administer epinephrine, ride in the ambulance with the child with an extra dose in case one is needed en route.

  7. Keep the child in the ER for several hours, as second-phase anaphylactic reactions may occur.

 

THE MOST COMMON FOOD ALLERGIES

 

MILK

  • It is estimated that 2.5 percent of babies and toddlers are affected by milk allergies.

  • There needs to be a clear distinction between a true milk allergy and a lactose intolerance - if a true allergy is found, avoidance is the only real preventative measure.

  • Physical Signs of A Milk Allergy: some babies and young children who are allergic to milk may not have the distinctive signs of eczema or asthma, but wear the evidence as plain as day nonetheless.

  • You may see any or all of these signs: dark blue, black or reddish circles under the eyes (known as "allergic shiners"), reddish earlobes, a reddened nose (which is the result of constantly rubbing the tip up and down to stop the itch, a movement known as the "allergic salute").

  • Milk puts hefty doses of protein and calcium in a child's diet, as well as riboflavin, pantothenic acid, phosphorus and vitamin D. The protein, riboflavin, pantothenic acid and phosphorus are easy to replace if the child eats eggs, meat, chicken or fish with legumes, nuts, seeds and whole grains. Vitamin D can come from direct sunlight (15 minutes a day without sun screen) or from vitamin D supplements.

  • Most children - about 85% - completely outgrow their milk allergy by the time they are three years old.

  • Unfortunately, though, milk allergic children are at a much higher risk for developing other food allergies. As reported by Dr. Sampson (in "Food Allergy," Journal of the Academy of Clinical Immunology, June 1999), 35% of infants with milk allergies by one year of age had other food allergies by age three, and 25% had other food allergies by age ten. Dr. Sampson recommends that milk-allergic babies and toddlers be kept away from the allergens most common to cause severe problems - eggs, peanuts, tree nuts, fish and shellfish - before the age of three.

 

The following terms on an ingredients label indicate the presence of milk. Avoid them!

  • artificial butter flavor

  • butter, butter fat, butter oil

  • buttermilk

  • casein

  • caseinates (listed as ammonium, calcium, magnesium, potassium, or sodium caseinate)

  • cheese and cottage cheese

  • cream

  • curds

  • custard

  • ghee

  • half and half

  • hydrolysates (listed as casein, milk protein, protein, whey or whey protein hydrolysate)

  • lactalbumin, lactalbumin phosphate

  • lactoglobulin

  • lactose

  • lactulose

  • milk (derivative, powder, protein, solids, malted, condensed, evaporated, dry, whole, low-fat, nonfat, skimmed, and goat's milk)

  • nougat

  • pudding

  • rennet casein

  • sour cream, sour cream solids

  • sour milk solids

  • whey (in all forms, including sweet, delactosed, and protein concentrate)

  • yogurt

 

The following terms may indicate the presence of milk.

  • chocolate

  • flavorings (including caramel, Bavarian cream, coconut cream, brown sugar, butter, and natural flavorings)

  • high protein flour

  • margarine

  • simplesse

 

Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a full list of a specific child's allergic food ingredients.

 

EGGS

  • Allergies to eggs are common in childhood and, - happily are frequently outgrown. But for the duration, complete and total avoidance not only is key to the child's health, but greatly improves the chances that the allergy will be outgrown.

  • There's the "here, there, everywhere" problem of finding foods, particularly baked goods and desserts, that are completely egg free. And there's the medical aspect: some vaccines - the influenza vaccine, for example - are cultured in egg protein.

  • Although for most children it's typically the egg whites and not the yolk that contains the allergen, it's impossible to truly separate them so that not a speck of white remains.

  • Children who are allergic to egg yolk are also highly likely to be allergic to chicken, turkey and other poultry.

  • There also seems to be a very strong correlation between egg allergies and asthma, with about 55% of egg allergic children eventually developing the disease.

 

Eliminating Eggs (Practical Guidelines):

  • Avoid obvious egg sources: scrambled eggs, omelets, timbalas, souffles, egg noodles, custards, and egg nog. Packaged egg substitutes are generally made with egg whites and should be avoided.

  • A shiny glaze on baked goods is a signal that the food was probably brushed with egg before baking.

  • Avoid mayonnaise and egg-based sauces such as hollandaise, bernaise, Foyot and Newburg. Salad dressings and sandwich spread frequently contain egg as well.

  • Assume that all bakery goods contain eggs. Some packaged cookies such as graham crackers and animal crackers may be egg-free and some national brands of breads and crackers are egg-free, but be sure to check the label carefully. When possible bake your own egg-free cakes and cookies.

