Food Allergy Series Part 2: How Do I Recognize A Food Allergic Reaction?

I am often asked as an allergist how can I tell if a child is having a food allergic reaction. It is not always easy to tell and thus it is important to know all the possible symptoms of a reaction. Being able to recognize the symptoms early on can prevent your child from having worsening and potentially life-threatening symptoms.



What are the symptoms of a food allergic reaction?

Skin:Flushing, hives (which are red itchy bumps on the skin), itchiness, swelling
Eyes:Redness, itchiness, tearing
Nose:Sneezing, itchiness, runny nose, congestion
Mouth:Tingling, itchiness (children will often say the food is “spicy” or try to scratch their mouths), metallic taste in mouth, swelling
Throat:Tingling, itchiness, swelling, choking (children will often hold or grab their throat), hoarse voice
Lungs:Coughing, wheezing, shortness of breath, difficulty talking
Stomach:Abdominal pain, nausea, vomiting, diarrhea
Heart:Low blood pressure, dizziness, fainting, paleness, blue skin
Neuro:Headache, impending sense of doom, anxiety


Children have unique ways of describing their experiences and perceptions, and allergic reactions are no exception. Precious time is lost when adults do not immediately recognize that a reaction is occurring or don’t understand what a child is telling them.

Some children, especially very young ones, put their hands in their mouths or pull or scratch at their tongues in response to a reaction. Also, children’s voices may change (e.g., become hoarse or squeaky), and they may slur their words.

The following are examples of the words a child might use to describe a reaction:

  • “This food’s too spicy.”
  • “My tongue is hot [or burning].”
  • “It feels like something’s poking my tongue.”
  • “My tongue [or mouth] is tingling [or burning].”
  • “My tongue [or mouth] itches.”
  • “It [my tongue] feels like there is hair on it.”
  • “My mouth feels funny.”
  • “There’s a frog in my throat.”
  • “There’s something stuck in my throat.”
  • “My tongue feels full [or heavy].”
  • “My lips feel tight.”
  • “It feels like there are bugs in there.” (to describe itchy ears)
  • “It [my throat] feels thick.”
  • “It feels like a bump is on the back of my tongue [throat].”

How can you tell the difference between a food allergic reaction and an asthma attack? What do you treat first?

  • Asthma and a food allergic reaction can look very similar, especially when there are only respiratory symptoms with a food allergic reaction. This occurs in about 20% of cases when no skin or gastrointestinal symptoms are present to suggest a food allergic reaction versus an asthmatic one. It is important to take into account the context of the symptoms. If for example you know you have eaten at home with only safe foods, then the symptoms are less likely to be a food allergic reaction than if you were eating out or at a party.
  • The beauty of epinephrine is that it is a great drug for both asthma and food allergic reactions, so you can never go wrong giving the epinephrine when there is any doubt.

What is the treatment for food allergies?

It is important to strictly avoid the food allergen and to carry an injectable medication known as epinephrine with your child at all times. This treatment is the standard of care. Many families ask how strict should they be in avoiding the food allergen. Even a tiny amount of a food allergen can trigger a life-threatening allergic reaction. Food allergies cause about 100-150 deaths per year. As a result, strict avoidance is the most likely way to keep your child safe.

Published on: February 12, 2013
About the Author
Photo of Grace Peace Yu MD MSc

Dr. Grace Yu is a pediatrician and allergist immunologist who has conducted ground-breaking research to help children with life-threatening food allergies. She cares for patients at the Palo Alto Medical Foundation and serves as an adjunct Clinical Faculty Member at Stanford University School of Medicine.

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