The best part about Thanksgiving is spending time with family and feasting on delicious foods, but the holiday can be a challenge for individuals with a food allergy. An allergy expert at the Baylor College of Medicine offers advice on how to accommodate food allergies so everyone can have a safe holiday season.

Dr. Carla Davis, associate professor of pediatrics at Baylor and section chief of immunology, allergy and retrovirology at Texas Children’s Hospital, said first it is  important to know the main food groups that can trigger allergic reactions:

  • Peanut
  • Tree nut
  • Egg
  • Dairy
  • Fish
  • Shellfish
  • Wheat
  • Soy

“It is common to see allergic reactions after or during Thanksgiving because it’s often a new environment and there are many new foods,” Davis said. “Foods that can cause reactions are commonly used in Thanksgiving meals, so it can be a partially dangerous time for people with these types of allergies.”

Prepare ahead of time

Preparation is essential when it comes to attending a Thanksgiving meal with a food allergy. Davis recommends adults and parents of children with allergies to contact their host to warn them about the allergy and ask about the ingredients in the dishes they plan on serving.

“If there is any question about whether the food has allergens in it I recommend avoiding it,” Davis said. “Again, I think the safest thing for adults or children to do is ask whether the food has their allergen in it.”

If the allergy is life threatening, Davis advises to keep an epinephrine pen and allergy medication on hand during the meal. It is important to always check that the expiration date on the epinephrine has not expired, she said.

Use substitutions, read labels

If you are hosting a Thanksgiving that will be attended by someone with a food allergy, there are still ways to prepare classic holiday meals without the allergens.

Davis recommends making a separate dish using food substitutions like coconut or rice milk instead of dairy, or oil and water for eggs so there are safe options.

When searching for ingredients or store-bought dishes, read the labels to make sure the allergen is not in the ingredients. Any packaging that has the label “may contain” or “processed in a factory with” the allergen should be avoided, Davis warns. 

“Ahead of the meal, I recommend that the food allergic person let the host know they would like to see the labels of the foods or ingredients that are store bought,” Davis said.

Watch for cross contamination

One of the most common ways allergic reactions occur at the table is when food is cross contaminated. Make sure a serving or cooking utensil of an allergy-free meal is never accidently mixed with a food that contains the allergen.

“This is a really important concept for people to understand, especially during Thanksgiving,” Davis said. “When food is served there should be a unique spoon used for each of the dishes, and these spoons should not be mixed around to different dishes.”

Beware of allergens in disguise

Certain dishes may seem allergy friendly but could have hidden ingredients. Even traditionally dairy-free desserts like meringue may contain raw egg, and vegetable casseroles are sometimes made with nuts and dairy creams. Southern dishes like gumbo that have traces of shellfish are also a common trigger during Thanksgiving, Davis said. 

Nuts and dairy are common causes of food allergic reactions during the holidays since it is harder to tell which dishes contain them, she adds.

“Wheat and soy allergic reactions are rarer during this time even though they are in a lot of different dishes,” Davis said. “Individuals with a life threatening wheat allergy tend to not venture out to eat new foods, but the biggest triggers I see are from peanut, tree nut and dairy.”

Davis warns that some ingredients in store-bought dishes may also contain other common allergens like sesame seed, which is not labeled as an allergy warning on products.

See an allergist for questions

If you think you may have a food allergy or are unsure what foods are causing the allergic reaction, Davis advises to visit an allergist for a diagnosis. The most accurate way to determine if a person is allergic to a food is through testing with an oral food challenge, where an allergist provides the patient with a small amount of food to eat to determine if it is triggering the allergic reaction. Blood and skin testing can guide allergists to determine when a food challenge is needed.