  • Avoid convenience foods and fast foods. All of the following may contain egg: canned goods, such as soups and pasta products; most packaged mixes for cakes, cookies, muffins and pancakes; commercially prepared hot dogs and hamburgers; fried cheese sticks, chicken nuggets and french fries; and unfortunately even pizza dough.

  • Many ice creams, sherbets, sorbets and other frozen desserts are made with eggs. If you can't read the label, don't let the children eat them.

  • Many popular candies contain eggs, particularly egg whites. Read labels carefully.

  • Any meat that has been mixed with bread (such as meatloaf) or breaded (such as fried chicken) probably contains eggs. Meats such as hot dogs, bologna, or sausage may include egg protein as an ingredient.

  • Many pastas - not just egg noodles - contain eggs. Read all labels carefully.

  • Simplesse (fat substitute) contains egg protein.

  • Do not use a pan that has been used to cook eggs unless you have first scrubbed it thoroughly with hot water and soap.

 

The following ingredients indicate the presence of egg protein and should be avoided by children allergic to egg.

  • albumin

  • egg (white, yolk, dried, powdered, and egg solids)

  • egg substitutes

  • eggnog

  • globulin

  • livetin

  • lysozyme (used in Europe)

  • mayonnaise

  • meringue

  • ovalbumin

  • ovomucin

  • ovomucoid

  • ovovitellin

  • simplesse

 

Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a full list of a specific child's allergic food ingredients.

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WHEAT

  • Wheat allergies are not as common as milk, egg or peanut allergies. They are also frequently not as severe.

  • Wheat turns up where it is least expected: soy sauce, canned soups, puddings, candies, packaged shredded cheese, french fries coated in wheat starch, sauces and gravies thickened with flour.

  • Alternatives to wheat flour include rice flour, buckwheat flour (not in the same food family), potato starch, rye flour, oat flour, and barley flour.

  • Be sure to check all cereal box labels carefully; some oat, corn, or rice cereals contain wheat or wheat starch.

  • Avoid foods that contain malt or cereal extract, unless your child's doctor says these foods are safe for your child to eat.

  • Spelt or karmut, both ancient forms of wheat, can be less allergic than wheat depending on the severity of the child's allergy. They are not appropriate for everyone however. Check with your doctor before introducing these foods.

  • Wheat products are frequently found in: baked goods and baked good mixes, including cakes, pies, cookies, crackers; chocolate and other candies; pancakes and waffle mixes; suaces and gravies; processed meats, breaded meats and casseroles; pastas; salad dressings; and soup.

  • FAN (Food Allergy Network) recommends these substitutions for 1 cup wheat flour in baking: 1 1/3 cups rice flour, 1 cup barley flour, or 3/4 cup amaranth flour plus 1/4 cup arrowroot, tapioca or potato starch.

  • Substitutions to wheat: oatmeal or rice in meatballs; meringues; buckwheat; Asian foods (rice, rice noodles); Mexican foods (corn tortillas); Indian foods (lentil flour, papadum); Italian (polenta, risotto); oatmeal; quinoa; barley; spelt; kamut; health food stores (wheat free waffle, pancake, cookies and cake mixes).

 

The following foods and ingredients indicate the presence of wheat and should be avoided by wheat-allergic children.

  • bran

  • bread crumbs

  • bulgur

  • cereal extract

  • couscous

  • cracker meal

  • durum or durum flour

  • enriched flour

  • farina

  • gluten

  • graham flour

  • high gluten flour

  • high protein flour

  • seitan

  • semolina

  • soft wheat flour

  • spelt

  • vital gluten

  • wheat (bran, gluten, germ, malt, starch)

  • whole wheat berries

  • whole wheat flour

 

Other products that may include wheat protein include

  • gelatinized starch

  • hydrolyzed vegetable protein

  • modified food starch

  • natural flavorings

  • soy sauce

  • starch

  • vegetable gum

  • vegetable starch

 

Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a list of a specific child's allergic food ingredients.

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PEANUTS

  • Nuts grow on trees; peanuts are legumes (growing on underground vines).

  • Peanut is a cousin of lentil, garbanzo beans, kidney beans, navy beans, pinto beans, black beans, soybeans and green beans.

  • Peanut allergies are severe, immediate and lifelong.

  • Most peanut-allergic children react to 1/100 of a peanut.

  • Peanuts are ground to thicken soups, stews, veggie burgers, casseroles and tossed into stir-frys and salads & chopped to add texture to bread and baked goods.

  • Peanut oil is in jelly beans, pizza, tomato sauce, vegetable soup, manicotti, and even pats of restaurant butter.

