It seems as if food allergies and intolerances have become increasingly common. While one in three people make dietary modifications for perceived reactions to certain foods, only about 5 percent of children and 4 percent of teens and adults have clinically proven food allergies. Many more, however, have intolerance to foods.

Although the symptoms of food allergies and intolerances are similar—headaches, hives, gut issues, itching, swelling and sneezing—their pathways are different. A food allergy is an abnormal response to a food that is triggered by the immune system. In food intolerances, the immune system is not responsible for the symptoms. Food allergies usually develop soon after the offending food is eaten, while the symptoms of a food intolerance are often delayed, showing up anywhere between six and 72 hours after consumption.

The Big Eight

Eight foods and food groups are responsible for the majority of food allergies: eggs, milk, fish, shellfish, peanuts, tree nuts, wheat and soy. In the United States, the Food and Drug Administration (FDA) requires food manufacturers to list these common allergens on food labels.

If an individual has an allergy or intolerance to one or more of these foods, knowing how and what to substitute in recipes will make food preparation easier. It is important to note that many of these foods can sneak into unexpected food products, so becoming a savvy label reader is a high priority. Familiarity with the ingredient list of a food item starts with learning the lingo for items that contain the offending food item.

Of course, anyone who has concerns about food allergies or intolerances should first speak with his or her healthcare provider for advice and to learn about treatment options if the food is inadvertently consumed.

Substitutions for the Big Eight

The following substitutions offer similar flavors, textures and nutrients to the eight most common food allergens. Ingredient names for hidden sources of these foods are also included.

Eggs

Foods to avoid: Eggs, egg whites, egg substitute
Nutrients provided: Protein, iron, folate, B12
Common hidden sources: Ice cream, egg substitutes, pasta, candy, hot dogs, meatballs, breads, rolls and other baked goods, mayonnaise, meringue, marshmallows, egg salad
Easy, healthy and tasty swaps:

• Egg replacer (try Ener G)
• Use mashed sweet potato or avocado in place of mayo
• Scramble tofu instead of eggs; add salsa for flavor
• In baked goods, substitute applesauce or make a chia or flax seed egg (3 Tbsp. water + 1 Tbsp. ground flaxseed)

Milk

Foods to avoid: Cow’s milk, butter, cheese, cream cheese, cream, half and half, buttermilk, ice cream, yogurt, cottage cheese, sour cream, pudding and whey
Nutrients provided: Protein, calcium, vitamin D (if fortified), B12, calcium
Common hidden sources: Chocolate, sorbet, veggie burgers, deli meats, commercial breads, salad dressings, mayo, dried milk solids, curds, ghee, Casein, caseinates in all forms, diacetyl, lactalbumin, lactose, tagatose
Easy, healthy and tasty swaps:

• Unsweetened rice milk, almond milk, hemp milk, cashew milk, coconut milk or soymilk
• Make a vegan cheese using roasted puree eggplant, nutritional yeast, almond milk and spices
• Dairy-free chocolate chips (try Enjoy Life)
• Dairy-free cheese (try Daiya)
• Soy-base swap using Tofutti

Peanuts

Foods to avoid: Peanuts, peanut butter, satay sauce, peanut butter cookies, powdered peanut butter, peanut butter-filled pretzels
Nutrients provided: Protein, unsaturated fats
Common hidden sources: Sauces, salad dressing, ice cream, cookies, baked goods
Easy, healthy and tasty swaps: Almond or cashew butter (if not allergic to tree nuts), sunflower seed butter

Tree Nuts

Foods to avoid: Almonds, cashews, walnuts, Brazil nuts, macadamia nuts, pine nuts
Nutrients provided: Protein, unsaturated fats
Common hidden sources: Nut butters, cookies, trail mix, baked goods, marzipan, pesto, pralines
Easy, healthy and tasty swaps: Sunflower seeds, sesame seeds, tahini (sesame seed paste), sunflower seed butter

Fish

Foods to avoid: Sushi, salmon, halibut, rockfish, red snapper, trout, tuna, swordfish, and other fish with gills
Nutrients provided: Protein, omega-3 fatty acids
Common hidden sources: Fish sauce, many Thai food dishes, fish-and-chips
Easy, healthy and tasty swaps: Chicken, turkey, beef, pork, tofu (for protein); walnuts, ground flax seeds, chia seeds (for omega-3s)

Shellfish

Foods to avoid: Shrimp, crab, lobster, crayfish; Mollusks: clams, oysters, mussels
Nutrients provided: Protein, B12, selenium
Common hidden sources: Sushi, clam juice, fish sauce, fish stock, imitation shellfish (surimi), oyster sauce, seafood flavoring, squid- or cuttlefish-ink, Thai and Vietnamese condiments and sauces
Easy, healthy and tasty swaps: Ocean or lake fish, chicken, turkey, lean beef, pork, tofu

Soy

Foods to avoid: Tofu, edamame, soy milk, tempeh
Nutrients provided: Protein, calcium, magnesium, iron
Common hidden sources: Soy sauce, teriyaki sauce, veggie burgers, veggie hot dogs/chorizo/cheese, miso, natto, soya, textured vegetable protein (TVP), tofu, Shoyu, and tamari. Soy may also be found in hydrolyzed vegetable protein, monosodium glutamate (MSG) and vegetable oil.
Easy, healthy and tasty swaps: Other beans and legumes

Wheat

Foods to avoid: Bread, cereal, crackers, baked goods
Nutrients provided: B vitamins, fiber (if whole), folic acid (if fortified)
Common hidden sources: Durum, emmer, farina, farro, graham, semolina, spelt, triticale, bulgur, couscous, matzo, pasta, seitan, malt and anything derived from it, soy and teriyaki sauces, food starch, hydrolyzed protein, dextrin and several other additives
Easy, healthy and tasty swaps: Almond flour, brown rice flour, tapioca starch, soy flour, potato starch, gluten-free flour blends, quinoa, amaranth, brown rice, millet, potatoes, oats