Summary: This blog provides clear, parent‑friendly guidance to help families keep children with food allergies safe and confident during Halloween, balancing practical tips with reassuring advice. It summarizes how common food allergies are, identifies likely candy triggers, and highlights that about 1 in 13 children are affected. It offers 6 practical tips for a fun, safe Halloween and recommends Food Sublingual Immunotherapy (Food SLIT) as a long-term solution for managing food allergy symptoms year-round.

Halloween is supposed to be fun and just a bit scary. But for children with food allergies and their families, it can be just plain scary. Food allergy affects an estimated 33 million Americans, including 5.6 million children under the age of 18.¹ The most common food allergens are milk, egg, wheat, soy, peanuts, tree nuts, sesame seed, fish, and shellfish. Outside of fish and shellfish, any of these triggers may be found in Halloween candy treats.

How Common are Food Allergies in Children?

Food allergies are one of the most common chronic conditions in childhood. With 1 in 13 children affected², chances are good that your child has classmates, friends, or neighbors managing food allergies every day, not just on holidays like Halloween.

Common Halloween candy ingredients that may contain allergens include:

• Milk and milk chocolate
• Eggs and egg‑containing treats
• Wheat in cookies, bars, and many candies
• Soy as an additive or emulsifier
• Peanuts and peanut butter candies
• Tree nuts (such as almonds, walnuts, hazelnuts)

Because candy labels can be confusing, and fun-size versions may have different ingredients, it’s especially important to be cautious during trick-or-treat night.

Signs and Symptoms of Food Allergy Reactions in Kids

Food allergy reactions can range from mild to severe. Symptoms may show up quickly, often within minutes of eating or even tasting an unsafe food.

Possible symptoms of a food allergy reaction may include:

• Rash or red, itchy skin
• Hives
• Vomiting
• A stuffy, itchy nose or sneezing
• Coughing, wheezing or shortness of breath
• Diarrhea or stomach cramps

For children who are severely allergic, a single bite of these foods may cause a life-threatening reaction called anaphylaxis.

What Is Anaphylaxis and When Is It an Emergency?

Anaphylaxis is an allergic reaction that affects several parts of the body that starts very quickly and can be life-threatening. Signs of anaphylaxis include:

• Throat tightness, hoarseness, or trouble swallowing
• Trouble breathing, cough, wheezing, or chest tightness
• Feeling lightheaded, faint, or confused

Children may have difficulty explaining what they are experiencing. Instead of saying “I’m having trouble breathing,” they may say their chest hurts, or that they can’t walk or trick-or-treat anymore. Anaphylaxis can lead to shock and even death if not treated promptly.

When to Use Epinephrine and When to Call 911?

If any symptoms of anaphylaxis develop, injectable or intranasal Epinephrine should be given immediately and 911 called to activate EMS. Do not wait to see if symptoms improve on their own. Children with known severe food allergies should always have access to their epinephrine when trick-or-treating or attending Halloween parties.

How Can Food Allergic Kids Have a Safe Halloween?

Kids with food allergies can enjoy Halloween safely by planning food‑free activities, carefully checking all candy before eating, carrying injectable or intranasal epinephrine, teaching them to decline unsafe treats, and choosing homes that offer non‑food treats, such as those participating in the FARE Teal Pumpkin Project®³.

Halloween Safety Checklist for Kids with Food Allergies: 6 Tips

Here are 6 practical tips to make celebrating Halloween fun and less scary:

1. Plan food-free fun to celebrate Halloween!
   1. Consider building your celebrations around activities, not treats. Ideas include costume contests, pumpkin carving or decorating, spooky story time, or other Halloween-themed activities.
2. Ensure children don’t trick-or-treat alone.
   1. Make sure allergic children are always trick‑or‑treating with an adult who understands their allergies and emergency plan. The supervising adult should know the child’s specific food triggers, recognize the signs of an allergic reaction, have immediate access to the child’s injectable or intranasal epinephrine, and be prepared to call 911 if a serious reaction occurs.
3. Educate friends and family before the big night.
   1. Help friends, relatives, and caregivers understand your child’s food allergies and how to keep them safe. Before Halloween, share a list of your child’s food triggers, explain your child’s emergency action plan, review where the epinephrine is and how to use it, and ask party hosts to have non-food treats available.
4. Have a candy check before anything is eaten.
   1. Make a rule that no candy is eaten until an adult has checked it. During your candy check, read labels carefully, look for known allergens, watch for “may contain” or “processed in a facility with” warnings, and consider swapping unsafe treats for a safe “Halloween treasure” box or other surprise at home.
5. Teach kids to politely decline any homemade foods.
   1. Homemade treats like cookies, brownies, and candy apples can be risky because ingredients aren’t always obvious. Teach your child to politely decline these treats and avoid eating anything without a clear label. You can also plan to bring safe treats for your child to enjoy while trick-or-treating.
6. Stick to your own community for trick-or-treating. You can also look for the FARE Teal Pumpkin® and non-food treats!
   1. The FARE Teal Pumpkin Project® helps make Halloween more inclusive and safe for children with food allergies. Homes with a teal pumpkin out front indicate they offer non‑food treats like stickers, glow sticks, and small toys. Encourage your child to look for teal pumpkins while trick-or-treating!

Beyond Halloween Night: Make A Plan with your Allergy Partners Allergist

While one night of preparation helps, long‑term planning is the best way to reduce anxiety year‑round. Food Sublingual immunotherapy (Food SLIT) offers a promising, long‑term approach to reduce allergic reactions to specific foods, helping families feel safer not just at Halloween but at every meal and celebration. Administered as small doses under the tongue and gradually increased under an allergist’s supervision, Food SLIT can build tolerance over time with a convenient, at‑home maintenance routine and generally mild side effects. It’s not an immediate cure, but for many patients it meaningfully lowers the risk of accidental reactions and gives families greater confidence during food‑centered events.

Keep Halloween Fun, and Not Too Scary

Being careful and being prepared are the keys to making Halloween fun and not so scary for kids with food allergies. If you’re concerned about your child’s food allergies, past reactions to Halloween treats, or how asthma might affect their safety, consider speaking with an Allergy Partners board-certified allergist about testing, an updated action plan, and emergency medications before the holiday.

Frequently Asked Questions: Halloween and Food Allergies

What Halloween candies are most risky for kids with food allergies?
Candies that contain milk, eggs, wheat, soy, peanuts, or tree nuts can be risky for kids with food allergies. Remember that the fun‑size versions can sometimes have different ingredients than the standard bars. Always read the label, even if your child has safely eaten the full‑size version before.

What should I do if my child has anaphylaxis while trick-or-treating?
If your child shows signs of anaphylaxis while trick‑or‑treating, give injectable or intranasal epinephrine right away and call 911 to activate EMS. Do not wait to see if symptoms improve on their own. Stay with your child until emergency help arrives.

What is the FARE Teal Pumpkin Project®?
The FARE Teal Pumpkin Project® is a national initiative that encourages families to offer non‑food treats for children with food allergies or other dietary restrictions. A teal pumpkin placed outside the home signals that safe, non‑food items are available. Please visit the FARE® website for more information.

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References:
¹Food Allergy Research and Education (FARE)©. https://www.foodallergy.org/resources/facts-and-statistics
²Center for Disease Control. https://www.cdc.gov/school-health-conditions/food-allergies/index.html
³The Teal Pumpkin Project ® is a worldwide campaign that promotes safe and inclusive Halloween trick-or-treating for children with food allergies, celiac disease, and other medical conditions.

The Teal Pumpkin Project ®, is a registered trademark of Food Allergy Research & Education (FARE)®.

If you have painful or unpleasant physical reactions to certain foods, you might be experiencing a food allergy, food intolerance, or food sensitivity. While all three issues can cause significant health challenges, they can be managed with careful prevention and treatment strategies.

It’s quite common to experience irritating, unpleasant, or painful physical symptoms after consuming certain foods. Maybe you develop heartburn after eating spicy foods or citrus, or you feel sluggish after a rich meal. However, if you have serious physical reactions after eating a particular food, you might believe you have a food allergy.

What are the Differences Between Food Allergies and Food Intolerances?

Although it is entirely possible that you’re experiencing an allergic response to an ingredient in your food, it is also highly likely that you could have a food intolerance, an autoimmune disorder, or food sensitivity. These conditions can trigger a variety of symptoms, and it’s important to recognize how the different conditions affect the body.