  • The main reason that peanut allergies are so widespread is our widespread exposure to peanuts, beginning in utero (peanut protein can be found in breast milk).

  • Peanut proteins are extremely stable and they do not breakdown in the cooking process or digestion. Peanut protein remains whole and unchanged, an explanation for such a potent allergen.

  • 35% of peanut-allergic children are also allergic to tree nuts. If a peanut allergic child has not been introduced to tree nuts, don't! Also stay away from shellfish and fish because they are also highly allergic.

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Completely eliminating peanuts from a diet involves three steps:

  1. Whenever possible, stick to whole, unprocessed or minimally processed foods (fruits, vegetables, meats, eggs, milk, cheese, pasta, rice or simple grain cereal). This makes good sense for all of us, but for peanut-allergic children it's particularly important. Eliminating or greatly reducing your child's intake of processed food has the added benefit of taking the worry out of eating, or at least reducing it considerably.

  2. Get REAL - Read Every and All Labels. No matter what the food, no matter how many times you've served it to your child, read the ingredients label. Ingredients may change at any time and may differ from region to region. Thirty seconds spent reading the label may very well save you the hours-long unpleasantness of reaction or even a trip to the emergency room.

  3. Whenever possible, bake it yourself. There are many national brands of breads and cookies you'll find safe to feed your child. However, do yourself and your child a favor and stay away from bakeries. The possibilities for cross-contamination are just too high.

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The following ingredients indicate or may indicate the presence of peanuts in a food and should be avoided by children allergic to peanuts.

  • peanut (also watch for the line "may contain peanut traces")

  • cold-pressed or expeller-pressed peanut oil

  • ground nuts

  • mixed nuts

  • hydrolyzed vegetable protein (may contain peanut protein)

  • hydrolyzed plant protein

  • vegetable oil, if the vegetable is not specific (may be peanut oil)

  • peanut butter

  • peanut flour

  • peanut starch

  • beer nuts

  • artificial nuts (may be deflavored peanuts)

  • natural flavorings (may contain peanut protein)

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Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a full list of a specific child's allergic food ingredients.​

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TREE NUTS

  • Tree nuts are the most potent of all known food allergens.

  • Tree nuts include: almonds, walnuts, hazelnuts, macadamia nuts, pine nuts, brazil nuts, pistachios, cashews, hickory nuts, chestnuts, and pecans.

  • There is a greater than average chance that peanut allergic children will also be allergic to tree nuts.

  • If a child is allergic to one kind of nut - almonds - it is not necessarily a done deal that he or she is allergic to all tree nuts.

  • Tree nuts are a popular addition to breakfast cereals, muffins, cookies, breads, ice cream treats, candies, waffles, snack foods and crackers.

  • Avoid any food that has the name of a nut or the word nut anywhere on the label. Also look out for marzipan, nougat and gianduja.

  • Commercial bakeries are off limits to tree nut allergic children! There is no way to clean the equipment well enough to prevent cross-contamination.

  • Restaurants also can have cross-contamination when they serve chicken salad with walnuts, green beans with almonds, and pecan pies.

  • Pesto with pine nuts could be in ravioli and canneloni.

  • Nut oils are commonly used in cooking sauces and filling. Simpler foods are a better bet - plain grilled chicken breast and baked potatoes.

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Most of the time, reading a label in order to avoid nuts is fairly straight-forward. The label will clearly state nuts, nut oil, or that particular kind of nut or nut oil being used. Nut butters, too, are clearly marked and should be avoided. Nuts are also present when these terms are used.

  • almond extract

  • Nu-nuts (artifical nuts)

  • nut meal

  • pinon, pignoli

  • Gianduja (chopped nuts mixed with chocolate)

  • marzipan (almond paste)

  • nut paste

  • mashuga nuts (pecans)

  • nougat

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Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a full list of a specific child's allergic food ingredients.

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SEEDS

  • Sesame, poppy and sunflower seeds are the chief offenders in this category.

  • Mustard (yes it's a seed) is particularly tricky.

  • Be wary of mayonnaise, prepared sandwiches and salads, marinades, salad dressings, grilled dishes, ground meat dishes such as meatballs and meat loaf, soups, stews, and gravies.

  • Sometimes the seed oils should be avoided as well.

  • As with nuts, seeds are commonly hidden in baked goods, toppings, fillings and sauces.

  • Cross-contamination is also a problem. Bagels packaged together, cookies piled at the bakery, and Chinese restaurants frequently use sesame seeds and oils.

  • Seeds are so small it's hard to notice if contamination has occurred.

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SOY

  • Usually not a life threatening allergy, but it can be.

