The Big 8 Allergens: What You Need to Know
Whether your child is a few months or a few years old, you’ve likely heard about the dangers of food allergies. But did you know that 90% of all food allergies in the United States are caused by only eight foods? Even if your kids aren’t affected by the so-called “Big 8 allergens”, you probably have a close friend or family member with children who are.
What is a Food Allergy?
A food allergy occurs when a person’s immune system reacts to a particular food as though it were harmful. To fight off the allergen, the immune system produces antibody immunoglobulin E (IgE), which may lead to respiratory, gastrointestinal or cardiovascular distress.
5 Fast Facts About Food Allergies
- Symptoms: Food allergy reactions range from mildly unpleasant, like hives or wheezing, to significant and life-threatening, like anaphylaxis, a severe allergic reaction that causes the body to go into shock.
- Prevalence: Food allergies are more common among children than adults. According to the Asthma and Allergy Foundation of America, in 2015, over 4 million children in the U.S. had known food allergies.
- Cure: While allergists are working on cures for food allergies, avoidance is currently the most common treatment. 80% of children with milk, egg, soy, or wheat allergies may eventually outgrow the allergy, while allergies to peanuts, tree nuts, fish and shellfish are more often lifelong.
- Development: It is possible to develop a food allergy at any age, even to foods you’ve eaten many times before.
- Seriousness: Food allergies are not the same as food intolerance. Food intolerances may lead to discomfort, but they do not involve the same measurable immune system response.
What Are the Big 8 Allergens?
Despite there being more than 170 known food allergens, the vast majority of allergic reactions in the United States are caused by the Big 8 allergens below.
1. Milk
Prevalence: An estimated 2–6% of children under 6
Cow’s milk is the most common food allergy in kids, but around 80% will outgrow the allergy before reaching school age.
Is a milk allergy the same as lactose intolerance? No. People with lactose intolerance lack the enzyme lactase, which digests the sugars in milk. While lactose intolerance may cause unpleasant symptoms like bloating or diarrhea, a milk allergy is more serious and involves an IgE-mediated immune system response.
Most Common Symptoms of a Milk Allergy: As is the case with all of the Big 8 Allergens, the symptoms of a milk allergy can be severe. Examples include:
- Hives
- Wheezing
- Shortness of breath
- Coughing
- Vomiting
- Swelling of the lips, tongue or throat
Treatments For a Milk Allergy: There are treatments available for reactions to a milk allergy, but much will depend on the severity of that reaction. Antihistamines can help if a reaction is mild, but serious reactions may require an injection of adrenaline. If you or someone you love reacts allergically to milk, you should seek medical attention just to be safe.
Alternatives to Milk: Milk doesn’t just come from cows or even animals. Those looking to drink an alternative can turn to rice milk, almond milk, soy milk, or oat milk, among others.
2. Egg
Prevalence: An estimated 2–6% of children under 6
Most children, around 67%, will outgrow their egg allergy before reaching age 5.
Egg Whites vs. Egg Yolks: Although it’s the egg whites that contain the most allergenic proteins, doctors recommend total avoidance of eggs, as it is impossible to completely separate the yolks from the whites.
Most Common Symptoms of an Egg Allergy: Egg allergies can also be severe, which is why they find themselves grouped among the Big 8 Allergens. Common symptoms of an allergic reaction to eggs can include:
- Hives
- Nasal congestion
- Sneezing
- Coughing
- Wheezing
- Shortness of breath
- Nausea
- Vomiting
Treatments for an Egg Allergy: The treatment for an allergic reaction to eggs is similar to that of cow’s milk. For mild reactions, an antihistamine may work well, but for more severe cases, an injection of adrenaline could be necessary.
Alternatives to Eggs: Unlike milk, eggs are basically eggs, regardless of what animal produces them. Therefore, those who are allergic to them should avoid them altogether, as even “egg substitutes” contain egg whites in many cases.
