Food allergies are increasing at alarming rates. In fact, one in every 13 children has a food allergy—which is about two per U.S. classroom!

If you have children in your program with food allergies or intolerances, you know how important it is to prepare and serve safe meals. Having a plan and being prepared will help make sure children feel included and can safely join in meals. Knowing common allergens, reading food labels, and avoiding cross-contact will help prevent an allergic reaction and keep children safe.

Food Allergy versus Food Intolerance

People often confuse food allergies and food intolerances. It is important to know the difference.

A food allergy happens when the body’s immune system reacts to a protein in food. The food that causes the reaction is called an allergen. Symptoms of food allergies range from mild to life-threatening and are listed below.
A food intolerance, or a food sensitivity, is when a person has a hard time breaking down a certain food. While food intolerances can cause gas, bloating, diarrhea, or upset stomach, they are not life-threatening.

Symptoms of an Allergic Reaction to Food

After eating a food with an allergen, mild or severe symptoms can appear within minutes or up to a few hours. They may be mild or severe and may include hives, nausea, vomiting, stomach pain, nasal congestion, runny nose, or swelling of the lips, tongue, or throat.

Anaphylaxis is a serious allergic reaction that may include difficulty breathing, dizziness, a drop in blood pressure, or loss of consciousness. If you suspect an anaphylactic reaction, call 911, and treat the child with an epinephrine auto-injector like Epi-Pen^® right away.

Very young children may not know when they are having an allergic reaction, but may be able to tell you how they are feeling. Children may say one of the statements below when having an allergic reaction.

My tongue (or mouth) is hot, burning, tingling, or itches.
It feels like something is poking my tongue.
My mouth feels funny.
There’s something stuck in my throat.
My lips feel tight.
My throat feels thick.

A child may also show nonverbal signs of an allergic reaction, including:

Putting their hands in their mouth
Pulling or scratching at their tongue
Slurring their words
Their voice may change (become hoarse or squeaky)

Refer to the child’s allergy care plan from the family for steps to follow in case of an allergic reaction. Talk with the child’s family about the foods eaten and the child’s symptoms. Closely observe the child in case the reaction gets worse.

Most Common Food Allergens

While over 170 foods can cause an allergic reaction, nine major food allergens make up over 90% of food allergic reactions in the U.S. They are listed in the table below, with examples and possible food sources.

Allergen	Foods Containing the Allergen	Other Possible Sources of the Allergen
Eggs	Eggs (dried, powdered, solids, white, yolk)	Baked goods, breaded items, fried rice, mayonnaise, meatballs, meatloaf, pasta, surimi
Fish	Finfish (cod, haddock, halibut, salmon, tilapia, tuna), fish sticks	Barbecue sauce, bouillabaisse, salad dressing, surimi, Worcestershire sauce
Milk	Buttermilk or milk (condensed, evaporated, low-fat, nonfat, whole), butter, cheese, cottage cheese, cream, ghee, whey, yogurt	Baked goods, breakfast foods (cereals, pancakes, waffles), lunch meat, hot dogs, margarine, meatballs, nondairy products
Peanuts	Peanuts, peanut butter, peanut flour, mixed nuts	Baked goods, cereal (granola, muesli), chili, marzipan, pancakes, trail mix, sauces (chili sauce, hot sauce, pesto, gravy, mole sauce), salad dressing, certain cuisines [Mexican, African, Asian (especially Chinese, Indian, Indonesian, Thai, and Vietnamese)]
Sesame	Sesame (flour, oil, paste, salt, seed), tahini Sesame may be listed under “spices” on a food label	Asian cuisine, baked goods, bread crumbs, cereals (granola, muesli), crackers, dressings, gravy, hummus, marinades, margarine, processed meats and sausages, sauces, soups, sushi, tempeh
Shellfish	Crustacean shellfish (crab, crawfish, lobster, prawns, shrimp)	Bouillabaisse, fish stock, seafood flavoring (crab or clam extract), surimi
Soy	Edamame, miso, soy (soy cheese, soy fiber, soy flour, soy grits, soy milk, soy nuts, soy sprouts, soy yogurt), soybeans, soy sauce, tempeh, tofu	Asian food, baked goods, dressings, grains prepared with soy (cereal, bread, chips, crackers, pasta, rice, tortillas), infant formula, processed and canned foods, sauces
Tree Nuts	Almonds, cashews, hazelnuts, marzipan (almond paste), mixed nuts, nut butters, pecans, pesto, pistachios, praline, trail mix, walnuts	Baked goods, barbeque sauce, cereal, cookies, crackers, marinade, certain cuisines (Chinese, African, Indian, Thai, Vietnamese)
Wheat	Wheat flour (all-purpose, enriched, whole wheat), bran, bulgur, durum, farina, germ, semolina, most bread products (bread crumbs, cereal, crackers, pasta, rolls)	Bread products using alternate grains, couscous, oats, salad dressings, sauces, soups, soy sauce, surimi

