Food Allergy Myths, Debunked

Food allergies are conditions in which the immune system mistakes a specific food for a danger and, in response, attacks the food. Foods that trigger allergic reactions are called “allergens.” Food allergies impact millions of children and adults, often developing in infancy or early childhood. Many of these patients have food allergies that can cause anaphylaxis, but some patients, such as patients with the food allergy “Food Protein-Induced Enterocolitis Syndrome (FPIES),” have other types of immune reactions which can also be severe.

Let’s review some of the common myths about food allergies.
 
Myth: Peanut is the most dangerous food allergen.
Fact: While peanut allergies can certainly be life-threatening, other food allergens - such as cashew, milk and egg - can cause allergic reactions that are just as severe as those caused by peanuts.

Myth: Allergic reactions always get more severe with additional exposures.
Fact: Although it is not true that reactions may get progressively worse with subsequent exposures to the allergen, it is concerning when a patient has a severe reaction as it does suggest that future reactions can also be severe.  
 
Although anaphylaxis is a severe allergic reaction, some patients have a type of food allergy that does not pose a risk for anaphylaxis. One type of non-anaphylactic food allergy is Food Protein-Induced Enterocolitis Syndrome (FPIES), which is a food allergy that causes vomiting and diarrhea ~1-4 hours after ingestion. While the reaction is not anaphylaxis, it can cause life-threatening low blood pressure and must be treated promptly, sometimes with IV fluids and medications that increase a person’s blood pressure. Another non-anaphylactic food allergy is eosinophilic esophagitis (EOE), in which certain foods trigger inflammation in the esophagus. This inflammation involves a type of blood cell called an eosinophil, which is not a type of cell normally found in the esophagus.  
 
Myth: Smelling an allergen can trigger anaphylaxis.  
Fact: While people often don’t like the smell of a food they’re allergic to, smell does not provoke an allergic reaction. What can occur is that the patient smells an allergen, and that smell triggers a strong memory of a past reaction or the fear of having a reaction and signs and symptoms of panic may occur – including an increase in heart rate, tight breathing, flushing of the skin and nervousness, all of which could be mistaken as signs and symptoms of anaphylaxis. There have been a few case reports of fish and shellfish being cooked and the allergen becoming airborne. One reaction occurred in a person breathing the air near a steaming pot of shellfish. Many foods, such as peanuts, do not aerosolize, meaning they do not float around in the air. This is because they are heavy and gravity pulls them to the ground. While smells can linger in the air, the allergen proteins do not, which is why smelling a food will not trigger anaphylaxis.

Myth: Antihistamines treat anaphylaxis.  
Fact: Antihistamines do not treat anaphylaxis because anaphylaxis involves more than just the release of histamines. In other words, if we only treat the histamine-related symptoms, the severe symptoms – such as a potentially fatal drop in blood pressure - can persist. In anaphylaxis, allergy cells called “mast cells” are responsible for the allergic reaction, and antihistamines do not stop those cells from releasing the chemicals that cause the reaction. Epinephrine, however, does shut down the reaction both by stabilizing the mast cells and by combating the symptoms of anaphylaxis. While antihistamines can be used in addition to epinephrine to treat the symptoms of anaphylaxis, they are not required. Furthermore, epinephrine administration should never be delayed while waiting to see if antihistamines help first.  
 
Myth: Kids with food allergies are not typically bullied due to their food allergies.  
Fact: Children (and adults!) with food allergies can be, and often are, targets of bullying due to their food allergies. About one in three children report being bullied because of their food allergy. While some children doing the bullying may not see such bullying as serious, it’s actually quite inappropriate and hurtful to be teased because of one’s medical condition. In some cases, this bullying can result in students not wanting to go to school or participate in otherwise fun activities because of the fear that bullying would occur. Kids with anaphylactic food allergies, for example, may be targeted by kids who try to make that child feel badly for a space being nut-free. Also, some kids with EOE have to strictly avoid multiple foods and may be teased that they can’t eat a certain food, like ice cream.
 
Myth: Eczema is usually caused by food allergies.
Fact: Eczema and foods have a complicated relationship. Eczema is not caused by a single food allergy, but eczema can increase the risk of having a food allergy. In a small number of children with eczema, specific foods can sometimes trigger or worsen eczema. However, allergists do not routinely recommend food allergy testing or elimination diets for kids with eczema. This is because eliminating foods from the diet in kids with eczema can actually lead to more severe, or anaphylactic, food allergies in the future. This has been a significant change in the past 10 years or so as the field of allergy has learned more about this relationship.  
 
