If your child has been recently diagnosed with a food allergy, you probably have a lot of questions. Your child’s clinical team in the Food Allergy Center can fill you in on all the specifics about your child’s condition, allergens and precautions you should take to keep your child as safe as possible. The information below can serve as a food allergy primer as you navigate your path forward for your child with a food allergy.

Reading food labels

Many parents of children with food allergies say they have had to become “food detectives” – reading labels and following clues – to avoid exposure to an allergen and the possibility of anaphylaxis. Clinicians urge patients and parents to always carry or have easy access to epinephrine in case an accidental exposure occurs.

According to the U.S. Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004, all packaged foods (like you buy at the grocery store) must disclose the presence of eight major food allergens – soon to be nine – and use the common names of these foods on the ingredients list.

Food labels must use the phrase “Contains ….” and list out any of these major allergens:

• Milk
• Wheat
• Egg
• Soy
• Peanut
• Tree nuts
• Fish
• Shellfish

These foods account for more than 90% of all documented food allergies in the U.S. and are considered the foods most likely to produce a severe or life-threatening reaction if ingested by someone allergic to them.

Food manufacturers will be required to add “sesame” to this list by January 2023.

One note: Coconut is classified and labeled as a tree nut by FALCPA, but it is a fruit and does not need to be avoided by children with tree nut allergies.

Be on the lookout for Precautionary Allergy Labeling

Precautionary Allergy Labeling (commonly called PAL) is:

• Voluntary for companies to follow.
• Not regulated by any law or regulatory body.
• Not standardized. Allergen content of foods with PAL varies and may include phrases like “may contain _____”, or “processed in a facility that prepares foods containing _____.” While PAL labels must be truthful, they can be confusing for newly diagnosed food allergy patients and their families.

Should you avoid foods with PAL?

Most people with IgE-mediated food allergies can tolerate foods with a PAL warning, but it depends on the individual’s sensitivity to the food allergen. It’s best to discuss with your child’s allergist before eating foods with these precautionary labels.

Ask your child’s doctor about possible differences in PAL labeling from large companies versus smaller company or local foods. Some food allergy families choose to avoid all PAL-labeled food – which may lead to possible unnecessary diet restriction. Other families, on the other hand, may not be minding PAL labels with enough caution and could potentially experience an allergic reaction. We encourage families to help their children avoid foods with PAL labeling until they can contact the food manufacturer to ask specifically about manufacturing practices and the risk of exposure to their child’s specific allergen.

Cosmetics

Do cosmetics include allergen or precautionary labeling?

According to the Federal Food, Drug and Cosmetic Act, all cosmetics for the skin, hair or nails must label all ingredients on their packaging. This includes any food-based items, if used.

Should you read all cosmetic labels?

You should discuss this with your child’s allergist based on your child’s allergen sensitivity level. In general, there is not be enough protein in these products to trigger a reaction. Food proteins in cosmetics and lotions may be irritating to those with sensitive skin or eczema; however, they will not trigger a systemic reaction if used as directed.

If your child ingests these products, you may need to seek help.

Food oils in products

Oils from certain foods are found in a multitude of products found in your home or other places your child may visit. These products could pose a challenge for your child with food allergies – even if the product is not intended to be eaten.

What should you be aware of:

• Full refining of oils for commercial-grade food processing leads to almost complete removal of the protein, making it safe in theory.
• In most cases, a peanut allergic individual can tolerate highly refined peanut oil, such as used for cooking many products at Chick-fil-a^© and some other restaurants.
• Sesame oil does contain sesame protein and should be avoided. Also, one should be cautious with some less commonly found unrefined nut oils – including flax, walnut, almond and sunflower. In most cases, if the oil is highly refined, it will be safe for a person who is generally allergic to the food.
• Other oils including soy (or soy lecithin), corn and most sunflower oils are all considered non-allergenic.
• There’s a difference between “cold-pressed” or “expeller-pressed” oils vs. highly refined oil (see below).

The presence of protein in oil depends on the extraction and processing method:

• Cold- or expeller-pressed oils are likely to contain protein that may cause an adverse reaction for an allergic individual. Examples: seed oils (sesame, flax, others), tree nut oils (such as almond), olive oil, virgin coconut oil and avocado oil. Cold- or expeller-pressed oils are often expensive and available in much smaller quantities. People with an allergy to the source food should avoid these oils.
• Highly refined oils contain minimal protein content, ranging from none to trace amounts. Examples: Peanut oil (except crude), soybean oil, palm oil, corn oil, canola oil, seed oils labeled “highly-refined”. These highly refined oils are often used in fried foods, are inexpensive and can be bought in bulk. People with allergies to the ingredient used in these highly refined oils should be able to tolerate these foods.

Food Allergy Quiz

Test your knowledge about food allergies today and get tips to keep your child safer.

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If you have questions about your child’s food allergies, please reach out to your CHOP allergist by calling 215-590-2549 or contact us online.

Contributed by: Megan O. Lewis, MSN, CRNP and Gita Ram, MD