  • Soy allergies usually are outgrown by children.

  • Soybeans and soy products including soy flour and soy protein show up in national brand foods such as cereals, candy, crackers, margarine, cookies, hot cocoa mixes, canned soups, sauces, stews, tuna, bread and pasta.

  • High protein is a tip off that soy flour is present.

  • Corn cereals are processed with soybeans so many contain traces of soy protein.

  • Look for "may contain soybean traces" on foods that may be affected by cross-contamination.

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The following is a partial list of ingredient terms that indicate the presence of soy.

  • hydrolyzed soy protein

  • miso

  • shoyu sauce

  • soy, including soy albumin, soy flour, soy grits, soy nuts, soy milk, or soy sprouts

  • soy protein, soy protein concentrate, or soy protein isolate

  • soy sauce

  • soybean, soybean granules, or soybean curd

  • tamari

  • tempeh

  • textured vegetable protein, also known as TVP

  • tofu

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The following ingredients may indicate the presence of soy protein:

  • flavorings or natural flavoring

  • hydrolyzed plant protein

  • hydrolyzed vegetable protein

  • vegetable broth

  • vegetable gum

  • vegetable starch

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Note: There may be other ingredients that cause allergic reactions in this category. It is best to check with a doctor or allergist for a full list of a specific child's allergic food ingredients.

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FOOD FAMILIES

If a child is allergic to one food, there is a chance that he or she will also be allergic to foods in the same family. This is not always the case, but it's better to have the knowledge than not know at all.

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HIDDEN ALLERGENS

Sometimes allergens are not necessarily hidden. It's just that you wouldn't expect to find them in certain places. Always read all labels every time you purchase an item.

 

MILK

At the Deli Counter:

  • If your child is highly allergic to milk, remember that deli slicing equipment is used for cheeses as well as meats. It is highly likely that some cross-contamination will occur if the order or two before yours was for sliced cheese. The only way to completely guarantee your child's safety is to purchase prepackaged kosher deli meats, as kosher dietary laws prohibit mixing milk with meat. If you have the good fortune to live near a kosher deli, by all means buy your fresh sliced meats there. 

  • Caramel color (may contain milk protein), found in many deli meats.

  • Natural flavorings (may contain milk protein), found in many deli meats. 

  • Milk or milk products in non-kosher meats such as frankfurters, bologna, salami, and other sausages. 

  • Any deli salads, due to the possibility of cross-contamination with milk-containing side dishes such as coleslaw and macaroni salad. 

  • Sandwich breads and rolls (may contain milk).

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At the Ice Cream and Candy Stores: 

  • While it's obvious that milk can be found in ice cream, frozen yogurt, sherberts, and most varieties of chocolate, it can lurk in virtually any confection, including hard candies, jelly beans, and candy corn. Do not allow your child to eat any candy or frozen treat unless you can read the ingredients, and watch out for the following situations: 

  • Milk-free chocolate or candies may be stored or displayed alongside milk-containing varieties. If the candies touch, or if the same scoop is used to serve them, there may be enough milk protein exchanged to give your child a reaction. Your safest bets are labeled, individually wrapped chocolate bars or labeled bags of candy. 

  • Read labels with extra care. A chocolate bar or bag of candy may not list milk on the ingredients label but may be marked D (dairy) or DE (dairy equipment), which means the sweet was processed on the same line as a milk-containing product.

  • Some ice cream shops sell soft frozen fruit treats that are advertised as milk-free. Skepticism is the safest route here: just saying it's so doesn't make it so. There may be casein (a milk protein) or natural flavor that contains milk protein in the product. Ask to read an ingredients statement. A safer bet (though not always an option) may be to purchase an individually wrapped and labeled popsicle or similar frozen confection. 

  • Sorbets may very well be milk-free (Ask to read ingredients.) but if they are being scooped out of a barrel in an ice cream shop, they have invariably been contaminated with milk protein. Avoid them. 

 

In Restaurants: 

  • Butter is a restaurant's favorite ingredient because it makes things taste so good. Some well-known chefs confess to adding a stick or more of butter to a single entree. Even when exercising restraint, many restaurant chefs believe that brushing butter on a broiling steak, slathering butter over roasted chicken, and adding a fat pat of butter to vegetables all in the name of gustatory pleasure. Unfortunately, however, when you inquire about a milk allergy, not everyone will make the butter connection. Be specific and crystal clear that your child's meal must be absolutely plain. 

  • Avoid salad bars and family-style buffets at all costs. Cross-contamination of the food is virtually guaranteed. 