Myth: There are no treatments for food allergy.  
Fact: There is currently no cure for food allergies. However, there are now two FDA approved treatments for anaphylactic food allergies including Palforzia (a form of peanut oral immunotherapy, “OIT”) and Xolair (a biologic medication injected regularly) which can both decrease the chance of a severe or life-threatening allergic reaction in the case of an accidental exposure to a food. In addition, OIT has been researched and is sometimes available for other food allergies beyond peanuts. There are also several other therapies such as sublingual immunotherapy (SLIT) or epicutaneous immunotherapy (EPIT) either being evaluated in research studies or being offered by certain allergy practices.  

For EOE, Dupixent helps treat the allergic inflammation of the esophagus, but as with Xolair in anaphylactic food allergy, it is not a cure. This means that once the drug is stopped, signs and symptoms of the condition tend to recur.

For FPIES, there are no treatments to decrease the risk of reacting; however, there are limited data that shows slowly incorporating small amounts of the trigger food into the child's diet may help the condition resolve sooner.  
 
There is no single best treatment, and food allergy treatment is not right for everyone. However, there are a growing number of options available, and this will likely continue to increase in the future. Treatments should not begin until a patient and the allergist have fully discussed the risks, benefits, alternatives and treatment should only be performed under the close supervision of an allergist.
 
Myth: Some children are too young to be tested for food allergies.    
Fact: A child can be evaluated for food allergies in early infancy, with the earliest evaluation typically occurring as soon as the baby demonstrates an adverse reaction to a food. Allergy testing for anaphylactic food allergies includes skin testing and/or blood testing, both of which can be performed on babies even after a few months of age. While we do not recommend screening babies for food allergies with testing panels, allergists can play an important role in helping prevent food allergies in babies by encouraging some foods, such as peanut and egg, be introduced to babies early, often and in developmentally appropriate forms. Early introduction of common food allergens can be especially important in preventing peanut allergies in babies who have severe eczema.
 
Myth: Food intolerance is the same as food allergy.  
Fact: Although the symptoms of a food intolerance can be incredibly uncomfortable and cause significant disruption in a person’s life, a food intolerance is not the same as a food allergy. A food allergy is an abnormal immune response to a food that occurs because the body mistakenly identifies the allergen as a danger. In contrast, a food intolerance is a non-immune adverse response to a food and can occur for a variety of reasons. For example, in the case of lactose intolerance, the person’ body is lacking the enzyme lactase. Without lactase, milk cannot be digested properly, so bloating, cramping and diarrhea can occur. It’s important for people to know whether they have a food allergy or a food intolerance so they can treat the condition appropriately.
 
Myth: You should always avoid food that has precautionary labeling for your food allergen.   
Fact: Precautionary labeling of food products with statements such as “may contain” or “processed in a facility with…” is not regulated by the FDA. This means there is no standard amount or threshold amount of a food that results in this type of wording appearing on a food label. It is known that there can sometimes be enough of a food allergen present in these foods to trigger food allergy reactions, but there is a lot of variation between different products. The chance of an individual with a food allergy reacting to these types of foods depends on multiple factors such as the food product and how sensitive an individual is to a food allergen. This issue highlights the importance of a patient discussing an individual plan with their allergist about whether they can consume foods with precautionary labeling.
 
Myth: Breastfeeding mothers must stop eating foods to which their child is allergic.  
Fact: Breast milk is composed of nutritional building blocks for babies. While colostrum (the breast milk expressed in the first few days of a baby’s life) is about 10% protein, breast milk beyond those early days is only about 1% protein. In this small amount of protein, different women secrete different amounts of food allergen protein into breast milk. It is rare for breastmilk to cause a food allergy reaction. There have been several analyses of breast milk that evaluated the presence of proteins for milk, egg, peanut and wheat: the amount of protein identified in these studies was low enough to estimate a less than a 1:1,000 chance of having an allergic reaction. Breast milk also contains other components that may make allergenic protein more tolerable to babies. In most cases, mothers can safely continue to breastfeed while eating foods to which their child is allergic.
 
