What Are the Top 9 Food Allergies?
Food allergies are a rapidly growing epidemic with no cure in sight. Nearly 10 percent of Americans have a food allergy (that’s 33 million Americans!) with signs and symptoms ranging from mild to severe: itching, skin rash, dizziness, wheezing, nasal congestion, nausea, vomiting, anaphylaxis, and more.
According to Food Allergy Research & Education (FARE), nearly any food can trigger an allergic reaction, but nine foods are responsible for the majority of them. These “top 9” food allergens are: peanuts, tree nuts, milk, eggs, soy, wheat, shellfish, fish, and sesame.
Let’s break each one down!
PEANUTS 🥜
Peanuts are one of the most well-known and common food allergies, affecting more than 1.5 million children and 4.5 million adults. Even though “nut” is part of its name, peanuts are a legume that grows underground—very different from tree nuts!
Peanuts can create a precariously high level of stress for parents as they’re the most common food allergy in children under the age of 18 AND one of the most common triggers of food-related anaphylaxis. One study found 20 percent of children outgrow their peanut allergy (most likely by age six), but it’s usually lifelong. While there isn’t a cure yet, therapies such as OIT and SLIT may help build a tolerance to peanuts, and a handful of other cutting-edge treatments are helping aid in allergy management.
TREE NUTS 🌰
Tree nuts—including almonds, cashews, hazelnuts, pecans, pistachios, and walnuts—are a common food allergy for both children and adults, affecting 3.9 million in the U.S.
Tree nut allergy is different than peanut allergy (see above ☝️), and more confusing because being allergic to one tree nut doesn’t necessarily mean you’re allergic to others. About 50 percent of children with one tree nut allergy have an allergy to another tree nut. When it happens, however, there are often correlations. Walnuts and pecans are almost 100 percent cross-reactive, as are cashews and pistachios.
Tree nut allergy carries a high risk of anaphylaxis and cross-contact (hello trail mix!), and less than 10 percent of people with a tree nut allergy outgrow it.
MILK 🥛
Cow’s milk allergy is one of the most common allergies in infants and young children. While many eventually outgrow the allergy, milk remains a top allergen for adults, too! A whopping 6.1 million Americans are milk allergic.
Remember, milk allergy and lactose intolerance are two different conditions! If someone suffers from a milk allergy, their body produces an immune response upon ingesting cow’s milk leading to mild (ex: hives, eczema) or very severe (ex: vomiting, anaphylaxis) symptoms. With lactose intolerance, a person lacks the enzyme necessary to digest lactose, the sugar found in milk, which results in symptoms like gas, bloating, diarrhea, and constipation.
EGGS 🥚
Not so egg-cellent news: egg allergy is also one of the most common food allergies in infants and young children. 😢 It affects about 2 percent of children with symptoms including skin rashes, hives, nasal congestion, and vomiting—anaphylaxis is rare. Luckily, 70 percent of children with an egg allergy will outgrow it by the time they’re 16 years old.
Whether someone is allergic to the creamy yolks or protein-packed egg whites (egg whites tend to contain the protein most commonly associated with an allergic reaction), about 70 percent can tolerate baked egg because heat disrupts the protein responsible for the allergic reaction.
Egg allergy is less common in older children and adults.
SOY 🫛
Soy wins the most insidious allergen award, because it seems to hide in everything! Almost 2 million people manage a soy allergy in the United States. While reactions are typically mild, the pervasive use of soy in processed food products means it’s an especially pesky offender.
Soybeans are a member of the legume family along with beans, peas, lentils, and peanuts. The good news? Soybeans are nutritionally rich and a complete protein, containing all nine essential amino acids. The bad news? Soy is used as an emulsifier under the name “soy lecithin,” and while lecithin is naturally occurring in soybeans, it’s often extracted using harsh chemicals and used as a “glue” to hold ingredients together in packaged foods. It’s found in vegetable gum, vegetable starch, baked goods, crackers, canned tuna and meat, infant formulas, skincare, and more.
As with any allergy, read your labels carefully!
WHEAT 🌾
Wheat allergy affects about 1 percent of U.S. children, though two-thirds of them will outgrow their allergy by age 12, according to a study published in the Annals of Allergy, Asthma, and Immunology.
A wheat allergy is not the same as celiac disease. Wheat allergy is an adverse immunologic (IgE-mediated) reaction to ingesting wheat protein resulting in skin, gastrointestinal, and respiratory symptoms. Celiac disease is an autoimmune disorder where the ingestion of gluten damages villi in the small intestine, making it hard for the small intestine to absorb nutrients from food. It affects one in 133 Americans (~2 million people) and 1 percent of the population worldwide.
Those with a wheat allergy can safely eat gluten-free foods, as they don’t contain wheat. However, those with celiac disease should take care when eating food labeled “wheat-free” as it may contain barley or rye, which contain gluten.
SHELLFISH 🦀🦞🦐🦪
Crab, lobster, shrimp, clams, oysters, scallops… if you have a shellfish allergy, you’re probably familiar with the diverse array of aquatic animals under the shellfish umbrella. And for good reason! Shellfish allergy is the most common adult food allergy, affecting 7 million Americans.
What’s more worrisome is that nearly 60 percent of this population has experienced a severe allergic reaction and almost half have developed their food allergy in adulthood. Shellfish allergies tend to be lifelong and can cause severe and potentially life-threatening reactions, including anaphylaxis. In addition, airborne exposure to shellfish can trigger milder reactions, such as difficulty breathing, itchy eyes, and coughing.
It’s important to note there are two groups of shellfish: crustaceans (crab, lobster, shrimp, crayfish) and mollusks (clams, mussels, oysters, scallops, octopus, squid). Allergy to crustaceans is more common than mollusks, with shrimp being the most common shellfish allergy in both children and adults.
FISH 🐟
More than 2.5 million Americans are allergic to fish—roughly 1 percent of the population—with reactions ranging from mild to severe. Similar to shellfish, 40 percent of fish allergy diagnoses go undiscovered until adulthood.
Fish allergy refers to finned fish, which includes tuna, halibut, cod, catfish, and salmon (not to be confused with crustaceans and mollusks, see above ☝️). Being allergic to fish does not mean you need to avoid shellfish and vice versa, though cross-contact between the two is common, so take care when preparing food and dining out at restaurants!
SESAME 🟤
Sesame is the newest “top 9” food allergen with the passage of The FASTER Act in April 2021. This federal legislation added sesame to the list of allergens that must be declared on all federally regulated packaged products in the United States. Its promotion to “top 9” status was the result of growing research indicating the allergy is on the rise. According to a study published in JAMA, 0.23 percent of the population (~780,000) has a sesame allergy.
The more troubling information was published in a separate study in Pediatrics, which cited that the highest rates of epinephrine prescriptions were for children with peanut, tree nut, AND sesame allergies. While sensitivity to sesame varies from person to person, it’s important to read food labels, as sesame can lurk under names such as benne, gomasio, tahini, halva, and sesame oil.
Do you have a food allergy that’s NOT in the “top 9” list? Tell us more about it below in the comments! We’d love to hear from you.
— Holly and the Amulet Team