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Food allergens: Overview of clinical features and cross-reactivity

Scott H Sicherer, MD, FAAAAI
Section Editor
Robert A Wood, MD
Deputy Editor
Elizabeth TePas, MD, MS


A limited number of foods are responsible for the most significant allergic reactions. These foods/food groups are milk, egg, peanut, soy, nuts from trees, fish, shellfish, and seeds. However, virtually any food can trigger an allergic reaction in some people [1].

This topic will review clinically relevant features of food allergens, including (when known) epidemiology, natural course, practical observations, and cross-reactivity. Other topic reviews discuss molecular aspects of food allergens, evaluation of food allergies, avoidance of food allergens, the natural history of food allergy, and oral allergy syndrome. (See "Molecular features of food allergens" and "Diagnostic evaluation of food allergy" and "Management of food allergy: Avoidance" and "Food allergy in children: Prevalence, natural history, and monitoring for resolution" and "Pathogenesis of oral allergy syndrome (pollen-food allergy syndrome)".)


When a patient has a confirmed allergy to one food, evaluation of related foods may be indicated to determine if these foods are also problematic. However, a "positive" allergy test to a related food may simply represent immunologic cross-reactivity due to the presence of a homologous protein that does not have clinical significance, which is more common than true clinical cross-reactivity [2]. Thus, an individual with an allergy to peanut (a legume) is likely to have "positive" serum immunoglobulin E (IgE) tests or skin prick tests to multiple legumes that are clinically tolerated (see 'Legume cross-reactivity' below). Approximate rates of clinical cross-reactivity are summarized in the figure (figure 1).

Concern about allergy can arise if a related food was never ingested or was not a regular part of the diet and was not recently ingested. In these cases, it may be reasonable to evaluate the patient for allergy to the related food to determine clinical tolerance, depending upon epidemiologic, social, and nutritional consequences and concerns. Further evaluation is generally not needed if a related food is already ingested routinely without reactions.

Tree nuts, fish, and shellfish are more commonly clinically cross-reactive. Caution and possible allergy testing (including oral food challenges) are warranted if ingestion of related foods not already tolerated is being considered.

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Literature review current through: Nov 2017. | This topic last updated: Sep 01, 2017.
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