The Eight Major Allergens

About 90% of all food allergy reactions occur in only 8 foods or food groups –  also known as the major food allergens – according to the U.S. Food Allergen Labeling and Consumer Protection Act (FALCPA).

“The 8 Major Allergens” are defined as one of the following foods or food groups, or is an ingredient that con­tains protein derived from one of the following foods or food groups:

• Milk
• Eggs
• Peanuts
• Tree nuts such as almonds, wal­nuts, and pecans
• Soybeans
• Wheat
• Fish
• Shellfish such as crab, lobster, and shrimp

Food allergies affect about 2% of adults and 4-8% of children in the United States, and the number of young people with food allergies has increased over the last decade, according to a recent report by the Centers for Dis­ease Control and Prevention (CDC). Children with food allergies are more likely to have asthma, eczema, and other types of allergies.

The Eight Major Allergens

Milk

Cow’s milk allergy is the most common food allergy among children, affecting about 2-3% of children, although many children will outgrow their allergy before school age.^2,3 Recent research also indicates that children who have milk allergy may be less likely to outgrow their allergy than they were in previous decades.²

In general, milk allergic individuals must avoid fluid milk, as well as any food made from milk and any food that contains milk or milk ingredients. Although some milk allergic children can tolerate baked milk (for instance, if cooked in a muffin), this should only be approved under the supervision of a physician. Unless otherwise designated, all sources of milk must be avoided to prevent an allergic reaction.

Common foods that may contain milk or milk products (not an exhaustive list):

✓ Fluid milk
✓ Yogurt
✓ Ice cream
✓ Cottage cheese
✓ Cheese
✓ Cream
✓ Creamer
✓ Butter
✓ Baked goods such as muffins, cake, and cookies
✓ Processed foods

Milk allergy and lactose intolerance are not the same thing. Lactose intolerance may cause discomfort for the intolerant individual, but is not life-threatening. Reactions to milk by an allergic individual can cause anaphylaxis, a life-threatening reaction.

Eggs

Egg allergy affects about 2% of children, but most will outgrow their allergy in or before their teenage years.⁴ Reactions to egg can be mild to life-threatening, so it should be strictly avoided by those with egg allergy.

In general, egg allergic individuals must avoid eggs and any product made with egg. Although some egg allergic children can tolerate baked egg (for instance, if cooked in a cake), this should only be approved under the supervision of a physician. Unless otherwise designated, all sources of egg must be avoided to prevent an allergic reaction.

Common foods that may contain egg or egg products (not an exhaustive list):

✓ Egg
✓ Liquid egg substitute
✓ Pasta
✓ Bread
✓ Eggnog
✓ Nougat
✓ Mayonnaise
✓ Meringue, meringue powder
✓ Baked goods such as muffins, cake, and cookies
✓ Processed food

Peanuts

Peanut allergy affects between 1-2% of children and 0.6% of the overall U.S. population.² Peanut allergic individuals may experience mild to life-threatening reactions, which can be unpredictable.

To prevent an allergic reaction to peanuts, all foods that contain or may contain peanuts should be avoided. Peanuts must be listed on food labels under the ingredient list or in a “contains” statement. Lupin is not a peanut ingredient, but has been reported to cause cross-reactivity reactions for peanut allergic individuals.

Common foods that may contain peanut (not an exhaustive list):

✓ Peanuts
✓ Peanut butter
✓ Powdered peanut butter/peanut flour
✓ Groundnuts
✓ Peanut sauce
✓ Boiled peanuts
✓ Unrefined/gourmet peanut oil*
✓ Baked goods such as muffins, cake, and cookies
✓ Processed foods

Tree Nuts

Allergy to tree nuts affects 0.4-0.5% of the U.S. population.² As many as 40% of peanut allergic individuals are also allergic to tree nuts.⁵ Tree nut allergy appears to be on the rise.⁵

Strict avoidance is required to prevent potentially serious or life-threatening reactions. Even though individuals with an allergy to one tree nut may tolerate other tree nuts, they are often advised to avoid all tree nuts to prevent reactions from cross-contact.⁵ Coconut is not a tree nut botanically, but FDA recognizes it as such. A healthcare provider should determine if coconut should be avoided.

Common foods that may contain tree nuts (not an exhaustive list):

✓ Almonds, walnuts, pistachio, cashews, pecans, hazelnuts, macadamia and other specific tree nuts
✓ Nut flours
✓ Nut butters
✓ Candy
✓ Baked goods such as muffins, cake, and cookies

Fish

About only 0.2% of children and 0.5% of adults are allergic to fish, with the allergy usually becoming known in adulthood.^2,6

Individuals with fish allergy may be allergic to one type, but not to others, which should be determined by an allergist.⁶ However, allergic individuals are often advised to avoid all types of fish to prevent reactions. Likewise, individuals with fish allergy may not be allergic to crustacean shellfish, but should discuss the risk with their healthcare provider. Strict avoidance is required to prevent potentially serious or life-threatening reactions.

