Key points
- A food allergy is when the body overreacts to an edible substance that is usually harmless.
- Food allergies are common in children. They are mainly caused by eating or drinking an allergen, not by touching it.
- Avoiding triggers is the best way to manage food allergies.
- Most food allergic reactions are mild, and you can manage them with antihistamine medicine.
- Anaphylaxis is the most serious type of allergic reaction; it is a life-threatening emergency.
- Children with food anaphylaxis should always carry their adrenaline device and their Action Plan for Anaphylaxis.
- If your child is having an anaphylactic reaction, you should lie them flat or sit them up, inject them with adrenaline and call an ambulance (000) immediately.
What is a food allergy?
A food allergy is when the body overreacts to something edible that is usually harmless. Allergic
reactions happen because the immune system thinks the food – known as an allergen – is dangerous and tries to fight it off.
Many children have food allergies. The most common in children are:
- Eggs
- Peanuts
- Tree nuts, such as almonds, cashews, pistachios, walnuts, pecans, macadamia, Brazil nuts and hazelnuts
- Cow’s milk
- Soy
- Wheat
- Fish
- Shellfish, such as prawns and oysters
- Sesame.
What triggers food allergies?
Food allergies are usually triggered by eating or drinking an allergen, rather than touching one. They tend to happen soon after eating the food.
It is normal for your child’s skin to be sensitive. They may get rashes when they are learning to eat and touching new foods. If your child eats a strawberry and develops a rash around their mouth, but they have no other symptoms, this is not considered an allergy.
Most allergic reactions are mild, but some can be severe.
Signs and symptoms of food allergies
Mild to moderate food allergic reaction
An allergic reaction to food usually includes one or more of the following signs and symptoms:
- Rash, such as hives, welts or wheals (red, lumpy rash, like mosquito bites)
- Tingling feeling in or around the mouth
- Stomach pain, vomiting and/or diarrhoea
- Facial swelling.
Speak with your child’s doctor about creating an Australian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Allergic Reactions.
Severe food allergic reaction (anaphylaxis)
Anaphylaxis is a severe allergic reaction that affects breathing and/or how blood moves around the body. It is a life-threatening emergency that needs urgent treatment.
If your child is having an anaphylactic reaction to food, they may show one or more of the following signs:
- Trouble breathing and/or swallowing
- Wheezing, coughing or choking
- Tongue swelling
- Throat swelling and/or tightness
- Trouble talking or a hoarse voice
- Dizziness and/or collapse
- Pale skin and floppiness (infants and young children).
They may also have symptoms of a mild to moderate reaction, such as a rash.
If your child has known food anaphylaxis, a doctor will prescribe them an adrenaline
device (such as EpiPen® or Anapen®). It is important that you and your child (if they are old enough) know how to use it. Your child’s doctor will also work with you to create a custom Australian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis.
Always use an adrenaline device immediately if your child shows signs of anaphylaxis, then call an ambulance (000).
Managing your child’s first food allergic reaction
The first time your child has an allergic reaction to food, it is a good idea to note their symptoms and possible triggers. For example, did your child’s mouth start tingling after they drank milk? If they have a rash or swelling, you could take photos as well. The more information you can gather for a doctor, the better.
Take your child to see their doctor and discuss their symptoms shortly after their reaction. They may refer your child to an allergy specialist for testing. This usually involves a skin-prick test and/or a blood test.
Peanut and tree nut allergies
Allergies to peanuts and tree nuts are most common in young children, but they can develop at any age. Unlike some other food allergies, peanut and tree nut allergies tend to last into adulthood.
Tree nuts that tend to trigger the most allergic reactions are:
- Cashews
- Pistachios
- Hazelnuts
- Walnuts
- Pecans
- Macadamias
- Brazil nuts
- Pine nuts
- Almonds
People who are allergic to cashews are more likely to be allergic to pistachios, and those allergic to walnuts are more likely to be allergic to pecans. This is due to similarities in protein structures.
What to do during an allergic reaction to food
Mild to moderate food allergy
An oral antihistamine medicine (liquid or tablet) can help your child with symptoms of mild to moderate food allergic reactions. It is best to use second-generation antihistamines, which are less likely to cause drowsiness, such as cetirizine, loratadine, desloratadine and fexofenadine. A doctor or pharmacist can suggest the best medicine for your child's needs.
Severe food allergy (anaphylaxis)
Your child will need adrenaline (epinephrine) during an anaphylactic reaction. This medicine reverses the effects of anaphylaxis by increasing blood pressure, reducing swelling and making it easier to breathe. Antihistamines will not help with an anaphylactic reaction.
Anaphylaxis first aid
- Lie your child down flat, if possible. If it is hard for them to breathe in this position or difficult to keep them still, sit them up with their legs out.
- Remove the safety cap from the adrenaline device (blue cap on EpiPen®, black needle shield and grey cap on Anapen®) and inject the adrenaline into their outer mid-thigh, with or without clothing. If they do not have an adrenaline device, call an ambulance (000) immediately.
- Call an ambulance (000).
- If your child still shows signs of anaphylaxis after five minutes, you can give them a second dose of adrenaline. This will not harm them.
- Start cardiopulmonary resuscitation (CPR) if your child becomes unresponsive and is not breathing.
Helping your child avoid allergic reactions
The best way to manage food allergies is to avoid known triggers. This can be tricky, as many allergens like soy, milk, wheat and eggs are in a lot of foods.
To reduce your child’s risk of an allergic reaction, teach them:
- not to share or swap food with others
- to wash their hands before eating
- to read food labels carefully – food and ingredients in Australia must declare any common allergens
- to be careful eating outside of home – for example, at friends’ houses or restaurants
- encourage them to declare their allergies when ordering food.