  • Frying oils are notorious carriers of allergens. If the restaurant features fried chicken or fish (which are often dipped in milk before coating), fried mozzarella sticks, or any other milk-containing fried food, it would probably be best for your child to avoid eating the restaurant's french fries unless they are cooked in a separate fryer. Be sure to ask if the french fries have a coating that contains milk, as many do. 

  • Breads, bread sticks, and crackers may be baked with butter or other milk products. 

  • Tomato sauces are frequently made with cheese or other milk products. 

  • Salad dressings, apart from plain oil and vinegar, may have cheese, whey, or other milk protein in them. 

  • Soups, stews, and meat gravies are often thickened with a roux made from browned butter and flour. Even if the item in question is a plain vegetable broth, ask specifically if it contains milk or butter. Better yet, avoid soups and gravies all together. 

  • In fact, it's probably safe to assume that any casserole dish - from chili to pasta dishes - has at least some milk protein in it. Stick to single-ingredient entrees. 

  • Desserts other than fresh fruit are a risky proposition. If your family enjoys restaurant desserts, pack a safe baked treat or milk-free chocolate bar for your child. 

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At the Grocery Store: 

  • Remember that lactose-free and dairy-free do not usually mean free of all milk protein. Soy and "veggie" cheese contain casein, a milk protein, and some may even contain whey. Dairy-free frozen desserts may be processed on a line with dairy products, which should be noted on or directly below the ingredients list. 

  • Avoid the in-store salad bar. Cross-contamination is a given. 

  • Most brands of margarine contain milk. 

  • Packaged foods - including the breads, pretzels, crackers, cereals, candies and cookies that you've regularly bought for years - can change ingredients at any time. Be sure to get REAL and Read Every and All Labels - every time. 

  • "Fun-size" versions of candy may contain different ingredients than the regular-sized products. 

  • Fat-free or low-fat versions of products you regularly use will have different ingredients. 

  • Strange as it may seem, canned meats and fish may contain milk protein.

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Miscellaneous: 

  • Milk protein may be present in prescription and over-the-counter medications. Always read the label or consult the Physician's Desk Reference before giving your child medications.

  • Food for dogs and cats frequently contains milk protein. Keep your little one away from the pet food dish!

  • Many personal care products such as lotions, soaps, and shampoos are made with milk or milk protein. 

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EGGS

At the Deli Counter: 

  • Because mayonnaise is rich in eggs, and the deli salads are rich in mayonnaise, avoid giving your child any salad items from the deli department. With different shifts or workers serving hundreds of customers each day, the odds are great that someone will stick the wrong spoon into the wrong bin and introduce egg protein, let's say, into the Greek olives or fruit salad. 

  • Because many pastas have egg in the recipes, avoid pasta salads. 

  • Many breads and rolls are made with eggs. If you would like your child to have a sandwich prepared with deli meats, buy a bag of rolls that have the ingredients listed and ask the counter person to slice the meat onto one of them. 

  • Prepared hot items -such as knishes, pizzas, fried chicken, macaroni and cheese, meatballs, and soups - may contain egg protein and should be avoided. 

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At the Ice Cream and Candy Store: 

  • Many ice creams, particularly premium brands, get their richness from eggs. So do many frozen yogurts, fine sherbets, and sorbets. Always ask about the ingredients. If one flavor is made with eggs, you must assume that the other barrels of ice cream have been cross-contaminated. Soft-serve treats, provided the ingredients check out, are a safer bet. 

  • Egg protein may be an ingredient in sprinkles and other toppings. 

  • Many candies are made with egg. If the same serving scoop is used for a variety of candies, you must assume some cross-contamination has occurred. Prepackaged or individually wrapped candies are a safer choice. 

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In Restaurants: 

  • Deep dish pizzas often incorporate egg in the dough, and other pizzas may as well. Always ask. 

  • Avoid the salad bar and family-style buffets at all costs. Cross-contamination is virtually guaranteed. 

  • Many pastas are made with egg. 

  • Any ground meat dish - lasagna, meat loaf, meat-filled dumplings, or meatballs, for example - will probably have some egg in it. 

  • Fried foods, including french fries, frequently have an egg coating. Any dish that requires one of its elements to be fried before being added to the casserole - eggplant parmigiana, for instance - may be made with egg. 

  • Any breaded item probably included egg in the recipe. 

  • Soups, particularly those with pasta or meatballs in them, frequently use egg protein. 

  • Salad dressings, apart from plain oil and vinegar, often contain eggs. 

  • Because many breads are baked with egg, avoid the bread basket and hamburger buns. 

  • Many Chinese dishes - from fried rice to egg rolls, egg foo young, egg drop soup, and others - are heavily laden with egg. 