Common foods that may contain fish (not an exhaustive list):

✓ Salmon, tuna, tilapia, swordfish, snapper, flounder, cod, anchovies, sardines
✓ Fish stock or broth
✓ Fish sauce
✓ Worcestershire sauce
✓ Asian sauces or sauce mixes
✓ Fish sticks
✓ Caesar salad dressinge
✓ Sushi
✓ Artificial crab sticks (surimi)

Shellfish

Shellfish allergy may affect as many as 2.6% of women and 1.5% of men.² Crustacean shellfish includes shrimp, lobster and crab and are the foods within the shellfish category that cause the most allergic reactions, according to the American College of Allergy, Asthma and Immunology.⁷

Mollusks, such as scallops, clams and mussels, are often tolerated by those with shellfish allergy, but allergic individuals should discuss the risks with their healthcare provider.

As with all food allergies, careful avoidance should be maintained to avoid accidental ingestion of allergenic food. Avoiding seafood restaurants and foods with “seafood” in the name (ex. “seafood chowder”) is an important strategy for avoidance.

Common foods that may contain crustacean shellfish (not an exhaustive list):

✓ Shrimp, lobster and crab
✓ Prawns
✓ Crayfish or crawfish
✓ “Fish” or “seafood” broth Asian sauces or sauce mixes
✓ Sushi
✓ Artificial crab sticks (surimi)
✓ Seafood or artificial flavoring

Wheat

Wheat allergy prevalence is poorly defined, but may affect 0.5% of the population.² However, it can be severe and even life-threatening.

Some wheat allergic individuals can eat other grains, but cross-contact is a concern.⁸ Risks should be discussed with a healthcare provider in advance of eating non-wheat grains.

Common foods that may contain wheat (not an exhaustive list):

✓ Cereals and cereal bars
✓ Crackers
✓ Breads and other baked goods, such as rolls, pastries and cookies
✓ Pasta
✓ Hot-dogs and processed meats
✓ Tamari and other Asian sauces
✓ Vital wheat gluten
✓ Artificial flavorings
✓ Thickeners

Soy

Soy allergy affects as many as 0.7% of the population.² It most often manifests in infancy and is usually outgrown by 10 years of age.⁹

Allergic reactions to soy can cause anaphylaxis, so strict avoidance is required for those who are allergic to soy.⁹   Although peanuts and soybeans are both legumes, individuals allergic to one may not be allergic to the other.⁹ Soy allergic individuals should discuss the risks with their healthcare provider.

Common foods that may contain soy (not an exhaustive list):

✓ Tofu
✓ Soy sauce
✓ Soy milk
✓ Asian sauces and sauce mixes
✓ Processed meats, including patties, sausages, and links
✓ Other processed foods
✓ Artificial flavorings
✓ Thickeners

Note: Highly refined soy oil has been processed and filtered. The refining process removes the allergenic protein. The FDA does not require highly refined soy oil to be listed as an allergen.⁴

References

1. U.S. Food & Drug Administration Website. Food Allergies: What you need to know. Available at
   https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAllergens/ucm079311.htm
2. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-sponsored Expert Panel. J Allergy and Clin Immunol. 2010;126(6):S1-S58. Available at
   http://www.jacionline.org/article/S0091-6749%2810%2901566-6/fulltext#sec4.1.2.
3. ACAAI Website. Milk & Dairy Allergy: Overview. Available at
   http://acaai.org/allergies/types-allergies/food-allergy/types-food-allergy/milk-dairy-allergy
4. U.S. Food & Drug Administration. Food allergen labeling and consumer protection act of 2004 questions and answers. Available at
   https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm106890.htm
5. ACAAI Website. Tree Nut Allergy: Overview. Available at
   http://acaai.org/allergies/types/food-allergies/types-food-allergy/tree-nut-allergy
6. ACAAI Website. Fish Allergy: Overview. Available at
   http://acaai.org/allergies/types/food-allergies/types-food-allergy/fish-allergy
7. ACAAI Website. Shellfish Allergy: Overview. Available at
   http://acaai.org/allergies/types/food-allergies/types-food-allergy/shellfish-allergy
8. ACAAI Website. Wheat Allergy: Overview. Available at
   http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy
9. ACAAI Website. Soy Allergy: Overview. Available at
   http://acaai.org/allergies/types/food-allergies/types-food-allergy/soy-allergy