Why Food Allergens Matter

Food allergies affect approximately 32 million Americans, including 5.6 million children. An allergic reaction to food can range from mild discomfort to life-threatening anaphylaxis that can cause death within minutes if not treated. As a food handler, understanding allergens is not just an exam topic; it is a matter of life and safety. The FDA estimates that food allergies cause roughly 30,000 emergency room visits and 150 to 200 deaths per year in the United States.

In 2023, sesame was officially added as the ninth major allergen under the FASTER Act, bringing the total to nine. These nine allergens account for approximately 90% of all food allergic reactions in the United States.

The 9 Major Food Allergens

1. Milk

Milk allergy is one of the most common food allergies, especially in children. It is an immune reaction to one or more proteins in cow’s milk, primarily casein and whey. This is different from lactose intolerance, which is a digestive issue. A milk allergy can cause severe reactions. Milk proteins are found in butter, cheese, cream, yogurt, ice cream, and many processed foods including bread, chocolate, and sauces. Always check ingredient labels for terms like casein, whey, lactalbumin, and lactaglobulin.

2. Eggs

Egg allergy primarily affects children, though some adults are allergic as well. Both the egg white and yolk can cause reactions, but egg white proteins are the most common triggers. Eggs are found in mayonnaise, baked goods, pasta, marshmallows, and many processed foods. Watch for ingredient terms like albumin, globulin, lysozyme, and lecithin (though most lecithin is soy-based).

3. Fish

Fish allergy refers to finned fish such as salmon, tuna, cod, bass, and halibut. Unlike some childhood allergies, fish allergy often develops in adulthood and is usually lifelong. Fish proteins can become airborne during cooking, which means even vapors can trigger reactions in highly sensitive individuals. Fish is found in Worcestershire sauce, Caesar dressing, some barbecue sauces, and Asian cuisine staples like fish sauce.

4. Shellfish

Shellfish allergy is separate from fish allergy. The two groups are: crustaceans (shrimp, crab, lobster, crawfish) and mollusks (clams, mussels, oysters, scallops, squid). Crustacean allergy is more common and often more severe. Like fish allergy, shellfish allergy frequently develops in adulthood. Shellfish proteins are found in some Asian sauces, bouillabaisse, and some supplements (glucosamine is often derived from shellfish).

5. Tree Nuts

Tree nuts include almonds, cashews, walnuts, pecans, pistachios, Brazil nuts, macadamias, and hazelnuts. Tree nut allergy is one of the most common causes of anaphylaxis. Someone allergic to one tree nut may not be allergic to all tree nuts, but doctors often recommend avoiding all tree nuts to be safe. Tree nuts are found in pesto, marzipan, nougat, pralines, many baked goods, and nut oils (though highly refined oils are sometimes tolerated).

6. Peanuts

Peanuts are technically legumes, not tree nuts, but peanut allergy is one of the most severe and common food allergies. Peanut allergy is the leading cause of food allergy-related anaphylaxis deaths. Peanut proteins are found in many foods including Asian cuisine, baked goods, candy, chili, sauces, and some ice creams. Cross-contact is a major concern because even trace amounts can trigger reactions.

7. Wheat

Wheat allergy is an immune reaction to proteins found in wheat. This is different from celiac disease (an autoimmune disorder triggered by gluten) and gluten sensitivity. However, the avoidance strategy is similar: stay away from wheat-containing products. Wheat is found in bread, pasta, cereal, crackers, cookies, beer, soy sauce, and many processed foods. Look for terms like durum, semolina, spelt, farina, and kamut on ingredient labels.

8. Soy

Soy allergy is common in children and usually resolves by age 10. Soybeans are used in an enormous number of processed foods, making soy one of the hardest allergens to avoid. Soy is found in tofu, edamame, miso, soy sauce, soy milk, and many processed foods including baked goods, canned soups, cereal, and infant formula. Soybean oil that is highly refined is generally considered safe for most soy-allergic individuals, but cold-pressed or expeller-pressed soy oil is not.

9. Sesame

Sesame became the ninth officially recognized major allergen in the United States in January 2023 under the FASTER Act. Sesame allergy is rising in prevalence and can cause severe reactions. Sesame is found in tahini, hummus, sesame oil, many breads and buns (especially hamburger buns), and various Middle Eastern, Asian, and African cuisines. Watch for terms like benne seeds, gingelly oil, and halvah on labels.

Preventing Allergic Reactions in the Kitchen

As a food handler, you play a critical role in preventing allergic reactions. Here are the essential practices:

Preventing Cross-Contact

Cross-contact occurs when an allergen is unintentionally transferred from one food to another. Unlike bacteria, allergens cannot be killed by cooking. If peanut oil contaminates a salad, no amount of heating will make it safe for someone with a peanut allergy. To prevent cross-contact:

• Use separate, cleaned and sanitized utensils, cutting boards, and cookware for allergen-free orders
• Wash hands thoroughly between preparing different dishes
• Store allergen-containing ingredients separately and clearly labeled
• Clean and sanitize all surfaces before preparing allergen-free meals
• Never reuse oil that was used to cook allergen-containing foods

Communication

• Take every allergy claim seriously, even if a customer seems overly cautious
• Servers must clearly communicate allergy information to the kitchen
• If you are unsure whether a dish contains an allergen, check with the chef or manager
• Never guess or assume; when in doubt, do not serve the food

What to Do During an Allergic Reaction

If a customer shows signs of an allergic reaction (hives, swelling, difficulty breathing, vomiting, dizziness), call 911 immediately. If the person has an epinephrine auto-injector (EpiPen), help them use it if they are unable to self-administer. Do not try to make the person vomit. Keep them calm and lying down with legs elevated (unless they are vomiting or having trouble breathing).

Allergens on the Food Handler Exam

The food handler exam typically includes 5-10% of questions about allergens. You should be able to list all nine major allergens, explain the difference between cross-contamination and cross-contact, and describe proper procedures when a customer reports an allergy. Review our allergens practice test for specific practice on this topic.