Food Allergies

A food allergy occurs when the immune system misidentifies a specific food as harmful, leading to an Immunoglobulin E (IgE) overresponse that can trigger potentially dangerous symptoms.

Food allergies can cause multiple symptoms that can vary from person to person. Common food allergy symptoms may include the following:

• Abdominal cramps or diarrhea
• Anaphylaxis (a potentially deadly allergic reaction)
• Difficulty breathing
• Dizziness or lightheadedness
• Hives
• Itching or tingling sensation in the mouth
• Nausea or vomiting
• Swelling of the lips, tongue, or throat
• Wheezing

Food allergies can be very dangerous. Anaphylaxis requires immediate medical intervention in the form of an epinephrine injection.

Food Intolerance

There are a lot of people who have uncomfortable physical responses to certain foods, but while some might be caused by allergies, most are the result of a food intolerance.

Because an intolerance to certain ingredients in food can trigger similar symptoms to food allergies, confusing the two conditions is quite common.

Food intolerance does not involve the immune response and is caused by a problem with the digestive system. The most commonly experienced form of food intolerance is lactose intolerance. Lactose intolerance is a deficiency of the enzyme lactase, which processes dairy lactose.

Unlike food allergies, food intolerance symptoms are typically limited to the digestive system. Common intolerance symptoms may include:

• Bloating or gas
• Abdominal pain or cramps
• Diarrhea or constipation
• Heartburn or indigestion
• Nausea or vomiting

While food intolerance can be extremely uncomfortable, it is not life-threatening.

Autoimmune Disorder/Celiac Disease

Celiac disease is an autoimmune disorder that causes a severe inflammatory response when gluten protein from barley flour, rye flour, or wheat flour is consumed. This response causes the small intestine to fail to absorb nutrients, a condition called malabsorption.

Celiac disease symptoms include the following:

• Nausea
• Chronic diarrhea
• Abdominal distension
• Gas
• Stomach pain
• Constipation

Celiac disease is categorized into two subgroups, according to the World Gastroenterology Organization:

• Classical Celiac Disease: Classical celiac disease leads to malabsorption symptoms, which include diarrhea, weight loss, and anemia.
• Non-Classical Celiac Disease: Non-classical celiac disease causes abdominal pain, discomfort, and constipation without indications of malabsorption.

Celiac disease is not considered an allergy – people with celiac disease are not in immediate danger if they eat gluten once. Over time, however, consistent gluten exposure can cause significant digestive distress, potentially leading to malnutrition.

Food Sensitivity

Some people develop issues that are not common to food allergies, autoimmune disorders, or food intolerance. Such issues are thought to be related to food sensitivity.

Food sensitivities are often considered synonymous with food intolerances, but the related symptoms aren’t necessarily similar. Reported food sensitivity symptoms can include the following:

• Joint pain
• Fatigue
• Neurological symptoms (brain fog)

How are Food Allergies, Food Intolerances, and Food Sensitivities Diagnosed?

Determining if a person has a food allergy or food intolerance involves a comprehensive evaluation by a healthcare professional. The diagnosis may include the following steps:

• Medical History: The healthcare provider will evaluate your symptoms, when the symptoms occur, and any family history of allergies or intolerances.
• Physical Exam: The provider will examine the skin for signs of an allergic reaction, such as hives or swelling.
• Food Allergy Testing: Allergy blood tests, such as skin-prick tests or IgE blood tests, may be conducted to measure the presence of allergy antibodies to specific foods.
• Elimination Diet: In cases where the specific trigger food is not clear, an elimination diet may be recommended. An elimination diet involves avoiding certain foods and slowly reintroducing them to identify the culprit.

Treatment and Prevention

Treatment for food allergies involves strict avoidance of the trigger food and, in some cases, medication or epinephrine injections for severe allergic reactions. Food intolerances can be managed by avoiding the trigger food and following the recommended diet.

Preventing debilitating reactions to foods involves taking the following precautions:

• Read food labels carefully to avoid accidental ingestion of allergens.
• Learn safe food handling practices to avoid cross-contamination.
• Carry emergency medications, such as epinephrine auto-injectors, in case of a severe allergic reaction.

If you are struggling with uncomfortable reactions to foods, please don’t hesitate to contact the helpful representatives at Allergy Partners to schedule a comprehensive evaluation.

