Early Exposure to Peanuts Can Help Reduce the Risk of Developing Allergies in Children

Updated on Dec 2, 2025 | Allergy, Featured, Research

Over the past decades, doctors and researchers have learned a lot about food allergies, conducting many studies that have helped us get closer to understanding why such allergies might occur and, potentially, preventing them from developing.

The current understanding is that exposing young children to peanut protein may reduce the likelihood that they develop peanut allergies as they grow up. The National Institute of Allergy and Infectious Diseases (NIAID) issued guidelines recommending early introduction of peanut-containing foods to infants in 2017.

“Over the past two to three decades, we have learned a lot, and allergists and pediatricians have changed their thinking and recommendations as new evidence and studies point us one way or another,” says Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital, who was also involved in the development of the NIAID 2017 guidelines.

How might peanut allergies—or food allergies in general—develop in people, and how might introducing peanuts at a young age help reduce this allergy risk? How can parents safely introduce peanut products to their young children? Dr. Sicherer explains the science and research behind this topic.

Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute, and Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

Do we know what causes peanut—or food—allergies in general?
There are many ways to answer this question, but to answer broadly, it boils down to two things: environment and genetics.

Environment can include diet, the way we live, where we live, what the child and household are doing. Is there a dog in the house? How are we using antibiotics and soaps? Was the baby born by cesarian section? There is evidence that seems to link higher rates of allergies to babies born by C-section. The list could go on and on.

The genetics side has also been extensively studied. We had done studies at Mount Sinai on the role genetics might play in peanut allergies, comparing identical and fraternal twins, and found that genetics has a lot to do with it. We found a lot of heritability of allergies, where having a family history of it is also a risk factor for the baby.

Has the rate of peanut allergies in children increased over time?
Our institute at Mount Sinai looked at this rate over an 11-year period. We started in 1997, where we did a random survey of households across the United States, and asked about children and adults having peanut allergies. We did that same survey in 2002 and 2008 as well.

In 1997, we found the reported rate for children with a peanut allergy to be 0.4 percent, or1 in 250 children. In adults, that rate was 0.7 percent, or 1 in 150 adults. In 2002, that rate for children doubled to 0.8 percent, or 1 in 125 children, and the rate for adults was roughly the same, at 0.6 percent.

In 2008, we did the survey again, and I was shocked by the number for children, which was 1.4 percent, or 1 in 70 children. That’s almost a tripling from 1997, while the rate for adults in 2008 remained the same.

At first, I wondered if there was an issue with our survey. But it should have been accurate because our method was the same across the years. I was convinced when our 2008 findings were matched with studies coming out of Australia, Canada, and England at that time, which were reporting prevalence rates of more than 1 percent for children as well. So it did seem there was a real increase between 1997 and 2008.

What might have caused this increase?
One way to think about this phenomenon would be to think first about the mechanism behind allergies, which is the immune system. Our immune system has evolved over thousands of years and various exposures to the environment to fight off germs and pathogens. It has a tough job of destroying these dangerous invaders while having to recognize and smartly ignore innocent proteins, like those in foods, or types of bacteria that are helpful to our bodies.

What if the ground rules changed quickly, and the immune system was faced with relatively sudden changes that made it harder to adapt and attack the right potential dangers entering our body?

The “hygiene hypothesis” posits that our modern, industrialized society could be a cause for the increased allergy rates. Exposure to fewer or different germs, while making us healthy in some ways, could result in the immune system going out of balance and attacking things it should be ignoring, like allergens including pollens, animal dander, and foods. Add to that the many other changes in our modern world, we have a perfect storm for trouble.

Furthermore, back in the 1990s and 2000s, the prevailing understanding—based on early studies—was for mothers, if they had babies who were at high risk of developing allergy, to avoid allergens during pregnancy and breastfeeding. They were also recommended to avoid feeding babies cow milk until age one, eggs until age two, and fish and nuts until age three—these were from the American Academy of Pediatrics (AAP) in the year 2000.

