How do you manage food allergies during the holidays?
Short answer
Allergy question
Plan ahead: tell the host about your allergy, ask how each dish is made, bring a safe dish you can eat, read labels on packaged foods, and watch for cross-contact from shared serving spoons and buffets. Carry your prescribed epinephrine auto-injectors and know the signs of anaphylaxis, since holiday meals often hide nuts, milk, egg, wheat and shellfish.
This is a general research summary, not a diagnosis. A clinician or a test can confirm what applies to you.
Key facts
The major food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame.
The FDA requires labeling on foods and beverages containing more than 10 parts per million of sulfites.
Shellfish, tree nuts, peanuts and fish are among the most common food allergies in adults.
The full answer
Holiday meals are hard for people with food allergies because the dishes are made by many different cooks, recipes change from year to year, and food is often served buffet-style. The American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Allergy, Asthma and Immunology (AAAAI) both note that allergens can hide in seasonal foods that people don't usually eat the rest of the year.
Where the major allergens hide
In the U.S., the nine major food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame, and the FDA requires them to be labeled on packaged foods.
- Tree nuts and peanuts: stuffing, sweet potato toppings, pecan and walnut pies, cookies, fudge, nut brittle, pesto and marzipan
- Milk, egg and wheat: gravy, mashed potatoes, casseroles, eggnog, breads and baked desserts
- Shellfish and fish: seafood dinners, appetizers and some stuffings (ACAAI notes shellfish allergy is one of the most common food allergies in adults)
- Sesame: breads, crackers and dips
Sulfites and wine
Sulfites are preservatives found in wine, some beers and ciders, dried fruit, bottled lemon juice, some pickled foods and some processed potatoes. The AAAAI explains that sulfite reactions are uncommon but real, can include asthma symptoms, hives and, rarely, anaphylaxis, and are more likely in people with asthma. The FDA requires labeling when sulfites are present above 10 parts per million. Wine can also contain histamine, and some people flush or get congested after drinking without having a true allergy.
Avoiding cross-contact
A serving spoon moved from the pecan pie to the pumpkin pie, a shared cutting board or a fryer used for shrimp can transfer enough allergen to cause a reaction.
- Tell the host early and offer to bring a dish you know is safe
- Serve yourself first, before spoons get mixed
- Ask about ingredients rather than guessing
- Read every label on store-bought foods, including desserts and gift baskets
Have a plan
If a clinician has prescribed epinephrine, carry two auto-injectors and make sure someone else knows how to use them. Hives with breathing trouble, throat tightness, repeated vomiting, dizziness or swelling of the lips and tongue can be anaphylaxis: use epinephrine and call 911. If you think you have a food allergy that hasn't been diagnosed, see a clinician for testing before the next holiday season.
The key points
The handful of things that decide the answer — skim these if you only read one section.
Allergens hide in seasonal dishes
Nuts in stuffing and pies, milk and egg in casseroles and eggnog, wheat in gravy, and shellfish in seafood dinners are common holiday surprises.
Sulfites are a holiday wildcard
Wine, dried fruit and some processed foods contain sulfites, which can trigger asthma symptoms or hives in sensitive people.
Cross-contact is a real risk
Shared serving spoons, cutting boards and buffets can transfer allergens between dishes. Serve yourself first or bring your own safe dish.
Labels and the host are your best sources
Read packaged-food labels for the nine major allergens and ask how home-cooked dishes were made.
Carry epinephrine if prescribed
Keep two auto-injectors with you, know the signs of anaphylaxis and call 911 after using epinephrine.
A note on how to use this
Informational only — not a diagnosis
This page is a general research summary about allergies and allergy care. It cannot tell you whether you personally have an allergy or what is triggering your symptoms. It is informational only and never a substitute for evaluation by a licensed clinician.
If you want a real answer for your body, at-home allergy testing or a visit with a clinician can identify what you actually react to — this page cannot diagnose you.
Frequently Asked Questions
Watch for pecan, walnut and almond pies, cookies, fudge, brittle, baklava, marzipan, nut-crusted meats, stuffing with chestnuts or pecans, candied sweet potato toppings, pesto, granola and gift-tin snacks. Some recipes use nut flours or nut oils that aren't obvious. When a dish is homemade, ask; when it's packaged, read the allergen statement.
Many classic desserts can be made without nuts: pumpkin or apple pie with a nut-free crust, sugar cookies, gingerbread, chocolate-dipped pretzels, fruit crisps with an oat topping and meringues. Use ingredients labeled free of peanuts and tree nuts, since chocolate chips and baking mixes can carry precautionary labels. Bake in a clean kitchen to avoid cross-contact.
True wine allergy is uncommon, but wine can cause reactions. Sulfites in wine can trigger asthma symptoms or hives in sensitive people, especially those with asthma. Wine also contains histamine and other compounds that can cause flushing, headache or a stuffy nose. Rarely, people react to grape proteins or fining agents. A clinician can help sort out the cause.
Sulfite reactions most often cause wheezing, chest tightness or coughing in people with asthma. Other possible symptoms include hives, flushing, itching, stomach upset and, rarely, anaphylaxis. Reactions usually happen soon after eating or drinking sulfite-containing foods such as wine, dried fruit or some processed potatoes. Tell your clinician if you suspect sulfites.
Ask which dishes contain shrimp, crab, lobster, clams or other shellfish, and whether any were cooked in the same pan, oil or water as other foods. Seafood stocks, sauces and some stuffings can contain shellfish. Steam and cooking vapors can affect some highly sensitive people. When in doubt, bring a safe main dish of your own.
If you have signs of anaphylaxis, such as trouble breathing, throat tightness, widespread hives with other symptoms, repeated vomiting, fainting or swelling of the lips or tongue, use your epinephrine auto-injector right away and call 911. Lie down with legs raised unless breathing is easier sitting up. Antihistamines alone are not enough for anaphylaxis.
Avoidance and an emergency plan remain the foundation. Some people with IgE-mediated food allergies can also work with an allergist on immunotherapy, such as oral or sublingual immunotherapy, which aims to raise the amount of food needed to cause a reaction. These treatments are physician-supervised, require testing first and are not right for everyone.
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Read moreWorried about every dish this season? Talk to a food allergy doctor
Curex's free quiz checks eligibility for food allergy testing and physician-supervised food allergy drops for IgE-mediated allergies, for ages 2 and up.
- At-home allergy test kit — no clinic visit
- Reviewed by board-certified allergists
- Find the trigger instead of guessing
This content is for general informational purposes only. It cannot diagnose you or tell you what is triggering your symptoms, and it is never a substitute for care from a licensed clinician. Curex offers at-home allergy testing and immunotherapy for confirmed environmental allergies; it does not provide emergency care.
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