  • Milk shakes may be made with egg-laden ice cream. There may be egg protein in smoothies as well. 

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At the Grocery Store: 

  • Many ice cream and frozen desserts, including sherbets, sorbets, and others are manufactured with egg ingredients. Get REAL - Read Every and All Labels - every time. 

  • Any baked goods - such as breads, crackers, cookies, bagels, rolls, cakes, donuts, and muffins - usually have egg in the recipe. If you cannot read the label, do not allow your child to eat it. 

  • Frozen waffles and pancakes are almost always made with eggs. 

  • Many candies, including candy corn, jelly beans, chocolate, and chocolate mints, may hide egg protein. Always read the label. 

  • Canned soups are another place where egg protein may be hidden. 

  • Granola bars and similar products may include egg as an ingredient. 

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PEANUTS

At the Deli Counter: 

  • Peanuts may be added to deli salads or used as a thickening agent in hot dishes. 

  • Fried foods and roasted chickens may contain peanut oil. 

  • If peanut butter sandwiches are made at the deli counter, the knives and cutlery and counters probably have enough peanut butter protein on them to cause a reaction. Ask for a few ounces of sliced meat or cheese wrapped in paper, and make your child's sandwich yourself.  

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At the Ice Cream and Candy Store: 

  • Peanuts, peanut starch, or peanut oil may be in any candy at all. If a peanut-free candy is stored with candy containing peanuts, the peanut-free candy must be considered unsafe to eat. Only allow your child to eat wrapped candy with an ingredients label that you can read. 

  • Ice cream shops use the same scoops for all ice cream flavors, so cross-contamination is a given. If possible, order your child a soft-serve cone, after you have determined that no peanuts are in the flavor and no peanut flavor has been served from that machine for a few days at least.

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At the Grocery Store: 

  • Many cereals either contain peanuts or are processed on the same line with peanut-containing products. Always read the label. 

  • Many crackers are processed on the same line as peanut-filled varieties. Read the label. 

  • Breads and muffins may contain peanuts or peanut flour, or may be processed on the same line with those that do. 

  • Do not allow your child to eat cookies, cupcakes, donuts, muffins, or other treats displayed in a bakery case. Not only are the ingredients a mystery, there is a good chance that even a "safe" item will have rubbed shoulders with a peanut-containing one. 

  • Avoid store-packaged bakery items, even those with ingredients labels. It has been experienced that these are less than reliable. 

  • Carefully read the labels on all packaged candies, including chocolate chips. It seems the majority these days will say "may contain peanut traces."

  • Use your own judgement with granola bars and granola cereals. 

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In Restaurants: 

  • Any fried foods - from chicken to french fries to potato chips - may have been fried in peanut oil. If the chef tells you the oil is a vegetable blend, it may contain peanut oil. If the oil itself is safe, but if foods containing peanuts are then fried in the oil, the oil will contain enough peanut protein to cause a reaction. 

  • Any soups, stews, casseroles, or other blended dishes may contain peanut butter, ground peanuts or peanut oil. Peanuts have shown up in dishes from chili to manicotti. Always ask about ingredients before ordering any dishes. 

  • Beware the bread basket: it has been known to contain muffins made with peanut flour and pats of butter with ground peanuts blended in. 

  • Some imported tomato sauces and pastas contain peanut oil. 

  • Peanut oil is used in numerous pizza recipes. 

  • Certain cuisines - Chinese, Japanese, Thai and African in particular - rely so heavily on peanuts that cross-contamination is inevitable. Avoid these restaurants. 

  • Desserts are problematic. Any baked dessert may contain peanuts or enough peanut traces to cause a reaction. Best bets are ice cream - provided your server can tell you the ingredients - and fresh fruit. Many parents choose to bring their own special dessert. 

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Miscellaneous: 

  • Many foods for small animals such as guinea pigs and hamsters contain peanuts. 

  • Peanuts and peanut butter are very appealing to wildlife, so they are often found in bird food and seed dispensers. 

  • Peanut butter is the lure of choice for mice. If you need to call in an exterminator, be sure to tell them to carefully hide all mousetraps. 

  • Lotions and creams may be made with peanut oil. Read every label carefully. 

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TREE NUTS

At the Deli Counter: 

  • Tree nuts may be added to salads. If any one salad in the deli case has tree nuts, there is a good chance for cross-contamination to occur with other salads. 

  • Pasta salad may be made with pesto, which usually has pine nuts as an ingredient and often walnuts as well. Always ask.  