For more information, resources, and videos on the nine major allergens refer to the following:

Food Allergy Research & Education (FARE): Common Allergens
Institute of Child Nutrition (ICN): Child Care Center Food Allergy Fact Sheets

Reading Food Labels

One way to avoid an allergic reaction is to read food labels. The current eight major food allergens must be listed in plain language on the ingredients label: eggs, fish, milk, peanuts, tree nuts, shellfish, soy, and wheat. Starting January 1, 2023, sesame must be labeled as an allergen on packaged foods. Contact the food manufacturer if there is any question about a food containing an allergen.

Watch for substitutions in your food deliveries. The replaced food might have an allergen not found in the product you usually buy.

Labeling Allergens

Allergens are included on food packages in one of three ways:

In the ingredients list, using the allergen’s common or usual name (ex., “whole wheat flour”)
In the ingredients list in parentheses after the ingredient that is not the common name (ex., “albumin (egg)”)
Listed after the ingredients list in a “Contains” statement (ex., “Contains milk and tree nuts”)

Labeling Allergens

Example 1:
Ingredients: Whole wheat flour, enriched wheat flour, honey, soy.

Example 2:
Ingredients: Whey protein (milk), lecithin (soy), albumin (egg), salt.

Example 3:
Ingredients: Whole grain wheat, honey, natural almond flavor.
CONTAINS WHEAT AND ALMOND

Advisory Statements

Advisory statements for allergens are located after the ingredients list and vary by product. Some common types of advisory statements include:

“May contain…”
“Made on equipment…”
“Processed or manufactured in a facility that also processes…”

Do not serve these products to a child with a specified food allergy. Even if a food has a small amount of the allergen, it could cause a reaction.

Advisory Statements

Example 1:
Ingredients: Whey protein, lecithin, salt.
Contains milk and soy. May contain traces of tree nuts.

Example 2:
Ingredients: Sunflower seed, sugar, salt.
Made on equipment that processes peanuts.

Example 3:
Ingredients: Sunflower seed, honey, salt.
Manufactured in a facility that also processes peanuts.

For more information on reading food labels, refer to FARE’s How to Read a Food Label webpage.

Avoid Cross-Contact

Another way to prevent an allergic reaction is to avoid cross-contact. Cross-contact happens when food that has an allergen touches another food or surface that does not have the allergen.

For example, a knife used to spread peanut butter is then used to cut a turkey sandwich without cleaning in between. Peanut allergens will get onto the turkey sandwich, making it unsafe for a child with a peanut allergy to eat.

Tips to Avoid Cross-Contact

Wash the following with soap, hot water, and friction:
- Utensils, cutting boards, dishes, pots, and pans
- Counters and tables
- Hands (sanitizing gels or water alone will not remove an allergen)
Cook or prepare the allergen-free foods first.
Wrap, label, and separate allergen-free foods from those with allergens.
Select an area in the kitchen for allergen-free meals, and use separate (or color-coded) equipment and utensils during preparation, cooking, and serving.
If an allergen accidentally gets into a dish, do not serve it to a child with a food allergy.
Teach children not to share food, drinks, or utensils.

What to Do If a Child Has a Food Allergy or Intolerance

If your program is on the Child and Adult Care Food Program (CACFP), you must provide allergen-free meals and a safe place for children with food allergies and intolerances. Every child and each situation is different, so handle each on a case-by-case basis. However, here are general guidelines for keeping children safe.

Talk with the family and get written documentation about the allergy or intolerance, such as:
- A medical statement that includes the food allergy or intolerance, foods to serve, and foods to avoid.
- An allergy care plan from the child’s family and health care provider that includes steps to follow if the child has an allergic reaction.
Highlight menu items that have a known food allergen.
Read all ingredients on packages before buying and preparing.
Supervise children while eating.
Train staff on allergens and steps to follow to avoid and respond to allergic reactions.