3. Soy
Prevalence: An estimated 1–2% of children under 10
What are common soy-based foods? If you’re allergic to soy, pay special attention when selecting vegetarian proteins and many Asian-inspired foods—both often contain soy-based products including, but not limited to:
- Tofu
- Tempeh
- Edamame
- Miso
- Soy Sauce or Tamari
- Soy Milk
Most Common Symptoms of a Soy Allergy: Soy allergies can prompt several different reactions in those who are allergic to it, including:
- Hives
- Itching
- Swelling of the lips and/or tongue
- Swelling of the throat
- Wheezing
- Difficulty breathing
- Abdominal pain
- Diarrhea
- Nausea
- Vomiting
Treatments for a Soy Allergy: For the most part, soy allergy reactions are relatively minor and can be handled with the administering of an over-the-counter antihistamine. However, some reactions are severe and will require immediate medical attention. If you have any doubt in this regard, always err on the side of caution and seek medical help.
Alternatives to Soy: Since soy appears in so many different foods, there really isn’t a short list of what can be used. For instance, soy milk can be replaced with almond milk, and tofu can be replaced with things like mushrooms.
4. Wheat
Prevalence: An estimated 0.4–1% of children under 6
About 20% of wheat-allergic children are also allergic to other gluten-containing grains like barley, oats and rye. Most children with a wheat allergy will outgrow it before school age.
Is a wheat allergy the same as celiac disease? No. Celiac disease is an autoimmune disease of the small intestine which requires one to avoid all sources of gluten, including but not limited to wheat. While celiac disease does involve an immune system response, IgE, the antibody responsible for life-threatening reactions, does not play a role in this disorder.
Most Common Symptoms of a Wheat Allergy: Allergic reactions to wheat allergies vary as widely as any in the group of Big 8 Allergens. Some reactions are minor while others can be so severe that they can be life-threatening. Examples of symptoms include:
- Throat swelling
- Mouth swelling
- Hives
- Nasal congestion
- Breathing difficulty
- Diarrhea
- Head pain
- Nausea
- Vomiting
- Anaphylaxis
Treatments For a Wheat Allergy: As seen above, the treatment for a wheat allergy depends largely on the severity of the reaction involved. Over-the-counter antihistamines can help greatly for those minor reactions, but one may need an immediate injection of epinephrine if he or she encounters anaphylaxis.
Alternatives to Wheat: Fortunately, there are a plethora of choices for those who want to replace wheat in their diets. Entire stores and brands offer gluten-free choices for common foods such as bread and the like.
5. Peanuts
Prevalence: An estimated 0.6–1.3% of the general population
Despite the name, peanuts are actually not a nut but rather a legume, like soy. However, as many as 40% of all people with peanut allergies also have tree nut allergies.
Nut-Free vs. Peanut-Free: If your child is allergic to peanuts, be sure to double check any “nut-free snacks” because “nut-free” doesn’t always mean “peanut-free.” Many nut-free snacks are also peanut-free, but it’s safest to look for the “peanut-free” label when choosing school-safe snacks.
Common Symptoms of a Peanut Allergy: The symptoms of an allergic reaction to a peanut allergy are largely similar to those associated with the other members of the Big 8 Allergens. See below:
- Hives
- Tingly mouth or throat
- Nausea
- Vomiting
- Diarrhea
- Tightening of the throat
- Wheezing
- Breathing difficulty
- Runny nose
Treatments for a Peanut Allergy: Once again, like many of the other members of the Big 8 Allergens, the most common response to a minor allergic reaction to wheat is an over-the-counter antihistamine. Severe reactions may require emergency epinephrine injections.
Alternatives to Peanuts: There are several choices for people who want to consume an alternative to peanuts. Common examples of them include seeds from sunflowers or pumpkins, pretzels, and soy or garbanzo beans.
6. Tree Nuts
Prevalence: An estimated 0.4–0.6% of the general population
People with tree nut allergies may be allergic to a single tree nut, a small subset of tree nuts or all tree nuts. Common tree nut allergens include:
- Almonds
- Brazil nuts
- Cashews
- Hazelnuts
- Macadamia nuts
- Pecans
- Pine nuts
- Pistachios
- Walnuts
The FDA also lists coconut as a tree nut, but coconut allergies are relatively uncommon, and most people with tree nut allergies can safely consume it.
