Allergen

Where It Hides

Alternate Names

• baked goods, bread, cookies
• cereals, crackers
• canned goods
• chewing gum
• imitation dairy food (imitation cheese, imitation milk, imitation ice cream)
• infant formula
• margarine
• mayonnaise, other spreads, dips
• meal replacements
• meat products with fillers (e.g. burgers); deli meats
• miso
• nutrition supplements (check labels; many companies are now making and labeling their products as soy- free)
• sauces (tamari, shoyu, teriyaki, Worcestershire)
• simulated fish and meat products
• soups, bouillon
• tempeh
• vegetarian and vegan dishes
• vegetarian burgers
• vitamin E
• thickening agents
• cosmetics and soaps
• medications

• bean curd (dofu, kori-dofu, soybean curds, tofu)
• edamame
• kinako
• natto
• nimame
• okara
• soya, soja, soybeans, soyabeans
• soy protein (isolate and concentrate)
• vegetable protein
• textured soy flour (TSF)
• textured soy protein (TSP)
• textured vegetable protein (TVP)
• yuba
• lecithin (not all allergists say soy lecithin needs to be avoided; ask your allergist)
• mono-diglyceride
• monosodium glutamate (MSG) may contain soy
• garbanzo beans (chick peas)

Sources:
-ImmunoCAP
-Canadian Food Inspection Agency

But using the epinephrine auto-injector is an emergency situation only, it’s not a treatment.
This is why “avoidance” is the operative word for managing a soy or legume allergy. However, this isn’t as simple or easy as that one word suggests.

Soy is found in many packaged food products. You may see it listed in the ingredients as “soy”, “soy lecithin”, “soyabean oil” or even “hydrolyzed plant protein” (which is often from soy). Soy is a cheap and easy binder, filler and preservative in packaged food products, so it’s very common to find it in crackers, breads, cookies and other foods that have already been prepared.

However, since soy is one of the most common allergens in Canada and the United States, some companies are catching on and are starting to avoid using soy products. However, caution must still be used while shopping because it is unlikely you will find a “soy-free” logo like you might for “peanut-free” on some packaged foods.

Other legumes like beans, peas, chickpeas and lentils are little bit easier to manage. However, they do present their own challenges. Chickpeas are the main component of hummus and hummus can be used not only as a dip on its own but in sauces as well.

If you have a soy allergy, Asian restaurants are off-limits because it is a staple in their cuisine. However, don’t let this discourage you from re-creating traditional Asian dishes minus the legumes. For example, you can create an equally good stir-fry with broccoli, chicken and rice instead of bean sprouts and peas.

Hand-Washing: When your child (or you) has a soybean or another plant from the legume familly, soap and water are your best friends. Hands should be washed thoroughly before and after eating. If you have a school-aged child, ensure he (or she) is able to wash his hands before snacks and lunch. With younger children, schools usually adopt an allergy protocol of washing hands among all children after eating. 

Cross-Contamination: It’s important to make sure soy or legumes and any products that contain them don’t come in contact with the food you are eating. That means thoroughly cleaning utensils and kitchen equipment after use. For example, if someone uses a spoon to take out some hummus in a bowl, make sure you do not use the same spoon for your own food.

When there is a child or adult with a soy or legume allergy in the household, many families choose to eliminate the allergens from the house. This is a personal preference and will depend in part on your family’s ability to be vigilant about keeping the allergic person safe.

Label reading: Whenever you eat a packaged food, you need to read the label in its entirety to check for any mention of peanut. Sometimes, soy (more so than other legumes) can have different names or can be hidden as an ingredient within a manufactured food. You also have to look for precautionary statements on package labels, such as “May Contain Soy.”

The better news is that food labeling in both Canada and the United States has improved considerably in the past few years, especially for the Top Ten food triggers. For more information on what you need to know when reading product labels, please view Label Aware.

One thing to be cautious of with soy allergy: imported foods. Not all countries have the stringent labeling requirements of Canada, the United States and the European Union. Don’t take chances if you suspect soy could be an ingredient of an import.

Speak Up About Food: With food allergies, you have to ask questions and get over shyness when someone else wants to serve food to you or your child with this allergy.

We teach kids to respect adults and authority, but with an allergic child, it’s important to teach them not to eat foods that others offer – unless mom or dad has pre-approved or (when they’re older) unless they’re sure of the ingredients. For adults, get over embarrassment; be certain to ask about ingredients, and learn to do this an efficient, confident manner.
See: Caution: Relatives Ahead

At School: For a parent of a child with soy or legume allergies, sending them off to school can be a time of anxiousness. While soy is on the top 10 list of allergens, it’s unlikely you will find schools restricting soy or soy milk in a class – nor asking other parents to please not send kids to school with hummus.

It’s important to communicate clearly and calmly with your child’s teacher and the principal, and to create an anaphylaxis emergency plan (also called a food allergy action plan) to protect your child. Also ensure that the teacher (and other staff e.g. a coach) is receiving at least annual training on using an epinephrine auto-injector and that he or she knows where your child’s “pen” is kept.