Dr. Campbell from Allergy Partners of Hampton Roads explains the difference between food allergies and food intolerance.

Food Oral Immunotherapy is a breakthrough for those living with food allergies. Children and adults with food allergies make up a large portion of my patients, and the number continues to grow. A recent study showed that 2% of children, or 1.6 million kids, have this life-threatening condition in the United States. As a parent with a child who is allergic to peanuts and tree nuts, this especially hits close to home. It is scary to always wonder if she will eat something while not under my watchful eye that leads to “the big one”. This is true especially now as she enters her teenage years where she is experiencing more freedom and independence.

Currently, there is no Food and Drug Association-approved treatment for food allergies. The American College of Asthma and Immunology recommends strict avoidance and always carrying an Epinephrine auto-injector. This is easier said than done. The list gets longer and longer as I holler to her when she runs out the door: Did you brush your teeth? Do you have your phone, your keys, and your epinephrine auto-injector?

However, there is hope on the horizon. Board-certified Allergists, including myself, have begun to offer Oral Immunotherapy to foods. This involves taking a daily food product. Patients start off with very small quantities, less than one-hundredth of the food. The amount is slowly increased over weeks to months in an allergist’s office. Eventually the patient will reach a maintenance that can vary based on the clinical scenario. Once this dose is reached, the patient will remain on a daily dose of the food product indefinitely. This process desensitizes the patient to the food. Therefore, if the food is accidentally ingested, the patient will be less sensitive to the food and less likely to have a severe reaction. Patients still need to carry their epinephrine auto-injectors and continue to eat the previous offending food on a regular basis.

There is not a cure–yet. But, this offers peace of mind to the child and their parents if and when an accidental ingestion occurs. This significantly improves the quality of life for the patient and their family members.

If you would like to know more about Oral Immunotherapy, please visit our website or call our office to set up an appointment.

By Dr. Elizabeth Majeski
Allergy Partners of Charleston

It can be frightening and scary news when you or your loved one is diagnosed with an egg allergy. You educate yourself about ingredient lists, make sure you know safe versus unsafe foods, and always have your epinephrine injector close by. You become an expert on all things “egg.” You are finally feeling comfortable with handling things, when all of a sudden, IT’S FLU SEASON!

You’ve read that most influenza vaccines are produced by growing influenza virus in embryonated chicken eggs, and therefore contain trace amounts of egg protein. It stands to reason then, that if you have an egg allergy you could have an allergic reaction to the flu vaccine. You ask your friends, your pharmacist, and even your primary care doctor, but nobody seems to give you a straight answer to the burning question: is the flu vaccine safe in people with egg allergies?

Well fear not, there is a correct answer: YES! The influenza vaccine is considered safe for those with any type of egg allergy. But, don’t take my word for it, take it from the CDC:

“People with egg allergies can receive any licensed, recommended age-appropriate influenza (flu) vaccine (IIV, RIV4, or LAIV4) that is otherwise appropriate. People who have a history of severe egg allergy (those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a health care provider who is able to recognize and manage severe allergic reactions.” (www.cdc.gov)

Now this recommendation is not just based on guess work. It is heavily rooted in data from the millions who have previously received the flu vaccine. In a review of published data from 2012, including 4,172 egg-allergic patients (513 of whom reported a history of severe allergic reaction after eating egg), there were no noted occurrences of anaphylaxis following administration of the flu vaccine, though some milder reactions did occur (www.cdc.gov).

Despite the evidence suggesting that egg allergic people can safely receive the flu vaccine, it is not safe for everyone. Those people with a history of severe allergic reaction to any component of the vaccine or after a previous dose are recommended to avoid it.

When you are not sure if you’ve had an allergic reaction to the vaccine, or you are extremely nervous about receiving the vaccine safely (egg allergy or not), Allergy Partners can help. Our board-certified Allergists can counsel you on whether it is safe for you to receive the flu vaccine. When necessary, we can also offer testing to components of the vaccine and in office administration under the direct supervision of the physician to make sure you receive the vaccine safely.

Remember, the flu can be deadly or cause serious harm to you or your loved ones. The CDC recommends that all people 6 months or older receive the influenza vaccine annually. Don’t let fear or misinformation stand in your way. Talk to your local Allergy Partners to make sure you are protected this season!

