If an ice cream says it's non-dairy or vegan, is it safe for someone with a milk allergy?

You shouldn't see ice cream with 'non-dairy' or 'vegan' on the label. To be called 'ice cream', ice cream must be made with a minimum amount of milk protein. So, if you have a milk allergy, you should avoid eating any ice cream products, even if they're described as 'non-dairy'.

Some ice cream is specifically labelled 'dairy ice cream', this means it must only contain dairy fats, whereas other ice creams are usually made with a mixture of vegetable or animal fat and dairy fat.

At the moment, there aren't any rules that say what the terms 'non-dairy', 'dairy free' or 'vegan' should mean. But it is illegal for any claim on a food label to be misleading.

Vegan foods shouldn't contain any milk, egg, meat or fish. Because there are no rules to say what 'vegan' means, the Agency recommends that the vegan foods shouldn't contain any products of animal origin. Some vegan products are produced in factories that also produce non-vegan foods and so might accidentally contain very small amounts of these foods.

If milk and milk products are deliberately used as an ingredient in the food, they must be listed on the label. So, if you have a milk allergy you should always check the food label.

I'm allergic to penicillin and read about a person with a penicillin allergy who went into anaphylactic shock after eating blue cheese. Is it true there is penicillin in blue cheese? And if so, why isn't it labelled?

It should be safe for people with an allergy to penicillin to eat blue cheese. This is because the type of mould used to make blue cheese, although it is part of the Penicillium family, isn't able to produce penicillin. There are some types of mould in the Penicillium family that can produce the antibiotic penicillin, but these aren't used to produce food.

There have been rare reports of people who are sensitive to penicillin having an allergic reaction after drinking milk that contained very small amounts of penicillin. In these rare cases, the penicillin had passed into the milk through animals that had been treated with antibiotics.

However, to stop veterinary medicines, such as antibiotics, getting into foods there are rules which mean that after treating animals with antibiotics, a certain amount of time must pass before either the milk or meat from the animals is allowed into the food chain. These rules mean these products should be safe for people with an allergy to penicillin.

I've heard that plain chocolate can contain milk even though it's not listed in the ingredients. Is plain chocolate safe for people with an allergy to milk?

Some plain chocolate might contain small amounts of milk. This is because most plain chocolate is made in the same factories and on the same production lines as milk chocolate. But because milk isn't used as an ingredient to make plain chocolate, it won't be mentioned in the ingredients list.

Some manufacturers put allergy advice, such as 'may contain milk' on their labels. But it isn't compulsory for food labels to include this type of statement. So if there isn't any allergy information on the label, don't assume the product is free from the food you are sensitive to.

If you have a severe milk allergy you might want to look for plain chocolate, or products that contain plain chocolate, that are labelled as 'milk-free' or 'suitable for people with milk allergy'. Special care is taken with these products to make sure they don't contain any milk.

I need to avoid foods containing gluten, but I am confused – can I eat spelt, bulgar wheat or buckwheat?

Spelt and bulgar are both types of wheat, which means they contain gluten. This means any product that contains these ingredients isn't suitable for someone trying to avoid gluten, such as someone with coeliac disease or a wheat allergy. Other cereals that contain gluten include other types of wheat, rye, barley, oats, kamut or any variety of these crops.

Interestingly, buckwheat isn't a member of the wheat family – even though its name suggests it is – it's actually a seed from a completely different plant. Buckwheat doesn't contain gluten, so it can be eaten by people with coeliac disease or a wheat allergy.

Manufacturers are required by law to list cereals containing gluten as ingredients, but not specifically to mention gluten on the product's label. Some manufacturers do however choose to name it in the allergy advice on a product's label. So, for example, you might see 'wheat' in the ingredients list and 'gluten' or 'contains gluten' in the allergy advice section.

When a product doesn't contain gluten the allergy advice section might say 'gluten free' or 'suitable for coeliacs'. If you're not sure whether a food contains gluten, it's best to check whether one of these cereals is listed as an ingredient or choose products that are labelled as 'gluten free'.

