Managing life with a food allergy can be challenging. Using three basic strategies can keep you safe and healthy - and they can be adapted to specific situations at school or work, or when dining out or traveling.

1. Research, Be Informed, and Communicate With Others

Research is a form of protection because it lets you know what to expect when choosing a food product or entering a new situation. Communication is an important part of research, and it involves educating others about your food allergy and requesting their cooperation.

For people with food allergies, reading food product labels can mean the difference between health and potentially dangerous allergic reactions. Keep these tips in mind when reading food labels:

• Read labels each time you buy or use the product, even those of familiar products, because ingredients can change.
• Keep in mind that phrases such as “natural flavors” or “spices” mean that a product can contain elements of any spice, fruit, vegetable, or meat not considered one of the most common allergens.¹ To be certain, contact the manufacturer.
• Phrases such as “peanut-free” and “egg-free” on food packaging are not supervised or regulated by the U.S. Food and Drug Administration (FDA).²

Other basic tips for researching and communicating:

• Familiarize yourself with policies regarding food allergies, whether at school or work or before flying with an airline.
• Create an allergy action plan that outlines the steps to take if you have a serious allergic reaction.
• Communicate with others about food allergies and ask for their cooperation. If someone still does not understand or has doubts about the seriousness of food allergies, it may help to print out information from your doctor or another trusted source.³
• Educate others about how to recognize the signs of anaphylaxis and how and when to use an epinephrine auto-injector.
• When dining out, speak with the host of the party, server, manager, or chef of the restaurant to let them know about your food allergy. Some people with food allergies carry a “chef card” listing their food allergens to make this communication easier.
• Use listings and phone apps that identify allergy-friendly restaurants that make it easier for those with food allergies to dine out with peace of mind.⁴

2. Avoid Food Allergens

Since there is no cure for food allergies, avoiding foods you are allergic to is the safest and most effective strategy for preventing food allergy symptoms and anaphylaxis - a life-threatening allergic reaction. Avoiding food allergens means reading labels and using care while storing, preparing, and serving foods.

Basic tips for avoiding food allergens include:

• Consider banning any product containing food allergens from your home.
• Keep foods that contain allergens completely separate from allergy-free foods at all times.
• Wash your hands thoroughly before preparing allergy-free meals.
• Make sure all equipment and utensils used to prepare allergy-free foods are washed thoroughly before each use, but especially after being used to prepare allergenic foods.
• Label safe foods clearly.
• Bring your own food to ensure allergen-free meals.

3. Plan and Prepare

Accidental exposure to food allergens can happen at any time. Because it’s not always possible to avoid exposure to food allergens, people with severe food allergies must be prepared to treat allergic reactions, including anaphylaxis.

Know the signs of anaphylaxis, and make sure anyone with whom you (or your child) frequently spend time with can recognize them, too:⁵

• Swelling of the lips or other parts of the body
• Flushed skin
• Breaking out in hives
• An attack of abdominal pain with nausea and vomiting
• Sudden weakness
• Sense of impending doom

An injection of epinephrine is the only treatment that can stop anaphylaxis. People with severe food allergies must always carry an epinephrine auto-injector. A second reaction occurs in 20 percent of people, so it is important to carry a second epinephrine auto-injector as well.⁶ Go directly to the nearest emergency room for follow-up treatment immediately after using an epinephrine auto-injector.

Apart from carrying epinephrine auto-injectors and being ready to use them, other strategies for preparation include:

• Wear medical alert identification jewelry to inform first responders in case of an allergic reaction.
• Place prominent tags on any purse or backpack containing epinephrine auto-injectors to help others find them fast.
• Set reminders or mark your calendar to replace epinephrine auto-injectors before they expire.
• Carry antihistamines such as Benadryl (Diphenhydramine), Claritin (Loratadine), or Zyrtec (Cetirizine) to treat mild to moderate symptoms of an allergic reaction. Antihistamines cannot treat anaphylaxis.

These three strategies can be adapted to any situation to keep you safe and healthy. Here are some specific examples of how to research, avoid, and prepare for food allergies.

HOME

• Consider banning any product containing food allergens from your home.
• Use separate equipment and utensils to store, prepare, and serve allergen-free food.
• Keep foods that contain allergens away from allergy-free foods at all times.
• Wash your hands thoroughly before preparing allergy-free meals.
• Make sure all equipment and utensils used to prepare allergy-free foods are washed thoroughly before each use, especially after being used to prepare allergenic foods.

SCHOOL

• Familiarize yourself with your child’s school’s policies regarding food allergies.
• In the U.S., parents of children diagnosed with severe allergies can work with teachers and administrators to create a written action plan known as a 504 plan.⁷ In the United Kingdom, allergy action plans are completed by doctors and submitted to the school.⁸ Both types of plans cover instructions on how to respond in case of anaphylaxis.
• In some classrooms, teachers notify parents about food allergens that should be avoided when bringing treats or snacks.
• Some schools may refer to online resources that list allergy-friendly snack foods.⁹
• Children with food allergies can experience social challenges as well as the danger of food allergen exposure. More than one-third of children with food allergies report bullying related to their food allergy. Parents can work with the school to identify and stop bullying of children with allergies.
• Ask for advance notice of field trips and special events to help make sure your child will have safe food options and not feel left out.

• Some schools have strict policies against children sharing foods at lunch. Other schools may ban bringing foods with peanuts.

• Pack safe lunches and snacks for your child.
• Make sure there is an epinephrine auto-injector available for your child.
• Have your child wear medical alert identification jewelry.

WORK - FOR ADULTS WITH FOOD ALLERGIES

• Let coworkers and managers know about your food allergies and work with them to minimize your risks from allergen exposure at work.
• Create a plan for what to do during a serious allergic reaction and make sure your manager and the human resources department have a copy.
• Educate coworkers about how to recognize the signs of anaphylaxis and use your epinephrine auto-injector.

