Food Allergy

Helping Patients With Food Allergy Safety

The dramatic rise in the incidence of food allergies is a growing concern. One in 13 children are now diagnosed with food allergies, a 50% increase since 1997. As diet education is paramount in the proper treatment of food allergies, RDs have the opportunity to share their expertise. Patients may come to you stressed and afraid, especially if they discovered the allergy due to a serious reaction. You can provide them with the tools they need to feel safe and prepared.

The first step in diet education includes teaching complete avoidance of their allergen. This is important because even a small amount of the allergen can cause a reaction. In this discussion, label reading should be covered. There is a lot of information on a nutrition label and you need to discuss how to interpret it. The Food Allergy Labeling and Consumer Protection Act went into effect in 2006, making it much easier to determine whether a food contains any of the top eight food allergens (milk, soy, wheat, eggs, peanuts, tree nuts, shellfish, fish). These must be listed in plain language in the ingredient list or following a “Contains” statement. Some companies also will include statements such as “processed in a facility that also processes peanuts” or “may contain trace amounts of milk.” Alert patients to watch for these statements as well.

For patients with allergies that aren’t in the top eight, reading the label can be trickier. You will need to educate patients on the other names for their allergens and how to find these in the ingredient list. You also can provide them with a list of foods that commonly contain the allergen.

Cross contamination is another area to discuss. Many patients will opt to remove the allergens from their house entirely, but some may not. For those who choose to keep the allergen in the house, discuss proper washing techniques of surfaces and kitchenware as well as hand washing. Cross-contamination is more prevalent in restaurants; as such, eating out can be very difficult for those dealing with food allergies. Patients will need to learn to communicate with waitstaff on the importance of avoiding cross-contamination with their allergen during the preparation of their food. Dining out can be extremely stressful, and many patients simply avoid it altogether, especially in the time immediately following diagnosis. One way to help ease into dining out is by using a “chef card” containing allergy information. This tool provides a visual reminder to the kitchen staff and helps patients feel more at ease.

Another important point to consider, especially when dealing with children, is nutrient deficiency. Since whole food groups may eliminated to avoid an allergy, RDs must recommend substitutions that fill nutrient gaps. Some allergies, such as shellfish, won’t create as much of a concern. Others, such as dairy, are much more difficult to avoid and can create nutrient deficiencies if no other changes are made to the diet.

RDs have a lot of information and strategies to contribute to populations with food allergies. By providing nutrition education that meets their needs, you will prepare these patients to live healthy and safe lives.

— Rachael Costello, RDN, LDN, is mother to three food allergy kids and an advocate for food allergy education. She runs Rachael Costello Nutrition, a private practice in the Chicago suburbs, and is an adjunct faculty nutrition instructor at Harper College. You can find her blog at

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