If the label says a food 'contains nuts' or 'may contain nuts', does this mean nuts such as almonds, walnuts and Brazil nuts or could it also mean peanuts?

This sort of information on a food label often doesn't distinguish peanuts from other nuts. So people allergic to any nuts (including peanuts) should avoid these products.

When nuts such as almonds, walnuts or Brazil nuts (known as tree nuts), or peanuts (also known as groundnuts and monkey nuts), are used in pre-packed foods, the name of the nut must be listed as an ingredient on the packet.

However, people with a nut allergy should still be careful because many nut ingredients are produced in factories that handle different types of nuts and so these foods could accidentally contain small amounts of other nuts accidentally.

Strictly speaking peanuts aren't actually 'nuts', they're 'legumes', but many people who are allergic to peanuts can also develop an allergy to one or more tree nuts. So, even if someone is only allergic to one type of nut it still might be better to avoid products containing any nut or peanut ingredient.

I think I have a food allergy or a food intolerance. Where can I get myself tested?

If you think you have a food allergy or a food intolerance, you should get advice from a qualified health professional.

Although you might see allergy and intolerance tests advertised in magazines, in the shops and over the Internet, for many of these tests there is no evidence that they are reliable.

Your GP or a dietitian should be able to help you. GPs can access a directory of allergy services developed by the British Society of Allergy and Clinical Immunology.

The directory lists consultant-led specialist allergy clinics in the UK and can be found on the British Society for Allergy & Clinical Immunology's website. You will need a referral from your GP to go to one of these clinics.

If you choose to go to a dietitian, you can go to one direct, but your GP might also be able to refer you. Remember that it's important not to cut out any major food groups from your diet without nutritional advice.

If you want to know more about allergies and allergy tests, you might want to read the guide from the Royal College of Pathologists, which is aimed at patients and relatives.

I have a severe peanut allergy and recently reacted to a coronation chicken sandwich from a sandwich bar. I have eaten this filling lots of times without a problem. Why might peanuts have been used in the filling and why weren't they labelled?

Coronation chicken is cooked chicken in a sauce flavoured with apricots and curry powder. The original recipe doesn't include any nuts, but sometimes it has toasted flaked almonds added to it. Some people use peanuts instead of almonds, probably because they are cheaper.

Sandwiches that are made in the same place they are sold, even if they are sold in a box or wrapper, don't have to be labelled with a full ingredients list. This is because they are not covered by the same labelling rules as pre-packed foods.

It is important to remember that recipes can vary. So even though you may have eaten a particular dish or type of sandwich before without any problems, it might not be safe for you to eat again if a cafe or sandwich bar changes its recipe, or if you go somewhere different. It's very important to ask the person serving you if a food contains peanuts, whenever you buy a food that doesn't have a full ingredients list.

Don't forget that if you have a severe allergy you should never go anywhere without your medication.

Should I stop eating a food if I think I'm intolerant to it?

Once you have been diagnosed by your GP or consultant as having a food allergy or intolerance, you should avoid the food or foods you react to.

But if you suspect you have a food intolerance but haven't had a diagnosis from a doctor, it's not a good idea to cut out important foods, such as milk, egg or wheat. This could mean you miss out on some vital nutrients, which isn't good for your health. So always seek the help of your GP or a dietician before making major changes to your diet.

What do I need to know about food allergy if I look after children?

If you look after children, for example in a nursery, crèche or school, or a Cub or Brownie group, it's very important to find out whether any of the children in your care has a food allergy. If they do, it is vital to discuss their needs in detail with their parent or carer, so you have as much information as possible on which foods the child should avoid.

If a child in your care has a food allergy, you must be sure that you (and any of your colleagues who might prepare food for the child) know how to avoid the ingredients he or she is allergic to.

Learn how to spot the food on the labels of pre-packed foods and don't let the child eat anything containing the food they need to avoid. If you're in any doubt, don't give the food to the child.

