Food allergy care at our Food Allergy Center

Common signs and symptoms

• Hives, flushing or itchy skin
• Swelling of the lips, tongue, face or eyes
• Itchy mouth or throat, or trouble swallowing
• Vomiting, stomach pain or diarrhea
• Coughing, wheezing or a hoarse voice
• Pale skin, dizziness or fainting
• In babies, sudden sleepiness or floppiness
• A sense that something is very wrong

Food allergy or food intolerance?

A food allergy involves the immune system and can affect your skin, gut, breathing and blood pressure. A food intolerance, such as lactose intolerance, causes digestive discomfort but isn’t dangerous in the same way. Telling the two apart matters, because only an allergy calls for epinephrine and strict avoidance.

Some people with pollen allergies get an itchy mouth from certain raw fruits or vegetables, a condition called pollen food allergy syndrome. In North Texas, ragweed allergy can go along with reactions to melon or banana, and grass allergy with tomato or melon. These reactions are usually mild, but they’re still worth an evaluation.

Food allergies can show up in other ways too, such as delayed, repeated vomiting in infants or trouble swallowing in older kids and adults. We can help sort out those patterns as well.

Common triggers

• Peanut and tree nuts
• Milk and egg
• Wheat and soy
• Sesame
• Fish and shellfish
• Some raw fruits and vegetables, in people with pollen allergy

Recognizing anaphylaxis and using epinephrine

Anaphylaxis is a serious reaction that involves more than one body system or affects breathing or blood pressure. Hives with vomiting, or lip swelling with coughing, are examples. It can happen even if past reactions were mild.

Epinephrine is the first-line treatment for anaphylaxis. Antihistamines may ease hives, but they won’t stop a severe reaction. Every patient we prescribe an epinephrine auto-injector practices with a trainer device until it feels routine, and we review the steps at follow-up visits.

• Give epinephrine into the outer thigh at the first signs of a severe reaction
• Call 911 right after using it
• Lie flat with legs raised, or sit up if breathing is hard
• If symptoms don’t improve, a second dose may be given after 5 to 15 minutes
• Carry two doses at all times

Testing and oral food challenges

A positive skin or blood test shows sensitization, not necessarily a true allergy. Many people test positive to foods they eat without any problem. That’s why we interpret every result alongside your history, and why we don’t order broad food panels at random.

Component testing, a type of blood test that looks at specific proteins within a food, can sometimes help estimate the risk of a serious reaction, especially for peanut and tree nuts.

An oral food challenge is the most reliable way to confirm or rule out a food allergy. You or your child eat small, gradually increasing amounts of a food in our office while our team watches closely, with emergency medicine ready. A passed challenge can bring a food back onto the menu.

Oral immunotherapy for food allergies

Oral immunotherapy, or OIT, gives a patient tiny daily doses of a food allergen, increased slowly over months with updose visits in our office. The goal is desensitization: raising the amount it would take to cause a reaction, so an accidental bite is less likely to be dangerous. OIT doesn’t mean the food can be eaten freely, and you still carry epinephrine.

During the build-up phase, you’ll visit every one to two weeks for a dose increase and a short observation period, then take that same dose at home each day until the next step.

Daily dosing takes commitment, and side effects such as mouth itching or stomach pain are common, especially early on. We talk through benefits and risks with your family before starting. For some patients with multiple food allergies, omalizumab, a biologic injection, may lower the risk of reactions from accidental exposure.

Safe at school, camp and restaurants

We help you prepare for the moments outside your home. Our team completes an emergency care plan for school or daycare, can support a 504 plan if your child needs accommodations, and teaches older kids and teens to recognize a reaction and speak up.

Label reading is a skill we practice with you. Under U.S. labeling rules, major food allergens must be named on packaged foods, but “may contain” warnings are voluntary and not standardized, so we’ll help you decide how to handle them.

We’re also glad to talk through travel, summer camp and eating out, so a food allergy doesn’t have to keep your family at home.

When to see an allergist

• You or your child had a reaction after eating a food
• You’re avoiding foods based on a test you aren’t sure about
• Your baby has severe eczema or egg allergy and is starting solids
• You want to know whether an allergy has been outgrown
• You need an epinephrine prescription, training or a school plan
• You’re interested in oral immunotherapy