By 2008, there were new studies showing that delayed introduction of allergenic foods might increase the risk of developing allergies. Around that time, I joined the AAP committee to rescind the previous recommendations.

What studies support early introduction of peanuts for reducing allergy risk?
A notable study started when Gideon Lack, MD, MSc, a professor of pediatric allergy at King’s College London, observed that in Israel, infants were often fed a peanut butter snack, Bamba, and that diagnoses of peanut allergies there were low. He conducted a study, published in Journal of Allergy and Clinical Immunology in 2008, that found that Israeli infants aged 8 to 14 months consumed a monthly median of 7.1 grams of peanut protein, and had a prevalence of peanut allergy of 0.17 percent. In the UK, the same age group consumed a monthly median of 0 grams of peanut protein, and the peanut allergy prevalence was 1.85 percent.

This prompted a landmark clinical trial, substantially funded by NIAID, called the Learning Early About Peanut (LEAP) study. The study assessed how infants ages 4 months to 11 months old with eczema and/or egg allergy—and thus at high risk for developing peanut allergies—would fare if fed peanut snacks until 60 months of age, compared with a group that avoided peanut products. The results, published in The New England Journal of Medicine in 2015, found that the prevalence of peanut allergies among those following the advice was 17.3 percent in the avoidance group, whereas the consumption group’s prevalence was 0.3 percent.

What do medical professionals and organizations recommend now?
In 2008, NIAID established a committee—which Hugh Sampson, MD, the Kurt Hirschhorn, M.D./The Children’s Center Foundation Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, was part of—to develop guidelines for the diagnosis and management of food allergies. At the time, the committee, like the AAP, didn’t make any active recommendations regarding early introduction of allergenic food, other than not delaying them in a set of guidelines in 2010.

When the LEAP study results came out, NIAID updated its guidelines in 2017—Dr. Sampson and I were authors—this time encouraging early peanut introduction, and with instructions about how to do it. There’s a resource called Appendix D that describes how to get peanuts safely into the diet, because peanuts and peanut butter can be a choking hazard for babies. Professional medical organizations, including the AAP and the American Academy of Family Physicians, have since adopted similar recommendations on the early introduction of peanuts. Additional guidelines extrapolate the advice to other common allergens—like milk, egg, and tree nuts—for them to be included in the diet in infant-safe forms on a regular basis, essentially treating solid foods as equivalent whether they are common allergens or not.

How can I begin introducing peanuts early for my child, safely?
If you’re nervous or worried, it’s helpful to talk to your pediatrician. They can walk you through ways of smoothing out peanut products into water, pureed fruits, or vegetables to give them safely. They’ll also be able to let you know how often and how much to feed your baby, as it does require a routine diet for it to confer a protective effect.

The bottom line is: If your baby is otherwise healthy and hasn’t had any problems with food allergies, typical food allergens can be added to a diverse diet, just like any other food in its safe form.

However, if your baby is already showing signs of allergy or problems with various foods, absolutely talk to your pediatrician, who may work with an allergist to fine-tune a path forward. The exciting thing is we do have treatments for food allergy now, and there are many great things happening in the field. Talking to your doctor can help your child lead a healthy, fulfilling life without the overhanging fear of triggering food allergies.

Appendix D instructions for home feeding of peanut protein for a low-risk infant

General instructions Feeding instructions
1. Feed your infant only when they are healthy; do not feed if they have a cold, are vomiting, or have diarrhea or other illnesses. 1. Prepare a full portion of the peanut-containing food.
2. Give the first peanut feeding at home, not at a daycare center or restaurant. 2. Offer your infant a small part of the peanut serving on the tip of the spoon.
3. Make sure at least one adult is able to pay full attention to the infant, without distractions. 3. Wait 10 minutes.
4. Make sure to spend at least two hours with the infant after feeding, to watch for any signs of allergic reaction. 4. If there’s no allergic reaction after the small taste, then slowly give the remainder of the peanut-containing food at the infant’s usual eating speed.