Think about how food is prepared and stored, particularly nuts and seeds and food containing them. If a child has a severe food allergy, it's very important to prevent bits of the food they are sensitive to getting into other foods, for example when foods are next to each other, or if someone uses the same utensils for different foods. In some cases, children can have a severe reaction to a tiny amount of the food they are sensitive to.

You and your colleagues should also learn to recognise the symptoms of a severe allergic reaction, so you can act quickly. These can include all or some of the following:

• swelling of the lips and throat
• difficulty breathing or swallowing
• collapse and unconsciousness
The medical name for a severe allergic reaction is anaphylaxis (pronounced anna-fill-axis).

You must also know what to do if a child has an allergic reaction, which might include giving an adrenaline injection. If you think that a child is having a severe allergic reaction, you should call 999 and ask for an ambulance with a paramedic, saying that you think the child may be having an anaphylactic reaction. It is better to keep the child calm and still and call an ambulance, rather than try to take the child to a doctor or hospital yourself.
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I was diagnosed with a peanut allergy as a child, but recently I accidentally ate a bit of a biscuit containing peanuts and I only had a slight rash and a bit of tingling in my mouth. Does this mean that I won't have a severe reaction in the future?

The severity of a reaction can vary depending on how much of the food you eat, and also on your general health at the time. If you are unwell or under stress, then you may experience a more severe reaction. So don't assume that you won't have a severe reaction in the future and always be careful about what you eat.

People who have asthma, as well as a food allergy, may find that if their asthma is not properly controlled they can have more severe reactions to the food they are sensitive to. So if your asthma symptoms are bad you need to be especially careful about what you're eating.

My nephew, who has a nut allergy, is spending Christmas Day at my house. What's your advice?

Eating just a tiny amount of nut could cause a severe reaction in someone who has a nut allergy. So you should do everything you can to keep your nephew away from nuts and foods that contain them.

When you're buying food for Christmas, check the ingredients list of each product for any mention of nuts. Some foods will say 'May contain nuts' on the label (because they may have come into contact with foods containing nuts when they were being made), so you should avoid these.

Look out for nut-free versions of traditional Christmas foods. A number of companies and shops produce Christmas puddings, mince pies etc. that don't contain nuts.

When your nephew has arrived, make sure you don't put out any bowls of nuts or peanuts. And don't forget that many foods can be made with nuts, including some foods that you might not expect to contain them. Here are a few examples:

• Christmas puddings and Christmas cakes
• marzipan used on Christmas cakes or in sweets
• chocolates
• nut roast
• mince pies
• stuffing
• toppings on some desserts
• sugared almonds
• Waldorf salad
• Bombay mix
• biscuits
• ice cream

Some people are so sensitive to nuts that they can react just from being near nuts, or from a kiss from someone who has been eating them. So the safest thing is not to have any nuts in the house while your nephew is there.

Can a person with a nut allergy eat pine nuts?

Pine nuts (sometimes called pine kernels) are not botanically classified as nuts, but there have been some reports of allergy to pine nuts, particularly in people who are allergic to a number of different types of nuts.

So it's a good idea to avoid pine nuts if you know that you are allergic to nuts, unless you have eaten them before without any problems. Don't forget to watch out for foods made with pine nuts, such as pesto (although pesto can also be made with nuts).

Can someone with a fish allergy take fish-oil supplements?

Someone with a fish allergy could have an allergic reaction to fish-oil supplements. It is the protein in the food that triggers an allergic reaction and some fish protein could be present in the supplements, depending on how highly processed and pure they are.

So, whether someone with a fish allergy would react to fish-oil supplements depends on how sensitive they are to the proteins in fish and how much protein is in the supplement. Different people react to different levels of protein and if someone is very sensitive they could react to tiny quantities of protein in a supplement. Swallowing fish-oil capsules whole would not necessarily prevent a reaction, because allergic reactions often occur in the gut, not just in the mouth or stomach.

If you have any reason to think that you might have a problem with taking fish-oil supplements, you should talk to your GP. He or she might refer you to an allergy specialist.

