Medically reviewed by GP Gareth James MBBS, DFFP, DRCOG, MRCGP on December 3, 2023. To give you technically accurate, evidence-based information, content published on the Check My Body Health blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
Navigating the world of food allergies can be overwhelming. With so many ingredients to keep track of, it’s easy to feel lost and anxious. This guide aims to provide clarity. By understanding the 14 major food allergens – what they are, where they hide, and how to manage them – you can take control and minimise the risk of reactions.
The 14 Major Food Allergens
When it comes to food sensitivities, 14 major allergens stand out as the most common triggers for reactions ranging from mild discomfort to life-threatening emergencies. These allergens are legally required to be highlighted on food labels in many countries, emphasising their widespread impact. Understanding these allergens is the first line of defence for anyone with a food allergy or those caring for someone with these sensitivities. Let’s dive into the details!
Cereals containing gluten
Gluten, a protein found primarily in wheat, rye, barley, and sometimes oats, can cause a wide range of reactions in sensitive individuals. For some, the symptoms revolve around digestive troubles like bloating, gas, and abdominal pain. Others might experience skin issues like rashes, hives, or eczema flare-ups. In severe cases, a gluten allergy can manifest as respiratory distress or even anaphylaxis. Gluten isn’t just lurking in obvious culprits like bread and pasta – it can be hidden in soups, sauces, processed meats, and even some candies.
- Symptoms:
- Digestive issues (bloating, gas, diarrhoea, etc.)
- Skin reactions (rashes, eczema)
- Respiratory problems (wheezing, difficulty breathing)
- Fatigue, headaches, “brain fog”
- Anaphylaxis (in severe cases)
- Sources:
- Bread, pasta, cakes, cookies, breakfast cereals
- Soups, sauces, processed meats, certain candies
Sulphites/Sulphur Dioxide
Sulphites, used as preservatives in various foods and drinks, are a common trigger for adverse reactions, especially in individuals with asthma. Respiratory symptoms like wheezing, difficulty breathing, and chest tightness are often the key indicators of a sulfite sensitivity. However, reactions can also manifest as hives, nausea, or in extreme cases, anaphylaxis. Dried fruits, wine, processed foods, and certain medications are frequent sources of sulfites.
- Symptoms:
- Respiratory distress (wheezing, shortness of breath)
- Skin reactions (hives, flushing)
- Digestive upset (nausea, vomiting)
- Anaphylaxis (in severe cases)
- Sources:
- Dried fruits (raisins, apricots, etc.)
- Wine and beer
- Processed foods (jams, canned vegetables, etc.)
- Some medications
Celery
Though seemingly innocuous, celery and its various forms (stalks, leaves, seeds, and root) can trigger allergic reactions. Often, celery allergy manifests as Oral Allergy Syndrome, causing itching, tingling, and swelling in the mouth and throat. However, skin reactions, digestive troubles, and even anaphylaxis are possible. Celery sometimes hides in soups, stocks, spice blends, and even celery salt, making careful label reading essential.
- Symptoms:
- Oral Allergy Syndrome (itchy mouth, swollen lips)
- Skin reactions (hives, eczema)
- Digestive issues (nausea, cramps)
- Anaphylaxis (in severe cases)
- Sources:
- Celery stalks, leaves, seeds, and celeriac (root)
- Celery salt, soups, stocks, spice blends
Crustaceans
This category encompasses a wide variety of seafood favourites like crab, lobster, shrimp, crayfish, and prawns. Crustacean allergies are frequently severe, with reactions ranging from hives and swelling to life-threatening anaphylaxis. Cross-reactivity between different crustaceans is common, and even airborne particles during cooking can trigger reactions in highly sensitive individuals.
- Symptoms:
- Skin reactions (hives, swelling)
- Respiratory issues (wheezing, shortness of breath)
- Digestive upset (nausea, vomiting, diarrhoea)
- Dizziness, lightheadedness
- Anaphylaxis (in severe cases)
- Sources:
- Crab, lobster, shrimp, prawns, crayfish
- Seafood sauces and flavourings
- Some processed foods (surimi, imitation crab)
Egg
A common ingredient in countless foods, eggs are a widespread trigger for allergies, especially in children. While many children eventually outgrow an egg allergy, it’s essential to take any sensitivity seriously. Symptoms of an egg allergy can include skin reactions, digestive troubles, respiratory issues, and even anaphylaxis. Eggs can lurk in unexpected places, making careful label reading crucial.