Stories Behind the Science: A New Way Forward With Food Allergies

Updated on Aug 15, 2025 | Allergy, Featured, Research

Stories Behind the Science: A New Way Forward With Food Allergies

The Esteves family on vacation, from left to right: Craig, Violet, Holly, Jackson, and Sailor Esteves.

Eating out for Jackson Esteves, 10, from Bayville, Long Island, had always been a gamble for him and his parents. With severe food allergies of various kinds—peanuts, dairy, sesame seeds, to name a few—having a meal in a restaurant, or even at a friend’s house, came with challenges and stress.

When Jackson’s parents were told that it could be possible to address at least his peanut allergy and make it less severe, they were ecstatic. “When the opportunity to participate in this trial was presented to us, we jumped,” said Holly Esteves, Jackson’s mother.

Jackson was enrolled into a study, named CAFETERIA, which explored whether it is possible for people who are allergic to peanuts—but are able to take small amounts—to be desensitized to the allergen through a form of immunotherapy that gradually exposes the individuals to peanut butter.

The study, funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, found that participants who received allergist-supervised treatment with peanut butter were able to tolerate more peanut butter than before, without any allergic reactions.

“Our study results suggest a safe, inexpensive, and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” said Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital.

The findings, published in NEJM Evidence, suggest multiple ways forward for the research team.

“There are still many things we need to know to really broaden the impact of this research,” said Dr. Sicherer, who is also Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute, and Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

“Can we apply this to other allergens? How do we know what the right threshold of tolerance should be? How do we identify whether patients are right for this kind of treatment? The road ahead is an exciting one,” said Dr. Sicherer.

Read below to learn more about how the CAFETERIA study helped Jackson live a fuller life, the next steps for researchers, and what it takes to get there.

A constant state
of hypervigilance

Jackson and Holly Esteves.

Jackson had lived with an allergy diagnosis pretty much since birth.

“It is a constant in our lives. I live with a seriousness that I used to be able to escape, but eventually, being in a perpetual state of high alert takes its toll,” said Ms. Esteves. Every day, several times a day, she worries that her son will encounter an allergic reaction. “I often feel worn down and tired from the worry, but I remember to slow down, breathe, and find gratitude in the little things.”

Over time, the Esteves family learned to adjust to a “never normal.”  “It’s not necessarily easier, it is just what we’re accustomed to,” said Ms. Esteves.

That means that when Jackson goes to school and camp, he carries his own lunch and safe snacks. Going to a friend’s birthday party? He has to bring his own meal and cupcake.

“When we travel, we also need a kitchen accommodation to prepare food,” said Ms. Esteves. “I’ve learned how to order in restaurants, how to engage in constructive conversations with school and camp staff, and really how to advocate for my son always.”

The CAFETERIA study kicked off in August 2019, and Jackson was one of 73 participants in the trial. Participants were randomly and equally assigned to either the ingestion group—starting with one-eighth of a teaspoon of peanut butter, and eventually increasing to one tablespoon—or avoiding peanut products entirely.

After 18 months, both groups were tested on how much peanut they could eat without an allergic reaction. Among those who completed the study, all 32 children in the ingestion group could tolerate two and a half tablespoons of peanut butter. Only 3 of 30 children in the avoidance group could tolerate that amount.

Jackson, who was in the ingestion group, had no issues with the escalation doses. He is currently working with Dr. Sicherer to address his other allergies.

“Today, Jackson is safely eating peanut butter. Not only were we able to open up his diet, but we forged a bond with the Mount Sinai community who deeply understand the need for innovation, treatment, and prevention of food allergy disease,” said Ms. Esteves.

Figure A of this diagram shows the percentage of each respective group that achieved desensitization to peanut product at the end of the trial. Figure B shows the percentage of each respective group that retained that desensitization after being subject to peanut product avoidance. Figure C shows the total dose of peanut product individuals in each respective group was able to tolerate from baseline to the end of the trial. Figure D shows the size of wheals of participants in each group when subject to a skin prick test, from baseline to the end of the trial.