By Dr. Jonathan Romeo

Allergy Partners of the Triangle

We are excited to share groundbreaking news in the realm of food allergy treatment: the recent approval by the Food and Drug Administration (FDA) of Xolair (Omalizumab) for the management of food allergies. This milestone marks a significant advancement in the field, offering hope and new possibilities for those living with food allergies.

Xolair, initially approved for allergic asthma and chronic idiopathic urticaria (commonly called hives), has now been granted expanded approval to include the treatment of moderate to severe persistent allergic reactions to foods. This decision comes after rigorous clinical trials demonstrating the efficacy and safety of Xolair in reducing the frequency and severity of allergic reactions to specific foods.

This approval heralds a promising shift in treatment options for individuals navigating the daily challenges of food allergies. Traditionally, the primary approach to managing food allergies has been strict avoidance and the use of emergency medications such as epinephrine to counteract severe reactions. While these measures remain crucial, they do not provide a definitive solution for preventing allergic reactions.

Emerging Treatments for Food Allergies

In addition to Xolair, other emerging treatments for food allergies show promise in desensitizing the immune system and reducing allergic reactions. Two notable approaches are food oral immunotherapy (OIT) and food sublingual immunotherapy (SLIT).

• Food oral immunotherapy (OIT) involves gradually exposing patients to small, controlled amounts of their allergen, starting with tiny doses and increasing over time. This process helps the body build up tolerance to the allergen, potentially reducing the severity of allergic reactions.
• Food sublingual immunotherapy (SLIT) works by administering small doses of the allergen under the tongue, training the immune system to become less reactive to the allergen over time.

While these treatments have shown encouraging results in clinical trials, they also come with their own set of considerations and potential risks. Patients considering OIT or SLIT should discuss the pros and cons with their healthcare provider to determine the most suitable treatment approach for their individual needs.

Renewed Hope and Expanded Possibilities for Treating Food Allergies

Xolair, food OIT, and food SLIT represent promising options for individuals with food allergies, offering renewed hope and expanded possibilities for managing this challenging condition. If you have any questions or would like to learn more about Xolair, OIT, SLIT, or any other aspect of food allergy management, please don’t hesitate to reach out to Allergy Partners. Together, we can empower you to make informed decisions and thrive despite food allergies.

As always, we are here to support you in exploring these allergy treatment options and navigating your journey toward better health and well-being. Find an allergist near you.

Being a mom can be challenging sometimes, but being a mom to a milk allergic child can be frightening and frustrating. You asked, and Dr. Catherine Cranford answered a lot of your questions on Cow’s Milk Allergic Children and how to help your child.

Food allergies have been a hot topic in the news over recent years. With the increasing rates of food allergies, it seems that all of us know someone whose life is impacted. While most of the recent news has focused on kids, a recent article by Dr Ruchi Gupta from Northwestern University suggests that rates of food allergies are likely increasing among adults as well.

Fortunately, there has also been a great deal of good news regarding food allergies. Over the last few years, several studies have suggested that early introduction of highly allergenic foods such as peanut and eggs may lead to a lower rate of food allergies later in life. In the past, allergists and pediatricians recommended delaying the introduction of these foods until at least 1 year of age to reduce the risk of developing food allergies. However, the tide has shifted and based on research studies such as the Learning Early About Peanut Allergy (LEAP) trial these recommendations have changed. The LEAP trial demonstrated that for infants at high risk of developing a peanut allergy, introducing regular peanut consumption during infancy lead to a dramatic reduction of peanut allergy at age 5. Based on this and other promising studies, the American Academy of Pediatrics recently published an updated report on the role of early infant diet on the prevention of allergic disease.

According to this report “there is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs and fish, beyond 4 to 6 months prevents atopic disease.” The report goes on to state that “there is now evidence that early introduction of peanut may prevent peanut allergy.” In other words, allergists and pediatricians now believe that adding these foods once an infant reaches 4 to 6 months of age may actually reduce the rate of food allergy. These exciting findings offer hope that we will be able to reverse the trend and actually see lower rates of food allergies in the future.

Changing recommendations and guidelines can be confusing for patients and families. Your local Allergy Partners providers can help you with up to date recommendations about food introduction for your children and discuss any concerns you have about current food allergies.

By Dr. Chris Copenhaver
Allergy Partners of Western North Carolina