Myth: Children should avoid a food because a family member has an allergy to that food.  
Fact: While a family history of a food allergy makes a child a little more likely to have food allergies, individual food allergies are not passed down from parent to child. In fact, early introduction of allergenic foods helps prevent food allergies, which may be especially important in children who have older siblings with food allergies. A study of siblings showed that the younger sibling of a child with food allergy is only slightly more likely to have an allergy compared to the general population. Also, data suggest that having an older sibling is actually protective against developing a food allergy. Ultimately, although it can be logistically challenging to have a child regularly consume another child’s allergen without the allergic child accidentally ingesting that food, it is important that non-allergic children ingest the allergen to help grow tolerance, and a child should not be assumed to have a food allergy because a family member has one.
 
Myth: Allergy tests determine the severity of your allergy.  
Fact: The testing tools available for food allergies, including skin prick tests and blood tests, only provide information about how likely a food allergy is in a particular individual. It does not provide information about the severity of a food allergy. Unfortunately, there is no test available to predict the severity of a food allergy.  
 
Myth: Babies shouldn’t eat common food allergens.  
Fact: Children as young as 3-4 months of age not only can typically eat common food allergens, but it is an important way of preventing the development of food allergies. The 2015 LEAP study was a trial demonstrating the benefits of early food introduction. It was found that early introduction of peanut significantly lowered the risk of developing a food allergy. The 2016 EAT study had similar findings about peanut and egg. The tolerance developed by early introduction seems to be long-lasting as children from the LEAP study were assessed at 12 years of age, and those children who had been ingesting peanut since early infancy were still significantly less likely to have a peanut allergy compared to the children who had been enrolled in the avoidance arm of the study. Overall, early allergen introduction is safe if babies are not exposed to choking hazards. For example, babies should not be fed peanuts but can have peanut powder mixed into their bottle or, when a baby is ready more solid consistency, the baby can have peanut butter diluted with breast milk or their favorite puree.  
 
Myth: Epinephrine is dangerous and should only be used if someone’s airway is closing.  
Fact: Epinephrine is a very safe medication for most people when used properly. Epinephrine in the form of an autoinjector or nasal spray contains the correct amount of epinephrine when prescribed appropriately, and the devices are fairly easy to use, making the administration of epinephrine safe. Early use of epinephrine is crucial in life threatening situations. While it should be used for a closing airway in an allergic reaction, it should also be used for symptoms such as vomiting, dizziness, loss of consciousness and/or wheezing. Some allergists may advise their patients to use epinephrine if the patient accidentally eats their allergen and begins having even mild symptoms, such as a few hives, because epinephrine can stop the allergy cells that cause the reaction from secreting the reaction-driving compounds. Epinephrine can raise the heart rate and increase blood pressure, but this is temporary. People with heart conditions may want to speak to their cardiologist as well as their allergist about strategies to best prevent and manage anaphylaxis.
 
Myth: Everyone should have food allergy panel testing done to find out what they’re allergic to.
Fact: Food allergy testing can be a helpful tool in specific situations. However, tests for food allergies including skin prick tests and blood tests (also called IgE tests) are not 100% accurate when testing for food allergies. This is because these tests are actually looking for allergic antibodies called “food-specific IgE,” and many people not allergic to that food have developed food-specific IgE. Why this happens is unclear. These tests have a high rate of "false positive" results, meaning a test appears positive even when someone does not have a food allergy. Because of this, food allergy tests should be used carefully. Food panels, where many randomly selected foods are included in a test, are not helpful and can over-diagnose food allergy.  
 

Infographic

MYTH: Food allergy reactions get more severe each time they occur.
TRUTH: Not really. There are many cofactors that can worsen severity such as exercise, amount ingested or acute illness.

MYTH: Allergy tests tell you how severe your allergy can be.
TRUTH: Allergy tests are only a guide to determine likelihood of allergy being present, not the severity.

MYTH: Babies shouldn’t eat common food allergens.
TRUTH: Guidelines recommend feeding allergenic foods to babies starting around 4-6 months as a way to prevent food allergy development.

MYTH: Epinephrine is dangerous and should only be used if someone’s airway is closing.
TRUTH: Epinephrine works fast, is safe, and can treat all symptoms of a food allergy reaction. Waiting too long can worsen the severity.

MYTH: Everyone should have food allergy panel testing done to find out what they’re allergic to.
TRUTH: Panel testing causes misdiagnosis, false positive results and unnecessary avoidance.

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10/2/2025