“I am incredibly grateful for our trial experience, for the wonderful professionals who took care of us, and for the research that I hope will help thousands, if not millions, of people,” she said.

And the CAFETERIA study didn’t offer just Jackson a new lease on life—it took a weight off Ms. Esteves too. “I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command,” she said.

“I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command.” —Holly Esteves, Jackson’s mother.

What it takes
to get to the next stage

Dr. Sicherer at the the Elliot and Roslyn Jaffe Food Allergy Institute.

With the CAFETERIA study concluded, Dr. Sicherer and his team are already contemplating next steps. The biggest question: can this method of immunotherapy be replicated in other food allergies?

A clear, direct way to test that would be a formal multicenter study in different types of food, said Dr. Sicherer. “That would be a huge undertaking—a clinical trial like that would require, perhaps, in the ballpark of $15 million, and years to run.”

But should the team’s hypothesis prove right, it could change how allergists can treat and advise children with high-threshold food allergies.

“A decade ago, allergists used to tell patients to completely avoid a food they were allergic to, even if they had a threshold before getting a reaction,” said Dr. Sicherer. “With the findings from the CAFETERIA study, it could be a future where patients could work with their doctors to start small, and eventually overcome their allergy.”

Specialists in the field have indicated interest in this new possibility, noted Dr. Sicherer. In a survey his team did, many allergists said they were open to recommending that patients with high-threshold allergies attempt a food escalation challenge.

Basic science
matters too

Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, has a lab focused on studying systems biology in allergy and asthma.

Even as the team is applying for grants from the National Institutes of Health (NIH) to fund that trial, researchers at Mount Sinai are working on parallel questions that the CAFETERIA study couldn’t address.

“Pharmaceutical companies have long focused on developing options for people who have low-threshold food allergies—meaning they react even to the slightest amount,” said Dr. Sicherer. “But not all patients with allergies are the same. What if they have higher thresholds, then how do we know which strategy—be it our protocol from the CAFETERIA study, or the commercial drugs—is best suited for them?”

There are two Food and Drug Administration-approved treatments for food allergies: Palforzia, peanut allergen powder, used as ingested immunotherapy for children with confirmed peanut allergies, and Xolair® (omalizumab), an injected antibody therapy used to reduce the risk of allergic reactions in case of an accidental exposure.

“Furthermore, we need a better way of identifying allergy thresholds in patients other than by feeding patients increasing amounts of a food to see when symptoms start,” said Dr. Sicherer.

A key to answering those questions: biomarkers. Researchers at the Elliot and Roslyn Jaffe Food Allergy Institute and elsewhere in the Icahn School of Medicine at Mount Sinai are tackling biomarkers at all levels, from basic science to human models. Some ongoing allergy research at labs at Mount Sinai include:

  • Hugh Sampson, MD, Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, focusing on the humoral immune system and the proteins it makes that cause allergic reactions.
  • Maria Curotto de Lafaille, PhD, working on B cells and food allergies.
  • Erik Wambre, PhD, Director of Technology and Business Development at the Human Immune Monitoring Center at Mount Sinai, working on T cell responses in food allergies.
  • Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, studying systems biology in allergy and asthma, including the microbiome.

Dr. Sicherer (left) with Hugh Sampson, MD (right), Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, whose lab focuses on the humoral immune system and the proteins it makes that cause allergic reactions.

These teams are firing on all cylinders to gather support. “Even philanthropic support can lead to something greater,” said Dr. Sicherer. “After all, that’s how the CAFETERIA study got started.”

To get NIH funding, one needs preliminary data as part of the application. In 2015, the Elliot and Roslyn Jaffe Food Allergy Institute launched the Food Allergy Treatment and Research Center, which is supported by philanthropy. The research center had a high success rate with a pilot study that was the precursor of the CAFETERIA study. With those findings, Dr. Sicherer applied for NIH funding in 2017, and was awarded the grant in 2018.

