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New York Presbyterian Hospital

Beware of food allergies: What to do in case of a reaction

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NewYork-Presbyterian Hospital
Food allergies are serious business for people who have them. And there are plenty who do. They must be mindful at all times of what foods they eat and the ingredients that have gone into making them — or potential consequences can result.


“At least 12 million Americans have food allergies, including eight percent of children under age 18,” says Dr. Oana Hantar, an internist with New-York Presbyterian Medical Group/Westchester. “The results can be wide ranging and severe, and possibly deadly.”

Food allergies can cause rashes and/or vomiting and abdominal pain, shortness of breath (mild or severe), coughing, trouble swallowing, a tight hoarse throat, weak pulse, low blood pressure, dizziness, pallor, and fainting or shock that can lead to cardiorespiratory arrest. “About 90 percent of all food allergies are caused by trigger foods such as milk, eggs, shellfish, wheat, soy, fish, peanuts, and tree nuts-such as almonds, walnuts, and cashews,” notes Dr. Hantar.

Food allergies affect children and adults of all races and ethnicities and can develop at any age. Young children may experience severe eczema (skin inflammations that create itchy, red, and burning rashes) triggered by a food allergy. While they sometimes can outgrow this for a period of time, the allergies can reappear later in life. In addition, food allergies are an increasing health concern in the geriatric population. “As individuals age, so do their immune systems,” explains Dr. Hantar, “making them more susceptible to allergic reactions.”

How is someone tested for food allergies?

The Oral Food Challenge: This highly accurate diagnostic test should only be performed by an experienced allergist at a medical facility. The allergist feeds the patient a suspected food in measured doses that are unlikely to trigger symptoms. Following each dose, the patient is observed for a period of time for any signs of a reaction. If there are no symptoms, the patient will gradually receive increasingly larger doses. If signs of a reaction occur, the food challenge will be stopped. “With this regimen, most reactions are mild, such as flushing or hives, and severe reactions are uncommon,” says Dr. Hantar. “If necessary, the patient will be given medications, most often antihistamines, to relieve the symptoms and the doctor will then discuss the best course of action.”

Skin Prick Tests (SPT) and Blood Tests. Food allergy symptoms are caused by the interaction between a food allergen and an antibody known as IgE. Both blood tests and skin prick tests are used to determine the presence of the antibody. In a skin prick test, the allergist places a drop of solution containing the food allergen on the patient’s forearm or back. Using a small plastic probe or needle, the doctor gently pricks or scratches the skin to allow a tiny amount of the solution to enter just below the surface. The SPT is generally not painful and there is no bleeding.


For mild to moderate symptoms: Food allergies can often be treated with antihistamines and asthma medications to help relieve breathing problems, or steroids for symptoms such as itching, sneezing, hives or skin rashes.

For severe reactions (a.k.a. anaphylaxis): The drug epinephrine is always prescribed, the only medication that can reverse the symptoms of anaphylaxis, the body’s severe reaction to an allergen including symptoms like hives, swelling, trouble breathing, nausea or dizziness. It should be taken at the first sign of an allergic reaction. “It is important this be followed up with a call to 911, as patients should always go to the emergency room for further treatment after food-induced anaphylactic reaction — regardless of whether the symptoms are still present,” cautions Dr. Hantar.

5-step action plan for food allergy safety

  1. Avoid your trigger foods — always. Vigilance is key.
  2. Work closely with your doctor to develop a Food Allergy & Anaphylaxis Emergency Care Plan. (See sample form at
  3. Have your medication handy at all times and in all situations; it would also be helpful to wear medical identification bracelets to alert emergency response workers of your condition, in the event you cannot.
  4. Be sure to take your medication at the first sign of a reaction.
  5. If you have a reaction, always visit the ER for follow-up treatment.

As to the future of food allergy care, Dr. Hantar says, “Researchers are currently seeking better, more efficient treatments for food allergies and are currently in clinical trials looking at oral immunotherapy (OIT), a procedure intended to gradually reduce the allergic sensitivity of a patient for a given food, particularly peanut, wheat, and milk products. The future looks promising.”

For more information on allergies, visit To find a physician, call 914-787-5000.