Some people take fish-oil capsules because of the long-chain omega 3 fatty acids they contain, or choose foods with added omega 3 fatty acids. These fatty acids can help prevent heart disease. If the omega 3 fatty acids come from fish, this should be stated on the label. Similar fatty acids are found in some vegetable oils, such as linseed, flaxseed, walnut and rapeseed, but they might not have the same benefits as those found in fish. These vegetable oils also contain unsaturated fats, which can help to lower levels of cholesterol in the blood.

Why does my wife gets blisters on her lips when she eats apples?

It sounds like your wife might be allergic to apples. Some people experience reactions such as itching, rashes or blisters when certain foods (especially fruit and vegetables) touch their lips and mouth. Other people just get a tingling sensation. This is called oral allergy syndrome and different types of fruit can cause it, including pineapple, mango and passion fruit, as well as apple.

These reactions usually happen in people who are sensitive to pollen, for example pollens from birch, grass, or plants in the daisy family such as ragweed and mugwort. This is because the allergens in these pollens, which certain people react to, are also found in some fruit and vegetables.

For example, people who are allergic to birch pollen are also likely to be allergic to apples. If you have hay fever and always have the same symptoms whenever you eat these types of fruit, then it should be safe for you to continue eating them. However, if you don't have hay fever, if your symptoms are getting worse or if you get symptoms in other parts of your body, you should avoid eating the fruit that causes the reaction and consult your GP.

Cooking often destroys the allergens in fresh fruit and vegetables that cause this kind of reaction, so your wife might be able to eat cooked apples without having an allergic reaction.

I'm lactose intolerant. What foods contain calcium, apart from milk and dairy products?

There are a number of foods you can eat, apart from milk and dairy products, to help you get enough calcium. Canned sardines, and other fish where we eat the bones, are good sources of calcium.

Other foods that contain calcium include:

• soya beans and tofu


• bread


• pulses such as chickpeas


• green vegetables, especially watercress and okra (but not spinach)


• other vegetables, such as cabbage and onions


• dried fruit, especially dried figs


• nuts, such as almonds, and seeds, such as sesame seeds

To help our bodies absorb the calcium from the foods we eat, it's important to get enough vitamin D. We get vitamin D from sunlight on our skin and from foods such as margarines and spreads, breakfast cereals and oily fish.

If you use soya, rice or oat drinks as a substitute for milk, try to choose those with added calcium.

People with lactose intolerance often find that they can eat cheese and yoghurt without any problems. Cheese contains much less lactose than milk. Yoghurt contains a similar amount of lactose to milk, but it still seems to be easier to digest for people with lactose intolerance. This might be something to do with the bacteria used to make it. Yoghurt and cheese are both excellent sources of calcium. Try to choose lower-fat types, or eat just a small amount of the high-fat options.

However, if you have a milk allergy, rather than lactose intolerance, you should avoid all milk products, including those made with milk from sheep and goats.

Please can you tell me exactly what ingredients go into 'vegetable oil'? My son is allergic to rapeseed oil so I'm concerned that if this is a part of vegetable oil he may react to products that contain it.

Vegetable oil is usually a blend of different oils. In the UK, the oils used most in vegetable oil are soya, rapeseed, sunflower, maize and palm kernel oils. Where vegetable oil is in pre-packed food, these oils will have been refined. The refining process removes almost all of the proteins from the oil. Since it's the proteins in foods that can cause allergic reactions, sensitive people probably won't react to refined oils.

This means that your son should be able to eat packaged foods that contain vegetable oil without having an allergic reaction. However, he should avoid unrefined rapeseed or vegetable oils, because these may still contain the proteins that sensitive people can react to.

By law, packaged foods must include a list of ingredients. When 'vegetable oil' appears in the list, this can refer to refined oil made from a range of vegetables or other edible plants, but not olive oil. The various different oils that make up the vegetable oil don't need to be labelled individually.

My baby has bad diarrhoea when I give her cheese, yoghurt or other dairy products. Could she be intolerant to cows' milk?