More Information

Food Allergy Research and Education (FARE) has detailed information at Food Allergy 101, including free downloadable posters and infographics to help educate and raise awareness about food allergies.

Mealtime Discussion Prompts

During mealtime, spark positive conversations to raise children’s awareness about food allergies and intolerances using the questions below. Make sure families are okay with discussing their child’s allergies during mealtimes.

Are there foods you cannot eat because they make you feel sick?
How do you feel when you eat those foods?
What should you do if you feel sick after eating a food? (Tell an adult what you ate, when you ate it, how you feel, etc.)
How do we keep our food safe? (Wash hands, do not eat foods we know make us sick, ask families or teachers if a new food is OK to eat, etc.)
What can we do so we are all safe during mealtimes? (Wash hands, keep hands to yourself, do not eat from others’ plates or share food with friends, etc.)

Menu Ideas

The following menu ideas provide a variety of foods, colors, and textures that do not contain any of the nine common allergens. Some recipes contain multiple meal components listed in parentheses after the recipe.

Breakfast

Turkey Breakfast Sausage
(Meat Alternate)

Hash Browns

1% Milk

Lunch/Supper

Taco-Seasoned Stuffed Peppers
(Meat Alternate or Vegetable, Grain)

Cucumber Spears

Strawberries

1% Milk

Snack

Black Bean Hummus
(Count as a Meat Alternate)

Carrot Sticks

You can find the featured Menu Ideas recipes in the resources below:

The Child Nutrition Recipe Box has USDA standardized recipes for child care centers and family child care homes.
The Child Nutrition Recipe Box: New CACFP Lunch/Supper Recipes has standardized recipes per age group (3–5 years old and 6–18 years old) and for servings of 6, 25, and 50.

References

Food Allergy Research and Education. (2020). Avoiding cross-contact. https://www.foodallergy.org/resources/avoiding-cross-contact

Food Allergy Research and Education. (2020, November). Tips for avoiding your allergen. https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/tips-avoiding-your-allergen

Food Allergy Research and Education. (2021, April 23). With the stroke of President Biden’s pen, FASTER Act for sesame labeling becomes law. https://www.foodallergy.org/media-room/stroke-president-bidens-pen-faster-act-sesame-labeling-becomes-law

Food Allergy Research and Education. (n.d.). Common allergens. https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens

Food Allergy Research and Education. (n.d.). Food allergy 101. https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/food-allergy-101

Food Allergy Research and Education. (n.d.). How a child might describe a reaction. https://www.foodallergy.org/resources/how-child-might-describe-reaction.

Food Allergy Research and Education. (n.d.). How to read a food label. https://www.foodallergy.org/resources/how-read-food-label

Food Allergy Research and Education. (n.d.). School posters and infographics. https://www.foodallergy.org/resources/school-posters-infographics

Institute of Child Nutrition. (2020, June 23). Food allergy fact sheet: Overview of food allergies. https://theicn.org/icn-resources-a-z/food-allergy-fact-sheets

Institute of Child Nutrition. (2021, November). Child care center food allergy fact sheets. https://theicn.org/icn-resources-a-z/child-care-center-food-allergy-fact-sheets

Institute of Child Nutrition. (n.d.). Black bean hummus – USDA recipe for child care centers. Child Nutrition Recipe Box. https://theicn.org/cnrb/recipes-for-centers-vegetables/black-bean-hummus-usda-recipe-for-cacfp/

Institute of Child Nutrition. (n.d.). Child nutrition recipe box. https://theicn.org/cnrb/

Institute of Child Nutrition. (n.d.). New CACFP lunch/supper recipes. Child Nutrition Recipe Box. https://theicn.org/cnrb/2022-cacfp-recipes/

Institute of Child Nutrition. (n.d.). Taco-seasoned stuffed peppers for ages 3-5. Child Nutrition Recipe Box. https://theicn.org/cnrb/ages-3-5/age-3-5-6-servings/taco-seasoned-stuffed-peppers-for-ages-3-5/

Institute of Child Nutrition. (n.d.). Turkey breakfast sausage – USDA recipe for child care centers. Child Nutrition Recipe Box. https://theicn.org/cnrb/uncategorized/turkey-breakfast-sausage-usda-recipe-for-cacfp/