- Symptoms:
- Skin reactions (hives, eczema)
- Digestive issues (nausea, cramps, vomiting)
- Respiratory problems (runny nose, wheezing, difficulty breathing)
- Anaphylaxis (in severe cases)
- Sources:
- Cakes, pastries, cookies, pasta
- Mayonnaise, sauces, mousses
- Meat products (meatballs, meatloaf)
- Egg-glazed foods
Fish
Unlike shellfish allergies, fish allergies refer to reactions to finned fish like salmon, tuna, cod, and others. Symptoms can range from mild skin reactions to severe respiratory distress and anaphylaxis. Although less common than some other food allergies, fish allergies require careful management due to potential severity. Be mindful of hidden sources of fish in sauces, relishes, and even some processed foods.
- Symptoms:
- Skin reactions (hives, swelling)
- Digestive issues (nausea, vomiting, diarrhoea)
- Respiratory symptoms (wheezing, difficulty breathing)
- Anaphylaxis (in severe cases)
- Sources:
- Fish dishes (salmon, tuna, cod, etc.)
- Fish sauces, relishes, salad dressings
- Worcestershire sauce, some processed foods
Lupin
Derived from a flowering plant, lupin is gaining popularity as a gluten-free and vegan-friendly ingredient. However, it’s also a rising allergen, especially for those with existing peanut allergies due to cross-reactivity. Symptoms of a lupin allergy can include skin reactions, digestive issues, respiratory distress, and in severe cases, anaphylaxis. Lupin often hides in unexpected places, emphasising the importance of label scrutiny.
- Symptoms:
- Skin reactions (hives, swelling)
- Digestive issues (nausea, vomiting, diarrhoea)
- Respiratory symptoms (wheezing, difficulty breathing)
- Anaphylaxis (in severe cases)
- Sources:
- Lupin flour (used in bread, pasta, baked goods)
- Some processed foods and snacks
- Vegetarian and vegan products
Milk
Cow’s milk is a common childhood allergen, though many children eventually outgrow it. Milk and milk products are found in a vast array of foods, making avoidance a challenge. Reactions to milk can range from mild digestive discomfort and skin issues to severe anaphylaxis.
- Symptoms
- Digestive issues (nausea, vomiting, diarrhoea, cramps)
- Skin reactions (hives, eczema, swelling)
- Respiratory problems (wheezing, runny nose)
- Anaphylaxis (in severe cases)
- Sources:
- Milk, cheese, yoghourt, butter, cream
- Baked goods, sauces, soups
- Milk-based chocolate and candies
Mustard
Mustard, in its various forms (seeds, liquid, powder), is a surprisingly tricky allergen. While relatively uncommon, mustard allergies can be severe. Reactions often include skin irritations, digestive troubles, and in some cases, anaphylaxis. Mustard can be present in unexpected places, requiring careful attention to labels and questioning when dining out.
- Symptoms:
- Skin reactions (hives, swelling, rash)
- Digestive issues (nausea, vomiting, cramps)
- Respiratory symptoms (wheezing, runny nose)
- Anaphylaxis (in severe cases)
- Sources:
- Mustard (liquid, seeds, powder)
- Salad dressings, sauces, curries
- Some processed meats and deli products
Molluscs
This broad category encompasses a variety of shellfish like oysters, clams, mussels, scallops, squid, and octopus. Reactions to molluscs can be severe and are often lifelong. As with crustaceans, cross-reactivity between different species of molluscs is common. Symptoms of a mollusc allergy can include skin issues, digestive problems, respiratory distress, and in severe cases, anaphylaxis.
- Symptoms:
- Skin reactions (hives, swelling)
- Digestive issues (nausea, vomiting, diarrhoea)
- Respiratory symptoms (wheezing, shortness of breath)
- Dizziness or lightheadedness
- Anaphylaxis (in severe cases)
- Sources:
- Oysters, clams, mussels, scallops, squid, octopus
- Some seafood dishes and sauces
- Fish products (may contain traces of molluscs)
Tree Nuts
Tree nuts are a group of commonly allergenic nuts, including almonds, cashews, walnuts, hazelnuts, pecans, pistachios, and others. While some may be allergic to only one type, cross-reactivity between different tree nuts is possible. Tree nut allergies are often severe, with reactions ranging from skin and digestive issues to life-threatening anaphylaxis.
- Symptoms:
- Skin reactions (hives, eczema, swelling)
- Digestive issues (nausea, vomiting, diarrhoea)
- Respiratory problems (wheezing, difficulty breathing)
- Anaphylaxis (in severe cases)
- Sources:
- Nuts themselves (almonds, cashews, walnuts, etc.)
- Nut oils, nut butters
- Baked goods, desserts, ice cream
- Some sauces and stir-fried dishes
Peanuts
Peanuts, technically legumes, are one of the most common culprits for severe food allergies. They often trigger life-threatening reactions, and even trace amounts can be dangerous. Peanut allergies often begin early in life and are lifelong. Symptoms include skin reactions, digestive upset, respiratory problems, and anaphylaxis. Peanuts can hide in unexpected places, requiring constant vigilance.
