Milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybean account for about 90 percent of food allergies in the U.S.
These allergenic foods, sometimes called the Big-8, must be listed on food labels in the U.S., and in several other countries.
The Next Six
After the Big-8 allergens comes the Next-6, six more foods frequently linked to severe allergic reactions. The half-dozen culprits are buckwheat, celery, lupin, molluscan shellfish, mustard, and sesame.
There are no U.S. regulations for labeling these six foods. However, labeling is mandatory according to European (celery, lupin, molluscan shellfish, mustard, and sesame), Canadian (sesame), Japanese (buckwheat, squid), and Australian/New Zealand (sesame) regulations.
Just as the Big-8 can "hide" within processed food and accidentally eaten by allergic consumers, so can the Next-6. For instance, flour substitutes may contain buckwheat, a culinary oil might be sesame oil, and spices on a food label can include mustard or celery.
Seeds: Buckwheat, Mustard, Sesame
Buckwheat, mustard, and sesame seeds might be used whole, milled, or made into pastes or oils. Because they are heat stable, their allergenic proteins remain intact in processed and heated foods.
- Buckwheat is sometimes a wheat flour substitute in baked products. An allergy to buckwheat is more prevalent in countries such as Korea and Japan, than in the U.S. Buckwheat is typically tolerated by those with a wheat allergy. Reactions range from skin rashes to anaphylaxis.
Mustard is used in a variety of foods such as instant soups, baby food, and pickled veggies. In those who are allergic, mustard can cause severe skin reactions, gastrointestinal, and anaphylactic reactions.
Sesame is used in food, pharmaceutical, and cosmetic items—often in oil, or paste form. Skin, respiratory, gastrointestinal, and anaphylactic responses can occur.
A Veggie, Bean, and Ocean Dweller
Celery, lupin, and molluscan shellfish also retain their allergenic potential through processing or heating.
- Celery is consumed as a stand-alone vegetable and spices processed foods such as dressings, soups, and broths. Celery reactions are frequently associated with pollen allergy, and are more common in countries that regularly consume raw celery (e.g., Germany, France, Switzerland). Reactions range from mild discomfort in the mouth to severe systemic responses.
Lupin, a legume, is an increasingly popular food ingredient, and when milled substitutes for soy or wheat flours in processed products. Some people with peanut allergy also react to lupin. Mouth, skin, respiratory symptoms, or anaphylaxis can occur.
Molluscan shellfish include the gastropods (e.g., abalones, land/marine snails, limpets, whelks), bivalves (e.g., oysters, scallops, mussels), and cephalopods (e.g., octopus, squid).
Those who develop an allergy to one type of mollusk often react to the others, and may be allergic to crustacean shellfish, dust mites, and cockroach as well. Gastrointestinal and respiratory symptoms can be local and mild, or systemic and severe.