In a way, the journey of this research has similarities with the treatment protocol, where patients escalate from one dose to the next, eventually getting their desired outcome, noted Dr. Sicherer.

“In this case, it began with small philanthropic support, leading to a small study and idea, which then led to the CAFETERIA study,” he said. “I can’t wait to see where it goes next.”

How Can I Find Relief From Fall Allergies?

Updated on Sep 23, 2024 | Allergy, Your Health

Many people enjoy the cool weather and colorful foliage autumn brings. But for those with fall allergies, the season also comes with watery eyes, itchy throats, and stuffy noses. Fortunately, there are ways to alleviate these symptoms and appreciate the change of season.

Rachel L. Miller, MD

In this Q&A, Rachel L. Miller, MD, Chief, Division of Clinical Immunology, and The Dr. David and Dorothy Merksamer Professor of Medicine (Allergy and Immunology), Icahn School of Medicine at Mount Sinai, explains what could be triggering your fall allergies and how to treat them.

What causes fall allergies?

The most common causes are weed pollens, especially ragweed, and outdoor molds. Ragweed is a very robust urban weed that is common in the New York City area—it grows in Central Park, along roadsides, and in sidewalk cracks, starting middle to late August through the fall. Outdoor molds, also prevalent during this time, are produced by decaying leaves and other organic matter.

How can I know if my symptoms are from fall allergies or non-allergies such as COVID-19 or a cold?

Allergies are more likely to trigger symptoms such as a stuffy nose, itchy throat, and teary eyes. If your throat is actually painful or you have a fever, that is more likely to be a virus. A cough can be caused by either.

What are the most effective over-the-counter treatments for fall allergies?

The first line of therapy is nasal steroids. Some effective over-the-counter nasal steroid sprays include:

  • Fluticasone (Flonase®)
  • Budesonide (Rhinocort®)
  • Triamcinolone (Nasacort® Allergy24HR)

These work by reducing inflammation in your nasal passages that trigger symptoms such as a runny nose.

Antihistamines also can be helpful to alleviate allergic symptoms like eye irritation and sneezing. Over-the-counter antihistamines include:

  • Oral treatments such as cetirizine (Zyrtec®) and loratadine (Claritin® and Alavert®)
  • Nasal medications such as azelastine (Astepro®)
  • Eye drop medications also with azelastine (Optivar®), ketotifen (Alaway® and Zaditor®), and olopatadine (Pataday®)

Higher strength treatments are available with prescription. An allergist can determine which options are best for your symptoms. You can also use over-the-counter sinus rinses, such as neti pots (NeilMed® and SinuCleanse®) and saline solution sprays, to cleanse your nasal passages of allergens and other particulates several times per week. Be sure to use distilled or sterilized water.

What medical interventions can reduce my symptoms?

The first step to seeking any allergy treatment is to schedule an appointment with an allergist. We can provide tests to determine if you have ragweed, mold, or other allergies. Based on the results, we may recommend certain allergy shots or prescribe daily sublinguals (under-the-tongue tablets). The latter is effective for treating ragweed allergies. For the sublingual tablet to be effective, you need to start the medication a few months in advance of allergy season and continue it during the season.

What else can I do?

In general, you want to reduce the amount of allergens you come in direct contact with. When you are outside, wear a head covering and sunglasses, so the pollen and mold spores don’t get in your hair and eyes. Take your shoes off when you are get home so you’re not tracking the allergens inside. Keep windows closed, and use an air purifier to reduce pollen and other allergens in your home. Shower and shampoo your hair before bed to remove allergens from your body and pillow.

Schedule an appointment with a Mount Sinai allergist.

Five Common Questions About Seasonal Allergies Answered

Apr 18, 2023 | Allergy, Your Health


If you find yourself sneezing and wheezing each spring, then you probably have seasonal allergies. And you’re not alone.  About one in four adults, and about one in five children have these allergies, according to the Centers for Disease Control and Prevention.