- Symptoms:
- Skin reactions (hives, swelling)
- Digestive issues (nausea, cramps, vomiting)
- Respiratory symptoms (runny nose, wheezing, difficulty breathing)
- Loss of consciousness
- Anaphylaxis (in severe cases)
- Sources:
- Peanuts and peanut products (peanut butter, peanut oil)
- Satay sauces, curries, baked goods, chocolate
- Some ice cream and processed foods
Natasha’s Law and Food Labelling
The tragic death of Natasha Ednan-Laperouse in 2016 sent shockwaves through the UK. The teenager suffered a fatal allergic reaction to sesame seeds unknowingly present in a pre-packaged baguette. This heartbreaking incident highlighted the critical need for clear and comprehensive allergen labelling, ultimately leading to the implementation of Natasha’s Law.
Natasha’s Law came into effect in October 2021, revolutionising food labelling for Prepacked for Direct Sale (PPDS) foods. PPDS refers to food prepared and packaged on the same premises where it is sold. This includes food from cafes, bakeries, fast food outlets, and mobile food trucks – anywhere you might grab a quick bite.
The law mandates that all PPDS food must have a full ingredient list with the 14 major allergens clearly emphasised (e.g., in bold, italics, or a different colour.) This significant change empowers individuals with food allergies to make safe and informed choices, reducing the anxiety associated with eating out or grabbing food on the go.
It’s important to remember that while Natasha’s Law significantly improves food safety, allergen labelling regulations can vary internationally. When travelling abroad, it’s important to familiarise yourself with local laws to ensure your safety.
Managing Food Allergies: Proactive Steps for Safety
Living with a food allergy requires a multi-faceted approach focused on avoidance, preparedness, and clear communication. Here’s a breakdown of key strategies:
- Medical Consultation is Essential: The first step is to seek a diagnosis from a doctor, often an allergist. They will perform allergy testing, such as skin prick tests or blood tests, to pinpoint the specific allergens causing reactions. Your doctor will help create a personalised management plan and discuss treatment options.
- Emergency Preparedness: Individuals with severe allergies should always carry emergency medication, such as an epinephrine auto-injector (e.g., EpiPen). It’s vital to know how and when to administer this medication in case of anaphylaxis, a life-threatening allergic reaction. Work with your doctor to create a detailed allergy action plan outlining the steps to take in an emergency.
- Communication is Key: Open communication about your food allergy is essential for your safety and those around you. Inform:
- Schools, daycare centres, and anyone involved in childcare.
- Restaurants and food service providers.
- Friends, family, and anyone hosting social gatherings.
- Become a Label Expert: Meticulous label reading is a must. Familiarise yourself with the various names or derivatives of your allergen that might appear on ingredient lists. When in doubt, don’t hesitate to contact manufacturers for clarification.
- Support and Resources: Living with food allergies can feel isolating, but there’s a whole community ready to help. Organisations like the Anaphylaxis Campaign (UK) and Food Allergy Research & Education (FARE) provide valuable resources, support groups, and up-to-date information to help you navigate managing your food allergy confidently.
Living with Food Intolerances: Managing Discomfort
While food intolerances don’t trigger the same life-threatening reactions as allergies, they can still significantly impact your quality of life. Common symptoms like gas, bloating, abdominal pain, and diarrhoea can be disruptive and uncomfortable. Here’s how to manage them:
- Differentiating Intolerances: It’s important to distinguish intolerances from allergies. Unlike allergies, intolerances involve digestive issues rather than an immune system reaction. A doctor or registered dietitian can help make a proper diagnosis.
- Identifying Triggers: Pinpointing the foods causing trouble is key. Strategies include:
- Elimination Diet: Remove suspected culprits, then systematically reintroduce them, noting any reactions.
- Food and Symptom Diary: Track what you eat and any symptoms to identify patterns.
- Medical Guidance: Consult a doctor or dietitian for personalised guidance.
- Finding Alternatives: Don’t despair – there are plenty of delicious and satisfying substitutes for common triggers. Explore the array of gluten-free, dairy-free, or low-FODMAP products, and discover new recipes and food combinations.
- Label Reading Remains Important: While intolerances aren’t as severe as allergies, avoiding your trigger ingredients means careful label reading. This will help manage symptoms and minimise discomfort.
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Knowledge is Power
Navigating the world of food allergies and intolerances can be overwhelming. However, understanding the 14 major food allergens, the importance of proper labelling, and management strategies are powerful tools. Whether you’re managing a severe allergy or dealing with troublesome intolerances, the key is proactive education and clear communication. By embracing these strategies, you can take control of your health, minimise risks, and enjoy a safer, more fulfilling life with food.
