Many people mistake a food intolerance for a food allergy. For those with diagnosed food allergy, contact with a certain protein causes the body to produce an immunoglobulin E antibody (IgE), which can result in a variety of symptoms. The majority of food allergy diagnoses require complete avoidance of foods containing the allergen. A food intolerance involves limiting intake of that food as it is difficult to digest, but doesn’t cause an immune response.
Whether someone has one or multiple food allergies, their diet will be restricted in some shape or form, which puts them at risk for nutritional deficiencies. Nutrients are necessary for proper growth, development, and good health at all stages of life.
Signs that you’re not getting adequate nutrition include:
- Increased or frequent illness
- Weight loss for adults and
- Lack of weight gain or growth in height for children
Even when consuming adequate calories, there is still a chance your diet may be lacking certain nutrients. Specific symptoms can be signs of deficiencies in vitamins and minerals, but can also have varying causes.
Nutrients in the Top 8 Food Allergens
The top eight allergens in the U.S are milk, eggs, wheat, peanuts, tree nuts, soy, fish and shellfish. These eight foods are the most common and account for 90% of food allergy reactions among people in the U.S.
Below are the nutrients provided in each of the top eight food allergens, and suggested alternatives for those who are eliminating a food allergen from their diet.
Suggested Alternative (if not allergic)
|Milk||Protein, Calcium, Riboflavin, Phosphorus, Vitamins A, D, B12, Magnesium, Zinc, Potassium||Increase protein foods: Meat, fish, poultry; whole grains, nuts, mushrooms, bright yellow and orange vegetables, fortified foods/beverages (with B vitamins, Calcium, Vitamin D)|
|Eggs||Protein, Iron, Biotin, Folate, Riboflavin, Selenium, Vitamins A, D, E, B12||Increase protein foods: Meat, fish, poultry, legumes, lentils, dairy; fruit, vegetables, leafy greens, whole grains, dried fruit|
|Wheat||B vitamins, Iron, Zinc, Selenium, Chromium||Alternative fortified grains (barley, rice, oat, corn, rye, quinoa, amaranth, farina), soybean, legumes, egg, milk, nuts, seeds, apples, banana, spinach and potatoes|
|Soy||Protein, Thiamin, Riboflavin, Iron, Calcium, Zinc, Vitamin B6, Folic Acid||Protein foods: Meat, legumes, whole grain bread products, egg, nuts, peas, seeds, milk, dried fruit|
|Peanuts and Tree Nuts||Protein, Magnesium, Manganese, Biotin, Copper, Niacin, Chromium||Protein foods: Meat, fish, poultry, legumes, dairy; whole grains, vegetable oils, soybean, eggs, fruit, vegetables, leafy greens|
|Fish and Shellfish||Protein, Omega-3 fatty acids, Potassium, Niacin, Vitamins B6, B12, A, E||Protein foods: Meat, poultry, legumes, fortified whole grains, oils, eggs, seeds, nuts, dairy; vegetables, leafy greens|
Alternatives to create balance and variety
It’s important to meet your nutritional needs with a balanced and diverse diet while avoiding your allergen(s). Generally, it’s recommended to aim for a diet with the least amount of processed foods. The best way to replace those nutrients is to find safe food alternatives with similar nutrients. Look for nutrient-rich replacements in whole foods such as:
- Meat and poultry
- Grains (excluding wheat)
- Legumes (excluding peanuts)
A growing number of food companies now make foods free of many common allergens. When choosing foods, take time to read the labels and nutrition facts to ensure the food is safe to consume and nutritionally adequate to replace lost nutrients not consumed due to food allergies. Choosing products with shorter ingredient lists may be the healthier option.
Tips for success
Below are some tips to help plan meals and snacks:
- Focus on all foods you or your child can safely eat by making food lists.
- Separate the foods listed into meals (breakfast, lunch, dinner, snacks) and then into food groups (vegetables, fruits, grains, protein, dairy).
- At each meal, use MyPlate as a guide to choose a food from each group to obtain a good balance of nutrients.
- Create variety by pairing different foods together for different meals and preparing them in different cooking methods.
- Diversify your diet by trying new cultural foods. Remember to always read food labels.
Eliminating major foods or food groups from your diet can have negative implications if the missing nutrients are not replaced. Registered Dietitian Nutritionists can assist patients with food allergies by creating strategies for short-term and long-term avoidance of food allergens, while focusing on the nutritional adequacy of their overall diet. Specific focus areas in which RDNs may be most beneficial to patients with food allergies include safe and nutritious food substitutions, label reading, advice for dining out in restaurants, and managing food allergens in schools.
For those looking to add an extra measure of safety, beyond avoidance, consider treating the cause of the allergy safely with sublingual immunotherapy.
By Katelyn Stelzer, Dietetic Intern at Allergy Associates of La Crosse
- Collins SC. Practice Paper of the Academy of Nutrition and Dietetics: Role of the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies. J Acad Nutr Diet. 2016;116:1621-1631.
- Diagnosing Food Allergies: Current Guidelines. eatrightPRO – Academy of Nutrition and Dietetics.
- Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol.2010;126(6):S1-S58, December 2010.
- James JM. Growth Comparison in Children With and Without Food Allergies in 2 Different Demographic Populations. Pediatrics. 2015;136(Supplement).