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Food
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The most common adult food allergies are shellfish, tree nuts and peanuts, fish, and sesame. Sesame became the ninth FDA-recognized major food allergen in January 2023. Adult-onset food allergies are often lifelong, unlike many childhood food allergies which resolve. Our food allergy testing service identifies the specific trigger and severity, and we have served Central Texas families for over 45 years.
Food allergy diagnosis starts with detailed history, then skin prick testing or specific IgE blood testing for suspected foods. For patients where testing alone leaves the diagnosis uncertain, we conduct supervised oral food challenges in our office, which remain the gold standard. Most testing visits complete in 60 to 90 minutes. Take the food allergy risk quiz for a quick screen, or read our food allergy and intolerance resource.
Eosinophilic esophagitis (EoE) is a chronic allergic condition where the esophagus becomes inflamed by allergic reactions to specific foods. Symptoms include difficulty swallowing, food getting stuck, and chest pain. EoE is diagnosed through endoscopy with biopsy and is treated by identifying and eliminating trigger foods, often with allergist coordination. Read our EoE resource for clinical detail. We work jointly with gastroenterology when needed.
Food allergy is an IgE-mediated immune response with rapid symptoms (minutes to two hours) that can include hives, swelling, breathing difficulty, and anaphylaxis. Food intolerance is non-immune (lactose intolerance, FODMAP sensitivity) and typically produces gut symptoms hours later without involving the immune system. The distinction matters for treatment: allergies require strict avoidance and epinephrine, while intolerances can be managed with dietary modification. The food allergy risk quiz helps separate the two, and our food allergy resource covers the difference in depth.
For peanut allergy specifically, oral immunotherapy (Palforzia for ages 4 to 17, off-label at other ages) builds tolerance over months and prevents severe reactions to accidental ingestion. Sesame OIT and tree nut OIT are emerging at some centers. For most other food allergies, strict avoidance plus epinephrine for emergencies remains the standard. We provide epinephrine prescriptions including Neffy (the new needle-free nasal spray epinephrine), and our food allergy management service handles the full spectrum of pediatric and adult food allergy.