More than 40% of children with food allergies have suffered severe allergen reactions.

Most of the time, it boils down to a lack of education. As an allergist with 30 years of experience, I’ve seen countless parents make the same avoidable mistakes when introducing allergenic foods to their children. 

Here are six of the most common errors and how to avoid them.

1. Giving a Full Dose for a Food Challenge

One of the most frequent mistakes is jumping straight into full therapeutic doses of allergenic foods during food challenges. 

Parents and some doctors think, “Let’s see what happens with a full serving.” This approach is risky and often unnecessary. Instead, you should give tiny amounts of the allergen and then ladder it up gradually.

Most of the time, children will tolerate more of the allergen with this approach.

Introducing peanuts early—between 4 and 11 months—has been shown to significantly reduce the risk of peanut allergy, particularly in high-risk children with eczema or egg allergies. This finding from the groundbreaking LEAP trial underscores the importance of starting small and early with allergenic foods. 

As a practical example, when introducing milk, begin with 1 milliliter (roughly a few drops) and administer it into the child’s mouth using a syringe. If tolerated, gradually increase the dose over several days or weeks. This step-by-step method reduces the likelihood of severe reactions and allows your child’s tolerance to develop safely.

As for what to challenge, here is a quick guide:

• Easier Foods: Peanuts, milk, and baked eggs are typically more manageable in food challenges. Many kids tolerate these well with gradual exposure, and they often outgrow these allergies over time.
• Harder Foods: Sesame seeds, soybeans, and non-baked eggs tend to be more stubborn. These allergens often require more caution and can be difficult to overcome, even with incremental challenges.

2. Not Isolating Foods During Testing

Another common error is testing multiple allergenic foods simultaneously.

Many parents unknowingly introduce combinations—like giving their child a piece of pie that has milk, eggs, peanuts, and more–-and then struggle to identify the culprit if a reaction occurs. There’s simply no way to isolate which allergen is causing it this way.

To find the allergen, focus on one food at a time. 

You can administer single-ingredient options like pureed peas, plain peanut butter, or a small serving of baked egg. If your child has had a prior reaction, consider testing under medical supervision to ensure safety.

To make it as simple and safe as possible, stick to whole foods. Avoid processed or packaged foods with multiple ingredients, as they can obscure what’s really causing the reaction. 

As always, if you’re unsure about a food, consult an allergist. 

3. Avoiding Investigation After an Allergic Reaction

It’s natural for parents to want to play it safe after an allergic reaction, but avoiding further investigation is a missed opportunity.

I’ve seen so many parents go to a restaurant and give their child a small piece of food like pizza, only for the child to experience anaphylaxis. The families will then eliminate entire food groups—like dairy or eggs—without confirming the exact allergen, leading to unnecessarily restricted diets.

This is especially problematic given the widespread misconceptions about food allergies. For example, the true prevalence of cow’s milk allergy (CMA) is less than 1% when confirmed through food challenges, yet caregiver-perceived prevalence can be as high as 10%. Misdiagnoses and over-diagnoses are common, causing families to restrict their child’s diet unnecessarily.

Instead of doing this, consult an allergist to identify the true trigger. 

Testing and detailed food diaries can help pinpoint the specific food responsible. Did your child react to the pizza because of the cheese, the crust, or the toppings? 

With proper investigation, you’ll know for sure and avoid cutting out foods your child might tolerate. This is especially important given that 80% of children outgrow milk or egg allergies by age six. 

Without re-testing, you may never know if your child has developed tolerance, causing them to miss out on essential nutrients and unnecessary lifestyle restrictions.

If your child is among the 20% who don’t outgrow milk intolerance, here are some top substitutes to consider:

• For Regular Milk: Almond milk is a preferred choice due to minimal cross-reactivity with cow’s milk. Walnut milk is another great option, while soy milk is less ideal because of potential cross-reactivity with cow’s milk.
• For Infants: Predigested milk products like Alimentum, Neocate, and EleCare are excellent for infants. These formulas break down milk proteins into smaller molecules, reducing the risk of triggering an allergic reaction.

4. Over-Reliance on Blood Tests

Many parents fixate on blood test results for food allergies, assuming a high IgE (Immunoglobulin E) level guarantees a food allergy. 

Too often I’ve seen doctors do blood panels for food allergies where the patient has a two plus or a four plus reaction to milk, and the patient thinks they’re allergic and needs to avoid it. But in reality, their “milk allergy” is actually asymptomatic hypersensitivity, which means you can have positive tests but no actual reaction when you eat the food. 

Making it worse, false positives for food allergies on blood tests occur 50% to 60% of the time.

The key is to combine test results with clinical history. If your child hasn’t shown any reaction to a food, there’s a chance the positive result is meaningless. 

Work with your allergist to determine whether a food challenge is appropriate.

5. Keeping Allergenic Foods in the Home

If one child has a food allergy, parents often think they can “just keep it away” while still allowing other family members to eat it. 

This is a recipe for disaster. Siblings might share snacks, offer a bite of their allergenic food like a peanut butter cookie, or accidentally contaminate common surfaces like counters or utensils. Plus, if you’re not home to constantly monitor, the chances of them having a severe reaction skyrocket. 

The safer approach is to remove the allergenic food entirely. 

This minimizes accidental exposure and simplifies mealtime for the whole family. For example, if one child is allergic to peanuts, don’t keep peanut butter in the pantry. Choose allergy-safe alternatives like sunflower seed butter instead. 

It’s a small adjustment that can prevent significant harm.

6. Ignoring Older Generations’ Skepticism

Grandparents and older relatives often don’t take food allergies seriously. 

I’ve seen so many severe reactions from a grandparent giving the child an allergenic food like a cookie, thinking that allergies are overblown or that “just a little bit won’t hurt.”

They’re simply not aware of the risks. 

They think that, because food’s natural, a kid shouldn’t be allergic to something that’s a natural food. What they fail to understand is that all allergens are natural. When you’re inhaling the air outside and tree pollen enters your lungs, all of it is natural.

This is why education is so vital.

If you have a loved one who does not take it seriously, then explain the severity of the allergy and provide specific instructions for care. Make it clear that even small amounts of the allergen can cause severe reactions.

For example, if your child is allergic to eggs, let your parents know that even a trace amount in a cookie could cause anaphylaxis. Offer safe alternatives they can use instead, like egg-free baked goods or allergy-safe snacks.

How to Avoid These Mistakes

Parenting a child with food allergies can be overwhelming, but avoiding these six mistakes makes it much more manageable. 

Here’s how to get started:

1. Start Small: Introduce allergenic foods gradually, beginning with tiny doses and increasing over time.
2. Keep It Simple: Isolate foods during testing to pinpoint the exact allergen.
3. Stay Curious: Investigate any allergic reaction with the help of an allergist to avoid unnecessary food restrictions.
4. Think Beyond Tests: Combine blood test results with real-life observations and allergist guidance.
5. Create a Safe Home Environment: Eliminate allergenic foods if one child is allergic to reduce risks for the entire family.
6. Educate Family Members: Set clear boundaries with older relatives to prevent accidental exposure.

By taking these steps, you’ll not only protect your child but also build confidence in managing their food allergies effectively. 

And if you have questions about food allergies or need expert care, reach out to me here.