Become familiar with the anaphylaxis policy or law in your province or state and use it to develop a plan tailored to your child. Be sure your allergic child knows not to share food with peers and not to take food from anyone, including the teacher, unless you’ve said it’s OK.

At a restaurant: Dining out with a soy or legume allergy may seem daunting at first, but it is possible to do so safely and enjoyably. First, find a restaurant you trust. Call ahead to ask the manager or chef about menu items and how they handle pans and utensils in the kitchen to avoid cross-contamination. If he or she is unable to answer your questions, don’t eat there.
When you arrive at the restaurant, tell your server directly of your serious soy or legume allergy and discuss menu items that will be safe to eat. If you don’t feel he or she is able to answer your questions properly, ask to speak to the chef or the manager. Be mindful of particularly risky foods: sauces, pre-packaged baked products, breads, salad dressing and items that may be cooked in soyabean oil. And remember: when in doubt, don’t eat it.

Be prepared: Make it a rule – no epinephrine auto-injector means no food. While you’ll do everything to make sure you’re not eating soy or legumes, accidents happen. Make sure you always have your auto-injector on you when you eat, in case of an emergency. If your child is allergic, make sure this rule is one he or she takes seriously. 

Educating Others: In order to successfully manage a soy or legume allergy, those around you/your child need to be aware of the allergy and the serious consequences that could result from eating them.
Plan what you’ll say to others to explain this condition. Be calm, clear about the information and keep the conversation based on facts. Politely request that they help you keep yourself or your child safe. You’ll often find that once a person understands about food allergies and anaphylaxis, they’ll be more than willing to help out. Be mindful that there is a learning curve, and don’t expect people who don’t live with peanut allergy to absorb it all as quickly as you have.

The tiny legumes – which are related to clover, peas and alfalfa – are incredibly versatile as a food, but they are also used in thousands of products such as soaps, cosmetics,plastics, clothing, inks, glues, lubricants, pesticides, coatings and insulation.

They are even used to make biofuel, and Ford Motor Company recently announced that it had developed a new type of soy-based rubber that they intend to use in cup holders and floor mats.

In foods, they are especially desirable, because they are high in protein but low in calories, carbohydrates and fats; they supply all nine essential amino acids; they’re high in vitamins and nutrients; they contain no cholesterol; and they are easy to digest.

Their consistency allows them to be transformed into oils and flours, as well as dairy and meat substitutes. Importantly, isolated soy proteins are used to emulsify fat and bind water, which keeps many products’ moistness without affecting other ingredients. For example, soy lecithin is often used in chocolate, margarine and cheeses to keep their ingredients from separating and clumping.

The isolates can also be used to give an elastic gel texture, which can make drinks such as soy lattes seem more creamy or full-bodied.

Besides a remarkable flexibility, soybeans are also one of the most inexpensive crops to grow, and they can thrive in a wide variety of climates. This explains why they are so desirable for a range of industries. Although the plant originated in Asia, the vast majority of the world’s supply is now grown in the United States and South America.

In recent years there has been an increasing amount of controversy about soybeans, with some scientists raising alarms about their effects on hormone production. Others are concerned that many soy crops have been genetically modified, and it’s unclear how those modifications will affect animals, humans and non-GM crops in the long run.

With the increased prevalence of soy in the North American diet, allergists have also noticed a corresponding rise in allergies to soy and soy products. Fortunately, many people with an allergy to soy can tolerate soy lecithin, which is found in thousands of foods – but it’s important that they discuss their allergy with their physician before eating any products that contain soy or soy products.

But the patients coming through Ham Pong’s offices in Ottawa and Vancouver were telling a very different story. Not only were more of them reacting to sesame, but those reactions tended to be severe; in fact, more of his patients were experiencing full-blown anaphylaxis from eating sesame products than from shellfish.

A more formal survey of more than 2,000 patients confirmed the allergist’s suspicions – but many of his colleagues were still not convinced. “I presented a study at an allergy meeting, and one of the allergists didn’t believe that sesame was a problem. So he asked parents for a show of hands of how many of their children had sesame allergy, and he was very surprised “at how many hands went up,” recounts Ham Pong. “It took him aback because there was no published literature on its prevalence at the time.”

Since then, there has been a significant amount of scientific literature to show that sesame is yet another one of those especially problematic foods, to the point where the European Union and Canada have added it to their priority allergen lists, which include peanuts, tree nuts, dairy, wheat, eggs, fish, shellfish and soy. The United States is investigating whether to follow suit.

But sesame isn’t the only new culprit to gain priority status in Canada; nor is it the only emerging allergen on the radar of North American scientists. The fact is, our diets are constantly in flux – often because particular foods are found to have special disease-fighting properties and become trendy, or because people from around the world bring their culinary influences with them when they arrive on North American shores.