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At the Ice Cream and Candy Store: 

  • Nuts or nut oils may be in any candy at all. If a nut-free candy is stored with candy containing nuts, the nut-free candy must be considered unsafe to eat. Only allow your child to eat wrapped candy with an ingredients label you can read. 

  • Ice cream shops use the same scoop for all ice cream flavors, so cross-contamination is a given. If possible, order your child a soft-serve cone, after you have determined that no nuts are in the flavor and no nut flavor has been served from that machine for a few days at least.

 

In Restaurants: 

  • Salads may have nuts tossed in or may be dressed with a nut oil. 

  • Slivered almonds may be tossed with vegetables or served on top of fish or chicken. If this is the case, simply removing the nuts does not make the food safe to eat. 

  • Ground nuts may be found in virtually any dish that calls for ground meat or chicken, from ravioli to spicy meatballs. Always ask. 

  • Breads frequently contain bits of nuts. 

  • If you notice a special fried entree that features nuts - pecan crusted fried chicken, let's say - assume that the cooking oil has enough nut protein in it to cause a reaction, and do not allow your child to order fried food. Occasionally, french fries will be cooked in their own separate fryer. Ask if this is the case. 

  • It's safest to assume that baked desserts either contain nuts or have been cross-contaminated with nuts. Ice cream or pudding may be a good choice if your server can check on the ingredients. Fresh fruit with whipped cream (Make sure the whipped cream ins't flavored with a nut extract!) may be another good choice.

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At the Grocery Store: 

  • Many more cereals than you'd expect contain nuts, particularly those touted as multigrain or that have the word "healthy" in their name.

  • Granola almost always contains nuts as do granola bars. 

  • Many whole-grain breads contain nuts or carry a warning about possible cross-contamination. 

  • Cookies and crackers may contain ground nuts. 

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Miscellaneous: 

  • Pet food for small animals may have tree nuts. 

  • Personal care products such as shampoos, body oils, creams, and lotions may be made with nut oil. 

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WHEAT

At the Deli Counter: 

  • Many sandwich meats are made with cereal fillers or modified food starch, which frequently have a wheat component. (If the ingredients merely says "starch," you may safely assume that it's cornstarch.) Hydrolyzed vegetable protein or hydrolyzed plant protein frequently contains wheat. Read the ingredients on the meat to be sliced before allowing your child to eat it. If your child is anaphylactic to wheat, understand that there is a risk of cross-contamination if meats with cereals or modified food starch are sliced on the same equipment. 

  • Processed cheese may also have a wheat component. Exercise the same caution as above. 

  • Dressed salads may contain soy sauce, which contains wheat, or other wheat-derived substances such as wheat germ oil. 

  • Turkey salad may have been made from a prebasted bird, and most basting sauces have wheat in them.  

  • Fruit salads stand the risk of cross-contamination from their neighbors. You're best off avoiding pre-made salads. 

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At the Grocery Store:

  • Do not assume that rice, corn, or oat cereals are wheat-free. Many such cereals are loaded with substantial amounts of wheat. Always read the label carefully. 

  • Be especially wary of sauces, gravies, and dressings - both savory and sweet - from tomato sauce to soy sauce to oyster sauce to chocolate sauce. You'll find at least some wheat protein in most of them. 

  • Along the same lines, avoid any foods that may have been marinated or prebasted. 

  • Most canned soups are another place for wheat to hide. Read the labels carefully. 

  • Many ice creams, sherbets, sorbets and Italian ices are made from some form of wheat. 

  • You'll even discover wheat in most chewy candies - licorice, jelly beans, gumdrops, candy corn and the like. Many brands of plain chocolate are safe, but it is a little-known fact that candy manufacturers often use flour on their production lines to keep the candy from sticking as it is processed. This is a perfectly safe and wholesome practice in general, but not for those with wheat allergies. To find out if this is the case with your family's chocolate of choice, contact the manufacturer directly. And of course, read all the labels. 

  • Many hot cocoa mixes are made with wheat starch. 

  • Although rice is a wheat-allergic child's best friend, most rice mixes will have some wheat ingredient in them too. If your child has a hankering for specialty rices, learn to whip up a quick and easy risotto. Your whole family will be the richer. 

  • Shredded cheese and processed cheeses usually contain some form of wheat starch or wheat protein. 

  • Many brands of yogurt use modified food starch as an ingredient, which may indicate the presence of wheat protein. Stick to the brands that are simply cultured milk, sweetener, and safe flavorings. 

  • Frozen vegetables in sauce will probably have some form of wheat or wheat protein. 

  • Here's an unusual one: the glue used on many envelopes, stamps, and stickers gets some of its sticky quality from wheat starch. Use the self-stick kind or a sponge. 