If your child is going to a party or a friend’s house, notify the host of their allergies in advance. Your child may need separate food if their allergens are hard to avoid. Make sure your child brings their antihistamines or adrenaline device if applicable.
Avoiding allergic reactions at childcare and school
In Victoria, childcare centres and schools must have an anaphylaxis management policy, along with staff trained in preventing and managing allergic reactions.
Talk to your school or childcare centre about your child's allergies and what relevant policies they have in place.
What is the difference between a food allergy and an intolerance?
Food intolerances and allergies are not the same thing, despite having signs and symptoms in common.
Allergy
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Intolerance
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Body system
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Body system
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Cause
- Immune system overreacts to a trigger.
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Cause
- Body cannot break down food properly – usually because of a lack of enzymes or certain chemicals in the food.
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Common symptoms
- Hives, welts or wheals (red, lumpy rash, like mosquito bites).
- Tingling feeling in or around the mouth.
- Stomach pain and/or vomiting.
- Diarrhoea.
- Facial swelling.
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Common symptoms
- Bloating and gas.
- Diarrhoea and constipation.
- Stomach pain.
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Diagnosis
- Based on results of skin-prick test and/or allergy blood tests.
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Diagnosis
- Usually based on clinical history and results of elimination diets – for example, cutting out dairy to see if symptoms improve. Allergy testing is not useful.
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When to get help
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Call an ambulance (000) if:
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- your child is having an anaphylactic reaction (symptoms like trouble breathing and/or noisy breathing, wheeze or persistent cough, throat swelling).
- use their adrenaline device before calling an ambulance, if they have one.
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Go to a hospital if:
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- you think your child is having a mild or moderate allergic reaction, but you are not sure how to treat it.
- your child's reaction is getting worse.
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See a doctor or health professional if:
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- you think your child has had an allergic reaction for the first time.
- your child is having a mild or moderate allergic reaction, and you have given them antihistamines, but you are still concerned.
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Look after your child at home if:
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- they are having a mild or moderate allergic reaction, but you are following their Action Plan and they are getting better.
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Common questions about food allergies
Will my child grow out of their food allergies?
Some children will outgrow their food allergies as they get older. Children who are allergic to milk, egg, wheat and soy are more likely to outgrow their allergies than those allergic to peanuts, tree nuts, fish, shellfish and sesame. The severity of their allergy may also change over time.
Is coeliac a type of allergy?
Coeliac disease is not an allergy, but it is caused by the immune system and can have similar symptoms. Coeliac is an autoimmune condition triggered by gluten – a protein in grains like wheat and barley. For people with coeliac disease, even trace amounts of gluten can cause inflammation and damage the lining of their small intestine. This damage makes it harder for them to absorb nutrients. It may lead to long-term problems like osteoporosis and liver disease if left untreated.
Should schools ban food products that children are allergic to?
Rather than a ban on common allergens, The Royal Children’s Hospital supports an allergy-aware approach to reduce risk. This means having systems in place to reduce the risk of allergic reactions and to understand how to treat a reaction if it happens. Some effective risk reduction methods include not sharing food, handwashing and educating staff.
How can I safely introduce my baby to common allergy-causing foods?
Feeding your baby common food allergens is a key part of healthy development. While it can feel scary, delaying exposure to common food allergens increases the chance of your child becoming allergic.
You should introduce
your child to allergy-causing foods like eggs, peanuts and cow's milk by 12 months of age. Try giving them one allergen at a time at home, in an age-appropriate form, and monitor for any reaction. For example, you could mix some boiled egg or smooth peanut butter into their usual food. Keep feeding these foods to your child regularly if they do not react. If they do have an allergic reaction, you should speak with their doctor.
My child has eczema. Should I be worried about food allergies?
Children
with eczema are at higher risk of developing food allergies and other allergic conditions like hay fever; this is a genetic tendency called ‘atopy.’ However, research shows that you can reduce this risk by introducing your child to common allergenic foods such as egg, wheat and nuts in their first year of life. You should then continue giving your child these allergens at least once a week to maintain their tolerance. Speak with your child’s doctor if they react to any foods.
If my child is allergic to peanuts, should they avoid all nuts?
Many children with peanut allergies can eat tree nuts without reacting. This is because peanuts are not technically nuts – they are legumes like lentils. If your child had no problems eating tree nuts before they reacted to peanuts, they can keep eating them. They can also safely try new tree nuts by starting with small amounts, such as a tiny pinch, and increasing the amount each day. Speak with your child’s doctor or allergist if you have any questions.
Why do so many children have food allergies now?
Food allergies seem to have increased a lot in recent decades. However, scientists are still exploring the reasons why. Some possible causes could be that children are trying common allergens later in childhood or that they get fewer infections when they are young.
My child has had a mild allergic reaction to some foods. Should I buy an adrenaline device just in case they have a severe reaction one day?
There is no need to buy an adrenaline device for your child unless a doctor believes they need one. If you are worried about your child’s allergies, it is best to speak with an allergy specialist. They will prescribe your child an adrenaline device if your child has anaphylaxis or is at greater risk of an anaphylactic reaction.
My child has asthma and food anaphylaxis. What are the best ways to keep them safe?
If your child has asthma and anaphylaxis, it is very important to manage their asthma symptoms. This will reduce their risk of serious breathing problems during a severe allergic reaction. You should take your child to see their doctor if they are using their asthma reliever more than once a week, as this is a sign their asthma may not be under control.
For more information
Developed by The Royal Children’s Hospital Allergy and Immunology department, with input from the Emergency department. We acknowledge the input of RCH consumers and carers.
Reviewed December 2025
Please always seek the most recent advice from a registered and practising clinician.