In this Q&A, Rachel Miller, MD, FAAAAI, System Chief of the Division of Clinical Immunology, answers five of the most frequently asked questions about seasonal allergies. Dr. Miller is also Dr. David and Dorothy Merksamer Professor of Medicine (Allergy and Immunology), and Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, where her research focuses on the causes of asthma.

What are the symptoms of seasonal allergies?

Sometimes commonly known as hay fever, allergies can affect the nose and eyes and cause congestion and sneezing, eye itchiness, sore throat, and fatigue.  The symptoms can be triggered during certain seasons by pollens, such as those from trees during the spring and those from ragweed during the fall.  Symptoms may be unrelated to seasons if triggered by exposure to dust or animals that emit allergens year round. Some people with allergies develop allergic asthma, where the inflammation is focused in the lower airways.  This can manifest as shortness of breath or wheeze.

Who is prone to having environmental allergies?

Allergic rhinitis, whether seasonal or nonseasonal, occur in people who are genetically predisposed but also re-exposed to triggers in the environment.  The symptoms can be worsened by other factors such as stress, air pollution and smoking.

What is the best way to control environmental allergies?

There is no cure for allergies. But you can manage allergies with prevention and treatment. The best way to control allergic rhinitis is to first identify the triggers. They differ for different people.  This can be assessed by visiting an allergist who could perform skin or blood tests after taking a careful history.  If tree pollen, for example, is identified as a trigger, then wearing hats, sunglasses outdoors and removing shoes and showering upon return indoors, can minimize exposure.  If dust, then avoiding sweeping and instead mopping or vacuuming can minimize exposure. A second step is treating with medicines.  We have many medicines now to treat this.  These may be nose sprays, pills, or eye medications.  They are usually well tolerated.  If someone cannot tolerate the medicines or has persistent symptoms, then allergen immunotherapy either through injections, known as allergy shots, or medicine under the tongue, can be considered.

Have questions about kids and allergies? Click here for more information on pediatric allergy and immunology at Mount Sinai.

What kinds of medication can I take to lesson my symptoms?

Two of the main types of medications used to treat allergies are antihistamines and steroids. These medications are available over the counter in the form of pills, nasal sprays, eye drops, and by prescription. Here are some suggestions:

  • Look for products containing a nondrowsy antihistamine if you suffer from sneezing or a runny nose.
  • A steroid nasal spray can be used on its own or in conjunction with an antihistamine nasal spray to quickly clear the nasal passages. A saline rinse prior to using a nasal spray may help wash away pollen and ensure better penetration of the medication.
  • Itchy, watery eyes can be treated by trying artificial tears to wash away the offending pollen or antihistamine eye drops can be prescribed.

When should I consult a physician about my seasonal allergies?

Environmental allergies can occur at any time in life and vary in occurrence and severity. If your symptoms are not easily managed or well-understood, you can consult with an allergist/immunologist. Symptomatic treatment in combination with prescribed medications can successfully treat most situations.  An allergist/immunologist can conduct skin testing to see what specific substances you are allergic to.  If so, arrangements can be made for you to receive allergy injections that can help desensitize you to the offending allergens.  However, this takes time and does not afford immediate relief of symptoms.

Learn more about Allergy and Immunology at Mount Sinai
Book an appointment

Food Intolerance or Food Allergy? How to Spot the Symptoms and Get Help

Updated on Mar 23, 2023 | Allergy, Gastroenterology, Your Health

Bloating, diarrhea, vomiting—these are just some of the unpleasant symptoms that food allergies and intolerances can trigger.

It’s normal to experience stomach issues from time to time. But if you find yourself experiencing them on a regular basis, you may have developed a food intolerance or a food allergy.

You can still enjoy a healthy, balanced diet. But if you think you have a food intolerance or allergy, you should not try to diagnose it yourself and should talk with a medical provider. Food allergies and intolerances can be difficult to identify, and trying to resolve them on your own may lead you to eliminate foods from your diet unnecessarily.