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At Ice Cream and Candy Store: 

  • Although some brands of ice cream have many wheat-free flavors, if there is a fudge-brownie or cookies and cream variety, you have to assume that the flavor your child wants has been cross-contaminated with a wandering ice cream scoop. Call the manufacturer to determine the ingredients of the soft-serve varieties, if any. And of course, the cone is a no-no. 

  • The only safe candy is a candy that's prewrapped with the ingredients clearly marked. Individually wrapped chocolate bars, hard candies, and chewy candies may all be perfectly safe so long as you can read the ingredients. 

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In Restaurants: 

  • Stick to plain grilled foods such as chicken, fish, steak and chops without sauce or marinade. Depending on the severity of your child's allergy, a hamburger that arrives on a bun may have enough wheat protein on it even after the bun has been removed to cause a reaction. (And the hamburger itself may have bread crumbs in it - always ask.)

  • Avoid fried foods. They will have been cooked in the same oil as breaded items. 

  • Desserts such as puddings and ice creams may contain food starch. Your child would do better with fresh berries and whipped cream, granita (available at Italian restaurants), sorbet (once the ingredients have been checked), or a nice dessert from home. 

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SOY

At the Deli Counter: 

  • Many deli meats, franks, and sausages have soy additives. Always read the ingredients. 

  • Soy protein may be present in canned meats and fish, so avoid deli salads. 

  • Bread, rolls, and English muffins may contain soy flour or soy protein. If you are ordering a sandwich for your child, make sure you know the ingredients of the bread.  

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At the Grocery Store: 

  • Any processed food picked at random off a grocery shelf stands a good chance of having some form of soy in the ingredients. 

  • Soy flour, hydrolized vegetable protein, and soy protein isolate are the most common forms. 

  • In general, soy bean oil and soy lecithin are considered safe for soy-allergic children, but be sure to consult your allergist to make sure this is the case for your child. 

  • Any and all processed foods may contain soy. The most common offenders are canned soup, rice mixes, cereals, crackers, cookies, candy, bread, muffins, baking mixes, snack bars, meat or chicken coating mixes, dairy-case dough, and frozen desserts. But soy protein may be found in virtually any processed food. Get REAL - Read Every and All Labels. 

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At the Ice Cream and Candy Store: 

  • Finer ice cream stores seldom use soy in their products, but you must always check. When in doubt, soft-serve may be your best bet, as the chances for cross-contamination are slimmest. Always ask to read the ingredients. Ice pops and other wrapped treats are even safer, as they have the ingredients printed on the package. 

  • Pure chocolate candies are generally not a problem, but always check the ingredients. Confections such as candy corn, jelly beans, gummy candies, and the like frequently contain soy.

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In Restaurants: 

  • Chinese and Japanese restaurants use so much soy sauce and other soy products in their cuisine that the best route is to simply avoid them. 

  • Soy sauce and teriyaki sauce are common ingredients in marinades, stuffed dishes (such as stuffed mushrooms), soups, stews, and salad dressings, but may be used to enhance the flavor of any dish at all. Be sure to alert your server to your child's allergy when ordering any restaurant meal. 

  • Hamburger and hot dog buns are often made with at least a little soy flour. 

  • Margarine may include soy protein in the ingredients and may be used in restaurant cooking. Be sure to ask if this is the case. 

  • Breads in the bread basket may have been baked with soy flour. 

  • Although it would be the rare bakery that used soy flour or other soy products in cakes, cookies, and pies, the possibility does exist. The safest restaurant desserts are ice cream (if you can find out the ingredients), fruit ices, and fresh fruit with whipped cream. 

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Food allergies are a serious issue and it is important that you understand what may make the children in your care ill. Please take the health and safety of the children in your care seriously and follow any physician's instructions on dealing with a food allergy. 

 

Resources: 

 

  • Barber, Marianne S., Maryanne Bartoszek Scott, M.D., and Elinor Greenberg, Ph.D. The Parent’s Guide to Food Allergies: clear and complete advice from experts on raising your food-allergic child. New York: Henry Holt and Company, LLC. 2001

  • Hammond, Leslie, and Lynne Marie Rominger. The Kid-Friendly Food Allergy Cookbook. Massachusetts: Fair Winds Press. 2004

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To receive a certificate of training hours you must complete a quiz based on the material above. You are required to get all questions correct. If you do not get 100% on the quiz the first time, you may take it over again. The results of the quiz will be emailed to Mid Michigan Child Care Food Program. When we receive the results of your quiz, a certificate of training completed will pop up that you can print. A copy of the certificate will also be emailed to you. 

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Food Allergies Quiz

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