New sensitivities are increasing among adults. Here's how to stay in the clear.
Credit: Illustration: Bee Johnson

Jacqueline Church was nibbling from a tin of nuts when she experienced her first allergic reaction seven years ago. Church, a chef/consultant who trains restaurant staffs to serve patrons with food allergies, recognized the symptoms of anaphylaxis, a severe response to an allergen, but couldn't quite believe it. "It was something I'd been eating all my life," she says. She's just one of many adults surprised by a new food allergy.

Adult-onset food allergies are increasingly common, says Jim Baker, MD, CEO and chief medical officer of Food Allergy Research & Education (FARE). But when Baker first started practicing 35 years ago, "it was almost unheard for an adult to develop a food allergy," he says. An estimated 15 million Americans have food allergies, according to FARE, and at least 15% of them developed those allergies as adults.

No one really knows why allergies are on the rise. The "hygiene hypothesis" is one theory: In our hyper-sanitary environment, we're not exposed to germs, which makes our immune systems overly sensitive. Another is that food is cultivated and processed differently than it was 30 years ago, and our bodies may process it differently as well. A better understanding of food allergy symptoms, along with more testing, also accounts for rising numbers.

While a reaction to a food allergen can be severe—think shortness of breath, tightening of the throat—it can also but subtle and easily mistaken for something else. "It's your immune system fighting food as if it's an enemy," says Vandana Sheth, RD, a dietician specializing in food allergies. Adding to the confusion, systems of food intolerance often mimic a true allergy. Unlike with an allergy, however, you may be able to eat small amounts of offending foods.

Diagnosing a food allergy involves skin or blood tests, but even those have up to 60% false-positive results. "You really need to do a food challenge to confirm an allergy," says Baker. That's a test in which you consume the suspected food in the safety of a doctor's office. Sounds scary, but when it comes to diagnosing a food allergy, it's the gold standard, says Baker. So if you're experiencing an itchy nose or upset stomach when you eat, see your doctor. Those mild systems can morph into worse, even life-threatening reactions later, Baker warns.

7 Stay-Safe Steps When You Eat Out

Dining out with a food allergy can be dicey. Here's how to take control.

Choose a quiet time. "The kitchen will have a much easier time making accommodations when they're not in the heat of a dinner rush," says Church.

Call ahead. Let the restaurant know about your allergy when you make the reservation. Also list that info in your profile for online reservation services like OpenTable.

Tell them again when you arrive. That includes the host, manager, and server. Show the server FARE's Food Allergy Alert Chef Card, which you can customize and download at Ask them to share it with the kitchen staff.

Order wisely. Focusing on dishes that don't require many changes helps minimize errors.

Confirm the dish when it arrives at the table. The server should announce the special order when delivering it.

Be consistent. Follow these steps every time you eat out, even where you're a regular. New staff may not be familiar  with procedures to serve patrons with allergies.

Be prepared in case of a reaction. Mistakes can happen. Make sure you carry an epinephrine injector, such as an EpiPen, at all times.