Laura Manning, MPH, RDN, CDN

In this Q&A, Laura Manning, MPH, RDN, CDN, a registered dietitian at the Inflammatory Bowel Disease Center in The Mount Sinai Hospital, explains the differences between food intolerances and allergies, how to identify the symptoms, and how to seek help.

What are food allergies?

When someone has an immune response and produces an allergy antibody against a certain food, they have a food allergy. The most common food allergies are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans, which are behind a majority of food allergies in the United States, according to the Food and Drug Administration. Allergic reactions typically occur within minutes, or up to two hours after ingestion.

What are the symptoms of food allergies?

An allergic reaction occurs every time you eat a food you are allergic to. Common symptoms include coughing, wheezing, itching, lip tingling, rashes, mouth swelling, hives, throwing up, and breathing difficulties. In severe cases, food allergies can cause people to go into shock and can be life threatening. You can experience changes in blood pressure and narrowing of your airways, which can cause difficulty breathing or vomiting.

What are food intolerances?

A food intolerance may happen when you lack enzymes responsible for digesting a certain food or food group. A common example is lactose intolerance, in which a person lacks a key enzyme for digesting lactose, a sugar found in milk. Other common examples of foods that may be poorly tolerated are beans, garlic, mushrooms, onions, and watermelon. These are foods that are high in FODMAPS, or fermentable carbohydrates, including lactose, fructose, fructans, galacto-oligosaccharides, and polyols.  These can rapidly ferment during digestion causing gas, bloating, diarrhea, and constipation when consumed in high amounts. Food intolerances typically develop in the gastrointestinal tract or the digestive system, and can sometimes be triggered by stomach infections. Certain gastrointestinal conditions, such as irritable bowel syndrome (IBS), can make someone more susceptible to FODMAP intolerances. Because FODMAPs are in a wide array of foods, it is important to seek help from a medical provider and trained dietitian to identify the foods causing the problem without completely eliminating them from a healthy diet.

What are the symptoms of food intolerances?

When you eat foods your body cannot digest, you will experience discomfort, including gas and bloating, and may also experience diarrhea, constipation, reflux, and gas.

What is the difference between food intolerances and food allergies?

Unlike food allergies, food intolerances do not involve the immune system, do not cause allergic reactions, and are not life threatening. People with food intolerances can usually have small amounts of these foods without a reaction, whereas those with allergies cannot. Those with food intolerances may even be able to acclimate themselves to these foods by eating small amounts over time, whereas those with food allergies cannot have even the smallest amount without a reaction. However, some food allergies may change or go away on their own with time, especially after adolescence. If you have a known food allergy, an allergist can help you safely retrial the foods you are allergic to.

How are food allergies diagnosed and treated?

A skin prick test, typically on the upper back or forearm, or blood test can identify food allergies. Because food allergies cannot be eliminated, you will need to avoid eating foods that trigger your allergies, including foods that have been manufactured in factories where those foods are also processed (a warning should be displayed on food labels). Working closely with a board certified allergist will help determine what your reactions are to certain foods and best treatments. You can schedule an appointment at the Elliot and Roslyn Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai. You can also find qualified food allergists nationwide through The American College of Allergy, Asthma & Immunology.

How are food intolerances diagnosed and treated? Can I use a food sensitivity test?

Unlike food allergies, there are no official tests for food intolerances, which makes them more difficult to diagnose. While food sensitivity tests are available and popular, they are not FDA-approved, are unreliable, and frequently lead people to eliminate foods unnecessarily, which can lead to health issues. If you have an intolerance triggered by a FODMAP, going on a supervised food elimination diet, or low FODMAP diet, can help you identify the foods behind the intolerance. This diet involves eliminating high FODMAP foods and then slowly reintroducing them to identify the triggers. To avoid malnutrition, you should only go on this diet with guidance from a gastroenterologist and a trained registered dietitian. These experts will guide you through the process of identifying foods you are intolerant to and help you modify your diet in the healthiest way possible.

