Fam Pract Manag. 2025;32(4):43-45
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Immunoglobulin E (IgE)-mediated food allergies affect more than 5.6 million children and more than 27 million adults in the United States.1–3 In IgE-mediated food allergic reactions, symptoms — including anaphylaxis — develop rapidly following exposure to an allergen.4 By contrast, non-IgE food allergies cause delayed reactions that mostly affect the digestive system,5 and food intolerances do not affect the immune system at all.6 Although more than 170 foods are known to cause IgE-mediated food allergic reactions, nine foods account for 90% of all cases.7,8
The American Academy of Family Physicians developed this point-of-care tool to help family physicians recognize, evaluate and manage IgE-mediated food allergy and prevent anaphylaxis.
Most Common Food Allergens7,8
Peanuts – Peanut butter, sauces, candies
Tree Nuts – Almonds, cashews, hazelnuts, pistachios
Milk – Cheese, yogurt, baked goods
Eggs – Mayonnaise, pasta, baked goods
Wheat – Bread, pasta, processed foods
Soy – Tofu, soy milk, soy sauce
Fish – Salmon, tuna, sauces
Shellfish – Shrimp, crab, lobster
Sesame – Seeds, tahini, bread
Hidden sources of food allergens include cross-contact in shared fryers, processed foods, unlabeled ingredients, and cross-reactivity between pollen and certain foods.
Key Points for Patient and Caregiver Education
Food label reading: “Contains” vs. “May contain” vs. “Processed in a facility with”
Cross-contamination: Avoidance of shared utensils, buffets, shared fryers
School/workplace plans: Food allergy action plan (e.g., www.foodallergy.org/living-food-allergy/food-allergy-essentials/food-allergy-anaphylaxis-emergency-care-plan); allergy response training for school/workplace staff
Emergency preparedness: Use of epinephrine auto-injector (e.g., EpiPen, Auvi-Q)
Common Cross-Reactions Between Airborne Allergens and Foods
| Airborne Allergen | Food | ||
|---|---|---|---|
| Birch pollen | Carrots Celery |
Fresh fruit Hazelnuts |
Parsnips Potatoes |
| Grass pollen | Kiwi | Tomatoes | |
| Ragweed pollen | Bananas | Melons |
Adapted with permission from Kurowski K, Boxer RW. Food allergies: detection and management. Am Fam Physician. 2008;77(12):1678–1686.
Symptoms of IgE-Mediated Food Allergic Reactions
| Mild Reactions Non-life-threatening symptoms occurring in one area of the body:
|
| Severe Reactions (Anaphylaxis) Mild symptoms occurring in more than one area of the body or any of the following potentially life-threatening symptoms:
|
Information from references 8–11.
ADDITIONAL AAFP RESOURCES
Food Allergy Management and Prevention for Clinicians
Get clinical tools, prevention strategies and evidence-based care guidance for diagnosing and managing food allergies.