In turn, those foods – from sushi to hummus to curry – get woven into our ever more colorful mainstream diet. Those constantly changing grocery lists, however, mean that our society’s allergies are bound to see shift as well.

“Until kiwi became popular because of the high levels of vitamin C, you didn’t see a lot of kiwi allergy – but now you see a fair amount because it’s a very allergenic fruit,” says Ham Pong. “But if there wasn’t much of it in the diet, it wouldn’t really be an issue. So what makes a food a problem in society is how allergenic the food is, and how much that food is adopted as part of the daily diet.”

Open Sesame

That’s likely what happened with sesame, says Dr. Robert Wood, director of pediatric allergy and immunology at the Johns Hopkins University School of Medicine in Baltimore. The seed became more common in breads, the popularity of traditional Middle Eastern foods such as hummus skyrocketed, and bagels, which are often coated with sesame seeds, became a mainstay in the mainstream North American diet.

And unlike some oils such as peanut and corn whose proteins are almost entirely removed during the refining process, Wood adds that sesame is a raw oil, and as a result can be just as allergenic as the seeds themselves.

“In our practice, it has become much more common, and appears to be the fourth or fifth most common allergen we deal with,” says Wood. In addition to pointing the finger at the increased prevalence of sesame in our diets, Wood says that one of the most notorious allergens on the list may also be adding to the problem.

“We see sesame allergy more commonly in children who also have a peanut allergy, and we suspect that there are some similarities in the allergens in sesame and peanuts,” he explains. “So there may be some of the sesame allergy that’s actually being driven by the increase in peanut allergy.”

But because the prevalence of sesame allergy is relatively new, regulatory bodies have yet to catch up. In the United States, food manufacturers must clearly declare the top allergens on its product labels – but as yet, sesame has not yet made that list, so it can still be hidden as “tahini”, “spices” or “natural flavouring”. (It’s also used in cosmetics and pharmaceuticals.)

In Canada, sesame was added to the priority allergens list in 2000, and mustard is in the process of being added as well, but the country has yet to enact new regulations that require manufacturers to label all priority allergens in clear language.

Reading labels is a way of life when you or a member of your family has a peanut allergy. Before eating anything in a package, be sure to read the label carefully. Look for hidden sources of soy or legumes and alternate names for them.

Also be on the lookout for precautionary statements. These are statements that indicate an allergen may be in the food, due to cross contamination during processing. Examples of precautionary statements include: “May contain soy” and “Manufactured in a facility that also processes soy.”

(FYI, while soy and peanuts are legumes that are priority allergens in Canada and the U.S., other legumes don’t have that same designation. Soy and peanut will be included in so-called “May contain” statements, legumes such as lentils or chickpeas won’t be.)

Allergists generally advise people with soy allergies to avoid all products that contain precautionary statements about their allergen.

If you are ever uncertain about whether a food product is safe for you, call the manufacturer to confirm. When in doubt, don’t eat it.

In Canada, new regulations have been proposed that would require food manufacturers list priority allergens in plain language on packaging, rather than using alternate names (ie: kinako, for soybean flour). Ingredients of ingredients that are priority allergens would also have to be listed. For example, manufacturers couldn’t simply list “vegetable protein” if the source of the protein is a priority allergen, such as a legume.

More on Canada’s New Food Allergen Regulations.

In the United States, the Food Allergen Labeling and Consumer Protection Act went into effect in 2006. FALCPA requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The allergens included in this regulation are milk, eggs, fish, shellfish, tree nuts, wheat peanuts and soybeans. These regulations do not include sesame and mustard, unlike the proposed Canadian regulations.

Separate legislation requires companies to declare sulphites if they are present at more than 10 parts per million, or if they had a technical or functional effect in the food.

Both Canada and the United States are studying ways to regulate the precautionary statements used on packaged food labels.

Peanuts are the most common legume that people will react to, and about 5 per cent of peanut allergic people will react to other legumes, such as beans, peas chickpeas and lentil.

In general, food allergy is on the rise in North America and other developed countries. In Canada, an estimated 7.5 per cent of people have food allergies, representing more than 2.5 million people. In the United States it’s estimated that 12 million Americans (or just under 4 per cent of the population) have food allergies.

A major study in the United States recently found that cases of peanut allergy in children more than tripled in a decade, and that more than 3 million Americans now have a peanut or nut allergy.

Here are the rates of some of the major allergens in Canada and the U.S.

CANADA

Source: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food LAbelling and Risk (SCAAALAR) study. Published in the Journal of Allergy and Clinical Immunology, June 2010.

UNITED STATES

Peanut, Tree Nut or both:
Children -  2.1 %
Adults – 1.3 %

Source: US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. Published in the Journal of Allergy and Clinical Immunology, June 2010.

Milk and egg allergy are both common in children. In the United States, 2.5 per cent of children under the age of 3 have a milk allergy. Egg allergy affects 1.5 to 3.2 per cent of children.

The good news is many children outgrow their allergies to milk and egg.

Source: AAAAI