Contact the Elliot and Roslyn Jaffe Food Allergy Institute at Icahn Mount Sinai
Find a gastroenterologist at Mount Sinai
Find a registered nutritionist through Clinical Nutrition Department at The Mount Sinai Hospital

How Can I Tell the Difference Between Seasonal Allergies and COVID-19?

Updated on Jun 30, 2022 | Allergy, COVID-19, Your Health

Today, every sniffle, every cough, and every sneeze are a cause for concern. “Do I have COVID-19?” races through our minds. Madeleine R. Schaberg, MD, Director of Rhinology and Endoscopic Surgery, Mount Sinai Downtown, helps you tell the difference between allergies and COVID-19.

How do the symptoms of seasonal allergies differ from COVID-19?

The main symptoms of allergic rhinitis or seasonal allergies are itchy, watery eyes, runny nose, nasal congestion, and sneezing, while the symptoms of COVID-19 are fever, cough, body aches, sore throat, and shortness of breath. Many symptomatic patients with COVID-19 will have a fever which, in an adult, is a temperature above 99°F.

Other symptoms of seasonal allergies include post-nasal drip, facial pressure and sinus headaches, and mild fatigue. We generally do not see a significant amount of coughing with seasonal allergies, except in patients with significant post-nasal drip or allergy associated asthma. Sneezing is generally a prominent feature of seasonal allergies, but it has not been reported with COVID-19, although it may happen occasionally.

In general, the key differentiating factors between COVID-19 and allergies are fever and body aches (malaise). Typically, you do not see either symptom in allergy sufferers. While you may see some mild fatigue with allergies, the fatigue we are seeing with COVID-19 is more extreme.

Are there other symptoms that may indicate COVID-19?

Yes, in addition to cough and fever, many patients will experience a loss of smell (anosmia). We don’t typically see a loss of smell with seasonal allergies, unless patients have significant congestion of the nasal passages or have polyps blocking their nasal passages. The loss of smell that is associated with COVID-19 is thought to be due to direct damage to the olfactory nerve and specialized olfactory neuroepithelium.

It’s also worth noting that, for most people, COVID-19 is an acute illness. Patients will develop symptoms between 2 to 14 days after being exposed to the virus. Those symptoms will then last 10 to 14 days. Although symptoms may differ from person to person, they will appear in most people within the 14-day exposure window. This is true whether you have a moderate case or a severe case.

Allergies are more of a chronic issue. They will generally manifest as mild symptoms and last for the allergy season, which is typically from April to mid-June.  Compared to COVID-19, seasonal allergies, as well as allergies that occur perennially, have a much longer time course. In addition, patients will often be familiar with their typical seasonal allergy symptoms, as they often will be similar each spring.

What is the treatment for allergies?

For allergies, the first line of treatment is over-the-counter antihistamines. The main inflammatory mediator of seasonal allergies is histamine. This would include such medications as, cetirizine, loratadine, fexofenadine, and levocetirizine. There are also many over-the-counter steroid nasal sprays, which are extremely effective for allergy relief, such as budesonide, fluticasone, and triamcinolone.

If patients don’t get relief with over-the-counter medication, then an appointment with a rhinologist would be appropriate to explore possible prescription medication.

There are many prescription medications that can be extremely helpful.

I’m unsure if I am suffering from allergies or COVID-19. What should I do?

If you are experiencing mild symptoms that you are concerned may be COVID-19, there are a number of testing options available.

In-person testing is available at all Mount Sinai Urgent Care locations for walk-in or scheduled appointment.

You can also have your symptoms assessed virtually throughout Mount Sinai Urgent Care. Physicians are available for online consultations, video calls, and via text from your mobile device. Additionally, you can contact your Mount Sinai primary care physician or use Mount Sinai’s Express Online Consult Click4Care to receive virtual assessment of your symptoms.

Make an appointment with Dr. Schaberg
Read more from Mount Sinai about COVID-19

Pin It on Pinterest