Common Symptoms of a Tree Nuts Allergy: If you’re sensing a theme among the reactions of those allergic to any of the members of the Big 8 Allergens, you’re not wrong, as once again the potential symptoms of a reaction to tree nuts includes:
- Hives
- Swollen throat
- Nausea
- Vomiting
- Diarrhea
- Wheezing
- Difficulty breathing
- Swelling of the lips
Treatments for a Tree Nut Allergic Reaction: Unlike other members of the Big 8 Allergens, a large number of reactions to a tree nut allergy can be extremely severe. People who suffer from this allergy should have epinephrine injections available at all times and it should be administered immediately.
Alternatives to Tree Nuts: If you’re suffering from a peanut allergy in addition to a tree nut allergy, you already know the substitutes for tree nuts. They include seeds from pumpkins and sunflowers, pretzels and beans.
7. Fish
Prevalence: An estimated 0.4% of the general population
Unlike many other foods, fish allergies most commonly appear in adulthood, not childhood. Reactions also tend to be comparatively severe.
Is a fish allergy the same as a seafood allergy? No. The general category of “seafood” comprises both finned fish and shellfish. Someone with a finned fish allergy may or may not be allergic to shellfish (and vice versa).
Common finned fish allergens include:
- Anchovies
- Halibut
- Mahi Mahi
- Salmon
- Tuna
Common Symptoms of a Fish Allergy: Fish allergies are sometimes difficult to pinpoint, but those who have them and who experience symptoms when reacting to fish can suffer through the following:
- Hives
- Itchy throat
- Closing throat
- Nausea
- Vomiting
- Diarrhea
- Runny nose
- Swollen lips
Treatments for a Fish Allergy: There are a lot of fish allergy reactions that are extremely severe and dangerous. As is the case with other members of the Big 8 Allergens, people who suffer from this allergy need to have ephedrine available in injection form.
Alternatives to Fish: Generally, fish is a source of protein and with some types of fish, omega-3 oil. One who suffers from a fish allergy can take supplements for omega-3 and consume other forms of protein.
8. Shellfish
Prevalence: An estimated 1.2% of the general population
Shellfish fall under two different groups:
- Crustaceans: crab, shrimp, lobster
- Mollusks: clams, mussels, octopus, oysters, scallops, squid
Some are allergic to both groups, while some are allergic only to one.
Common Symptoms of a Shellfish Allergy: Shellfish are beloved around the world because of their flavor and nutritional value in some cases, but they are also notorious because of the number of people allergic to them. The symptoms of an allergic reaction to shellfish include:
- Hives
- Dizziness
- Nausea
- Vomiting
- Diarrhea
- Itchy skin
- Wheezing
- Breathing difficulty
- Swollen lips and throat
Treatments for a Shellfish Allergy: As is done in response to the other members of the Big 8 Allergens, those who suffer from a shellfish allergy need to be ready to have an injection of ephedrine administered should anaphylaxis arise in response to consuming these types of foods.
Alternatives to Shellfish: It’s possible that some people with shellfish allergies can still consume some types of fish, but if that could be you, check with your doctor before taking that step. Otherwise, much like with a fish allergy, omega-3 oil and proteins prevalent in shellfish are readily available in supplements and other foods.
Nurture Life’s Allergy Promise to You
If your child has food allergies, you know the importance of understanding exactly what is (and isn’t) in their meals and snacks. And as parents ourselves, we at Nurture Life understand, too!
We’ve put allergy-friendly practices at the heart of our kid-focused food and nutrition philosophy:
- We maintain a state-of-the-art food production facility with top food safety practices and certifications.
- Our allergy-friendly meals for toddlers and kids are safe for school.
- We use meal tags to help you identify vegetarian, vegan, gluten-free, milk-free, egg-free and soy-free meal options.
- Our baby, toddler and kids meals and production facilities are completely free from peanuts and tree nuts (except coconut).
Nurture Life takes the health of your children seriously and would be happy to help you in any way that we can. If you have questions about the Big 8 allergens, our ingredients or our allergy-friendly facilities, please email our child nutrition team at support@nurturelife.com.
Dr. Steve Handoyo is a Clinical Associate of Pediatric Allergy and Immunology at the University of Chicago. For more information or to schedule an appointment, please visit his University of Chicago page or call 773.702.6169.
