Food For Thought

*To take the corresponding CDE quiz, visit the College of Emergency Dispatch.*

There are about 33 million Americans¹ avoiding the neighborhood potluck, and it’s not due to social awkwardness or competitive cornhole. The culprit is what creative ingredients lie in the homemade dishes on the checkered tablecloth.

For those with food allergies, the unknown is more than a portion-sized problem; every 10 seconds, a food allergy reaction sends a patient to the emergency room. Delayed recognition or postponed treatment after an accidental exposure has the potential to become deadly.

As a mother of a mischievous six-year-old with a peanut allergy, this means I not only carry epinephrine injectors everywhere, but I carry an extra helping of worry, too.

We live in a world of sunflower butter, homemade treats, and closely examined food labels. Since reports suggest most fatal food allergy reactions are triggered by food consumed outside the home,² we can’t go to the local ice cream shop, but he makes a great date anyway.

One in every 13 children has a food allergy—about two in every U.S. classroom.³ Among children, reports of food allergies have been increasing for decades, up by 50% between 1997 and 2011, and up by 50% again between 2007 and 2021.⁴

This is no small concern for parents sending their kids back to school beyond their supervision, as more than 15% of school-aged children with food allergies have had a reaction at school.

Growing anxiety may be why about 25% of surveyed allergy parents choose to avoid overnight camps, 15% avoid restaurants, and more than 10% avoid childcare settings or playdates at friends’ houses, often turning to homeschool options primarily based on preventing allergen exposure.⁵

These statistics emphasize that food allergies can not only be life threatening but life-limiting as well.
Of course, this is not just a childhood problem; some food allergies are developed later into adulthood.

Surprisingly, one in 10 adults deal with a food allergy, with more than half having experienced a severe reaction.⁶ Some allergies (including peanut, tree nut, fish, and shellfish) are less likely to be outgrown with age.⁷ Other factors include age of onset, severity of reactions, additional allergies, conditions like asthma and eczema, race and sex, and family history.⁸

Unfortunately, the top nine food allergens are found in many share-worthy cuisines and confections: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans, and sesame (added in 2023). Even when these ingredients are not specifically added to a food, trace amounts caused by shared equipment can cause cross-contamination concerns.

Food labels required by the U.S. Food and Drug Administration can only promise so much safety. Advisory labels such as “May contain [allergens]” and “Made in a facility that also processes [allergens]” are voluntary and not yet regulated in the United States, though there are petitions to change that.⁹ Mislabeling can also cause alarm, such as a 2025 New Jersey (USA) recall for Ritz cracker sandwiches marked as “ cheese” flavoring instead of peanut butter.¹⁰

Understanding food allergies
Food allergies trigger the body's immune system to overreact and fight against an otherwise harmless substance, releasing immunoglobulin E (IgE) antibodies into the body. (This reaction is very unlike food intolerance, which primarily creates an uncomfortable digestive issue with difficulty processing certain foods.) Upon subsequent exposures to an allergen, the IgE antibodies identify that food or protein as a threat, causing histamine to be released into the bloodstream.¹¹

The first symptoms of an allergic reaction usually appear within a few minutes up to two hours after exposure. The patient may experience hives, skin or throat swelling, sudden gastrointestinal problems (abdominal discomfort or nausea), or breathing problems (wheezing or coughing).

Severe cases create a life-threatening reaction known as anaphylaxis, which can include vomiting or diarrhea, severe tightening of the airways, color change, dizziness, rapid pulse, drop in blood pressure, and/or loss of consciousness.

Epinephrine administration
Epinephrine, also known as adrenaline, is a hormone produced by the adrenal gland when a perceived danger enacts a “fight-or-flight” or acute stress response. The body may experience rapid heart rate, increased blood flow to the muscles (added strength), pale skin, dilated pupils, increased energy produced by the liver, and deeper breathing.¹²

When administered as a synthetic medication, epinephrine can be used to treat cardiac arrest, septic shock, and asthma, and it is the only medication that can reverse anaphylaxis.

In the case of a severe allergic reaction, Emergency Medical Dispatchers (EMDs) using the Medical Priority Dispatch System^™ (MPDS^®) may refer to Protocol P: Epinephrine (Adrenaline) Auto-Injector Instructions (added in 2015) to guide hesitant callers through the nerve-wracking process of administering an injection.

These medications include EpiPen^®/ EpiPen Jr.^®, Adrenaclick^®, Allerject^®, Emerade^®, Anapen^®/Anapen Jr.^®/Chenpen^®, Auvi-Q^®, Jext^®, and other generic versions. A new FDA-approved nasal spray, neffy^®, has recently been added to the protocol as an equally effective alternative that may be less intimidating to administer.

