Food allergies affect a very small percentage of adults and infants. According to information from the Allergy Society of South Africa, "it is estimated that only between 1% and 4% of the general population suffers from a definite food allergy" and that "food allergy tends to be more common in children (up to 6%) than adults." When you are allergic to a type of food or ingredient, your immune system has a reaction to that allergen every time it is eaten, even in very small quantities. It results in skin rashes, itching, swelling of the lips or tongue, stomach cramps, vomiting, diarrhoea, a runny or stuffy nose or asthma or anaphylactic shock. While most of the symptoms will appear within minutes or several hours, anaphylactic shock is a very serious instant allergic reaction that requires immediate medical attention. Among adults, allergic reactions are usually to peanuts, tree nuts, shellfish, eggs, milk, soy, fish, fruit or wheat. Children suffering from a food allergy usually react to milk, eggs or peanuts, and may outgrow their allergies.

Food intolerances are more common than allergies and do not involve the immune system. Symptoms include nausea, diarrhoea, flatulence, cramping and bloating, and these are usually felt when large quantities of the trigger food is eaten. Lactose, gluten and food additive intolerance are the most common.

If you suspect that you may have a food allergy or intolerance:

• Make an appointment with your health care provider to help you determine your allergy or intolerance and how best to manage it.
• Read packaging - most suppliers will list ingredients and any food allergens that are in the product.
• Make sure that friends, family and colleagues know about your allergy and what to do in case of an emergency.
• If you are unsure about the ingredients in any meals, ready-prepared foods or sauces, check with the chef before you eat it.

Allergies are the body’s immune response to a substance (called an allergen) that is usually harmless. The allergic person's immune system perceives the allergen as dangerous and reacts to defend itself, causing the symptoms of an allergic reaction.  These symptoms vary; most people suffer discomfort, while a few people have a life-threatening reaction (called anaphylaxis).

Milk allergy affects between 2% - 7.5 % of infants and is considered one of the most common childhood food allergies.  Cows’ milk is often the first allergy because it’s the first food encountered in large quantities during infancy.  Babies and children are thought to be particularly susceptible because of the immaturity of their immune and digestive systems.  Milk allergies in infants can develop within days to months of birth.

Milk is an important part of a child’s diet and should only be eliminated if you are sure your child is allergic to it.  If your baby is on cow's milk, your doctor may suggest a change to soy formula or exclusive breastmilk, if possible.  However, up to 20% of cow’s milk allergic babies will also develop allergies to soy milk.  There are other foods that contain good sources of calcium, including lactose-reduced or lactose-free milks and dark green leafy vegetables.  (There is roughly as much calcium in a glass of milk as there is in 2-3 cups of broccoli.)  The easiest and safest way to maintain calcium balance is with a calcium supplement.  Consult your doctor before starting supplementation.

Most children will outgrow cow’s milk, egg and wheat allergy by 5 years.  Peanut, fish and nut allergy are less likely to be outgrown, with less than 20% outgrowing nut allergies.

There is a more delayed reaction with food intolerance. The digestive system is more likely to be affected and symptoms include tummy pain, colic, bloating, wind, diarrhea, and sometimes vomiting.  In both cases, you need to visit your paediatrician.

When baby is ready for solids, it’s recommended to start with foods that are known not to cause an allergic reaction (such as carrots, pears, sweet potatoes, lamb, chicken and rice) and avoid foods that do (such as wheat, fish, eggs, corn products, citrus fruits and nut butters). A slow introduction of the latter list of foods, one at a time, will then allow the baby to adjust.  Parents should monitor any allergic reactions.

If you suffer from a wheat allergy you should avoid all wheat products, and if you suffer from a gluten allergy, you should also avoid gluten-containing products such as barley, oats and rye. Avoiding all wheat or gluten products can be very tricky, so it is imperative that you meet with your relevant healthcare provider to determine sensitivity and to make sure that you get all the nutrients you need from other sources. You can eat potatoes, rice, sweet potatoes and any products marked gluten-free. When baking, try to use recipes that are specifically for non-wheat flours as substituting wheat flour with the equivalent amount of non-wheat flour may not give you the same end-result. Try making this cornstarch pancake batter which can be used to make pancakes for sweet and savoury fillings.

Nuts are a good source of protein, but those who are allergic to nuts can have very serious reactions and should therefore avoid them at all costs. Some people are allergic to tree nuts, such as cashews, walnuts and Brazil nuts. The most life-threatening nut allergy is to peanuts which are widely used in all types of products. Most suppliers will mention whether their product contains nuts, came into contact with nuts, or was made in a factory that uses nuts, so be sure to read the labels or ask someone in the customer care department if you are not sure.

Shellfish and fish allergies can be severe. You may be allergic to just one type of fish or shellfish, but it's quite common for there to be some cross-reactivity, and so if you are allergic to crayfish, you may also be allergic to other crustaceans. Allergy tests can help determine what you are allergic to. If buying fresh fish or shellfish in the supermarket make sure that you choose pieces that are not touching the food that you are allergic to. At sea food restaurants, always mention your allergy to the waiter. If you are eating seafood for the first time, check for any of the related symptoms such as a skin rash.

An egg allergy is usually in reaction to the egg white proteins and is more often seen in children than adults. Egg is included in many products, such as dressings, mayonnaise, baked products and pastries. Your child may outgrow the allergy, but until that time, use dressings that do not include egg, look for recipes that don't use eggs when baking, and read product labels. To replace moisture, try using 3 tablespoons of puréed apple, or 1 medium squashed banana to replace one egg, or about 15ml cornstarch if the purpose of the egg is to bind the ingredients. Make your own yoghurt sauce to use instead of mayonnaise.

Soya allergy can be managed by avoiding soy products - again, be aware of which products contain soy and always read labels. There may also be a reaction to peanuts, peas and lima beans.

Dried fruits, some vegetables and acidic juices may cause some type of reaction because of the sulphite additives. Most labels will mention whether the product contains sulphites. Cross-reactivity between certain pollens and foods has also been recorded, with there being the possibility that those who are allergic to ragweed pollen also having a response to melon and banana, whereas those allergic to birch pollen may be sensitised to apples, celery, hazelnuts and carrots.

An allergy to cow's milk is more common among children that adults. It's possible that there may then also be a reaction to soy or goat's milk. Speak to your health care provider about other options such as heat-treated milk or milk powder. Lactose intolerance is more frequent among adults who may lack the enzyme involved in the process of digesting milk sugar. If you suffer from lactose intolerance, you may be able to tolerate small amounts of milk and yoghurt. In some recipes calling for the use of milk or cream, you can often use the equivalent amount of water, soy milk, or apple or grape juice like we've used here for this butternut and rocket risotto.

• Do not cut any foods out unnecessarily.
• Wear a bracelet that indicates what your allergy is.
• You can still enjoy healthy, tasty meals. Any recipe that calls for a food that you're allergic to can be adapted by replacing the trigger food with something else. For example, instead of shrimp you can use chicken, or instead of nuts you can use seeds.
• If your child is allergic, have them tested again when they're older as they may have outgrown the allergy.

For more information got to the Allergy Society of South Africa's webpage http://www.allergysa.org/main.htm. There are also many cookbooks available that cater for people with allergies and intolerances.