• Keep your food separate from coworkers’ food.

• Make sure the location of your auto-injector is clearly labeled.
• Wear medical alert jewelry so coworkers and emergency responders will understand what is happening if you cannot speak during an allergic reaction.

EATING OUT

• Before dining at someone’s home, speak with the host of the party about your child’s food allergy.
• Suggest a trusted, allergy-friendly restaurant.
• At restaurants, talk to the server, manager, or chef to let them know about your child’s food allergy.
• Do not eat in restaurants where cross-contamination with your allergen may be difficult to avoid. For instance, those with severe seafood allergies should avoid seafood restaurants altogether. People with severe peanut allergies may do best to avoid restaurants serving cuisines in which peanuts are a staple, for example, Thai, Chinese, and Vietnamese.¹⁰
• In both the U.S. and U.K., organizations provide listings and phone apps that identify allergy-friendly restaurants that make it easier for those with food allergies to dine out with safety and peace of mind.

• Consider eating at home and showing up later for socializing, after the meal is finished.

• It is best to have a back-up plan whenever possible in case allergen-free food cannot be guaranteed at a restaurant or in a social situation. Bring a snack or a meal for your child just in case.
• Always carry your epinephrine auto-injector.
• Carry a chef card listing your food allergens.
• Wear medical alert jewelry so coworkers and emergency responders will understand what is happening if you cannot speak during an allergic reaction.

HOLIDAYS AND BIRTHDAYS

• Host the party at your own home to ensure control over foods that are served.
• For parties held away from home, let the host know about your child’s food allergy and offer to work with them to ensure an allergy-free menu.
• Visit this link for suggestions specific to each holiday or occasion.¹¹

• If both safe and non-safe foods will be offered, make sure they are clearly labeled and keep separate serving utensils for each dish.
• When possible, focus events around activities everyone can enjoy rather than food.

• If there is no way to prevent cross-contamination, bring a separate, allergy-free meal and treats for the person with food allergies.
• Always have your child carry an epinephrine auto-injector.
• Make sure that your child wears medical alert identification jewelry.
• Wear medical alert jewelry so coworkers and emergency responders will understand what is happening if you cannot speak during an allergic reaction.

Travel can be stressful for people with food allergies, but research and planning can help keep journeys safe for everyone. These general tips can help ensure safe travels for people with food allergies:

• Chain restaurants can offer familiarity and predictability.
• Check allergy-friendly lists for restaurants in your destination to get some ideas about where to eat once you arrive.
• Staying at lodging with kitchen access, such as an extended-stay hotel suite or an apartment rental, allows for cooking while on vacation.
• Air travel can present many risks for people with food allergies. Before flying communicate with the airline in advance to notify them of your allergy and request accommodation.¹² Pack your own food to avoid relying on airline meals. Avoid using the blankets and pillows provided by the airline - they may be contaminated. Some airlines will create a “buffer zone” for those with food allergies.
• Travel abroad represents more unknowns than almost any other situation people with food allergies encounter. Print out food allergy picture cards to notify restaurants of the foods you need to avoid.¹³ Carry translation cards to meet these important communication needs. Check whether your family will have health insurance coverage in case you need medical treatment, and know where the nearest emergency department is in each city you will visit.¹⁴
• Make sure you pack any medications you may need, including multiple doses of epinephrine auto-injectors.

Sources

1. Attention, Allergy Sufferers: Beware of Natural Flavors. Food Safety News. https://www.foodsafetynews.com/2015/12/attention-allergy-sufferers-beware-of-natural-flavors/. Accessed February 2019.
2. How to Read Food Labels. FARE. https://www.foodallergy.org/life-with-food-allergies/living-well-everyday/how-to-read-food-labels. Accessed February 2019.
3. Educating Others. Food Allergy Canada. https://foodallergycanada.ca/allergy-safety/educating-others/. Accessed February 2019.
4. Allergy Eats. https://www.allergyeats.com/. Accessed February 2019.
5. Signs and Symptoms. Anaphylaxis Campaign. https://www.anaphylaxis.org.uk/what-is-anaphylaxis/patient-signs-and-symptoms/. Accessed February 2019.
6. Food Allergy. American College of Allergy, Asthma & Immunology. https://acaai.org/allergies/types/food-allergy. Accessed February 2019.
7. Section 504 and Written Management Plans. FARE. https://www.foodallergy.org/education-awareness/advocacy-resources/section-504-and-written-management-plans. Accessed February 2019.
8. Allergy action plans for children. BSACI. https://www.bsaci.org/about/pag-allergy-action-plans-for-children. Accessed February 2019.
9. Safe Snack Guide. SnackSafely.com. https://snacksafely.com/safe-snack-guide/.
10. To eat or not to eat? A step-by-step guide to dining out with a food allergy. Echo. https://www.echo.co.uk/blog/dining-out-with-a-food-allergy. Accessed February 2019.
11. Maintaining a Healthy Lifestyle. Kids With Food Allergies. https://www.kidswithfoodallergies.org/page/maintaining-a-healthy-lifestyle.aspx. Accessed February 2019.
12. Safer Flying Strategies for Travelers with Peanut or Nut Allergies. Asthma and Allergy Foundation of America. http://asthmaandallergies.org/wp-content/uploads/2013/12/Safer-flying-tips-with-peanut-and-nut-allergies-PDF.pdf. Accessed February 2019.
13. Food Allergy Picture Cards. AllergyTranslation. https://allergytranslation.com/picture-cards/. Accessed February 2019.
14. Traveling With Allergy. Allergy UK. https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/615-travelling-with-allergy. Accessed February 2019.