Emergency medical response
To handle a patient with a severe allergic reaction, the EMD will turn to Protocol 2: Allergies (Reactions)/Envenomations (Stings, Bites). There, the Key Questions address the patient’s responsiveness (alertness), difficulty breathing or swallowing, severity of past allergic reactions, and the availability of epinephrine.

Bryon Schultz, IAED^™ Medical Academics & Standards Expert, explained that EMDs need to recognize five key things when handling anaphylaxis:

1. Food allergies can be challenging to identify because the caller may not know the patient’s condition is related to food. Patients may not initially present severe symptoms. Nearly 98% of allergy patients are conscious and breathing at Case Entry according to the IAED Data Center, but that can change quickly.

2. Do not delay providing epinephrine when needed. The potential side effects (increased blood pressure or heart rate) are so benign for most patients that the risk of anaphylaxis far outweighs any complications, especially for an airway compromise.

3. If available epinephrine isn’t prescribed for the patient, the Protocol P panel “Medicine Not Prescribed for Patient” cautiously evaluates whether severe symptoms indicate its use. This includes when the patient has a dosage not recommended for their body size (adult vs. child). For anaphylaxis, it is better to err on the side of administering what is available.¹³

4. If the epinephrine is expired, a dose that may have lost some of its potency or efficacy is still favorable over no medication.

5. In any case, remember that more than one dose of epinephrine may be required. Protocol P advises the caller to give a second injection after five minutes if symptoms have not improved.

Conclusion
The future is bright for the food allergy community. Patients now have immunotherapy treatments and medications that can reduce their risk of future anaphylaxis. New advancements may introduce implantable powdered epinephrine devices, similar to glucagon devices used in diabetic patients.¹⁴ Also, proposed legislation supports police officers carrying epinephrine, as they commonly arrive first on scene.¹⁵

As this school year begins, I’m heralding the hope that education, preparation, and prevention are the allergy golden rules. I’ll be submitting my son’s epinephrine at the school, encouraging him to wear his medical bracelet, informing teachers and staff, packing his lunch, and teaching him to “ask before you snack” and “tell if you feel unwell.” It's a relief that trained, confident, and calm EMDs can walk me and others through the worst of reactions, if needed. There are still joys and adventures to be had—we’ll just skip the trail mix.

Sources
1. “What Is a Food Allergy?” Food Allergy Research & Education. 2025. foodallergy.org/resources/what-food-allergy (accessed July 26, 2025).

2. “Facts and Statistics.” Food Allergy Research & Education. 2025. foodallergy.org/resources/facts-and-statistics (accessed July 26, 2025).

3. See note 1.

4. See note 2.

5. See note 2.

6. See note 2.

7. Bishop, S. “Likelihood of Child Outgrowing Food Allergy Depends of Type, Severity of Allergy.” Mayo Clinic. 2013; July 26. newsnetwork.mayoclinic.org/discussion/likelihood-of-child-outgrowing-food-allergy-depends-of-type-severity-of-allergy (accessed July 26, 2025).

8. See note 7.

9. “Food Allergies.” U.S. Food and Drug Administration. 2025. fda.gov/food/nutrition-food-labeling-and-critical-foods/food-allergies (accessed July 26, 2025).

10. Bloom, D. “Mondelēz Issues US Recall of RITZ Peanut Butter Cracker Sandwiches Due to Labeling Error.” SnackSafely.com. 2025; July 9. snacksafely.com/2025/07/mondelez-issues-us-recall-of-ritz-peanut-butter-cracker-sandwiches-due-to-labeling-error (accessed July 26, 2025).

11. See note 7.

12. “Epinephrine (Adrenaline).” Cleveland Clinic. my.clevelandclinic.org/health/articles/22611-epinephrine-adrenaline (accessed July 26, 2025).

13. Patterson, B. “Life-Over-Limb.” Journal of Emergency Dispatch. International Academies of Emergency Dispatch. 2022; Feb 9. iaedjournal.org/life-over-limb (accessed July 26, 2025).

14. Bloom, D. “MIT Develops Implantable Device to Deliver Epinephrine in an Emergency.” SnackSafely.com. 2025; July 21. snacksafely.com/2025/07/mit-develops-implantable-device-to-deliver-epinephrine-in-an-emergency/?utmsource=newsletter (accessed July 26, 2025).

15. Bloom, D. “Gio’s Law Would Arm Police Across the US with Epinephrine and Training on How and When to Use It.” SnackSafely.com. 2025; July 8. snacksafely.com/2025/07/gios-law-would-arm-police-across-the-us-with-epinephrine-and-training-on-how-and-when-to-use-it/?utm_source=newsletter (accessed July 26, 2025).