There are a number of different conditions where people have an abnormal reaction to cows' milk, including cows' milk allergy, cows' milk protein intolerance and lactose intolerance. Symptoms of these conditions can include diarrhoea, vomiting, bloating and wind, as well as asthma or eczema.

Cows' milk allergy and cows' milk protein intolerance are common in babies and children. Many children with these conditions will grow out of them when they get older.

Breastfeeding is best for babies since it provides all the nutrients that a baby needs for healthy development in the first six months of life. However, if you choose not to breastfeed, infant formula is the only alternative to breast milk and your baby will need breast milk or formula milk until they're at least a year old.

Formula milk is based on cows' milk and if your baby is diagnosed with a cows' milk allergy, your GP might prescribe hydrolysed milk formula for her. You shouldn't give her partially hydrolysed formula or soya formula without consulting your GP, because babies with cows' milk allergy may also react to these types of formula.

Some breastfed babies with cows' milk allergy may also react if their mother has eaten milk or dairy products.

Solid foods such as yoghurt, fromage frais and cheese sauces can be introduced at 6 months when you start weaning your baby. If you think your baby is intolerant to cows' milk and dairy products, it's important to consult your GP, who will be able to refer her to a specialist for a proper diagnosis and nutritional advice.

I have coeliac disease, and I am very sensitive to gluten so I need to stick to a strict gluten-free diet. Is it true that some foods labelled as 'gluten free' still contain some gluten? How can I find out what foods are suitable for me?

Yes, it is true, for a number of reasons, like contamination in the factory and the addition of a special starch which has been treated to reduce the amount of gluten, foods labelled as ‘gluten free’ have been allowed to contain small amounts of gluten.

However, new rules, published on 21 January 2009 relating to the use of the claims ‘gluten free’ and ‘very low gluten’ should make it easier for you to choose foods that are suitable for you.

Foods labelled as 'gluten free' are allowed to have small amounts of gluten in them (less than 20 parts of gluten in a million). This is because it’s difficult to make foods that are completely free of gluten. As well as 'gluten free', a second labelling term 'very low gluten' has been created. This is for foods that contain a special type of starch which has been treated to remove almost all the gluten. This starch is needed in certain foods, for example bread and cakes, to add consistency and texture. However, because of the way in which it's made, manufacturers find it very difficult to remove all of the gluten from the final food and so this category allows for a slightly higher level of gluten (100 parts of gluten in a million).

People with coeliac disease can safely eat small amounts of gluten. The amount will vary from one person to another. If you eat a lot of products labelled as ‘very low gluten’ in a day this could damage your gut, but eating small amounts of these products is still thought to be safe.

Having two labelling categories will allow people with different sensitivities to choose foods which are most suitable for them. However, it’s important to remember that foods labelled as 'very low gluten' won’t be suitable for everyone, so speak to your GP or dietician before introducing these into your diet for the first time.

Ofcourse, there are lots of other foods that are naturally free from gluten such as potatoes, maize and rice, that are also good sources of starchy carbohydrate. Fruit, vegetables and unprocessed meat and fish are also free from gluten, but some processed meats such as sausages and burgers are made with cereals that contain gluten.

It’s always best to check the ingredients list on all food packs for cereals containing gluten to make sure they don’t contain gluten. It’s also important because the new labelling rules give manufacturers until 2012 to reformulate products or change their packaging, so there could still be foods on the shelf with previous labelling until then.

Coeliac UK is an organisation that produces resources to help people with coeliac disease maintain a gluten free diet and the helpline number is 0870 444 8804.

My daughter has coeliac disease and I'd like to buy her some gluten-free mince pies. Can I get them anywhere?

A number of companies make gluten-free mince pies and other food products that are suitable for people with coeliac disease. Coeliac UK produces a list of gluten-free foods for its members.

Manufacturers are not required to state on food labels how much gluten is present in foods. But foods marketed for people with coeliac disease, and those made from ingredients such as maize (which naturally does not contain gluten), or from wheat which has had the gluten taken out, may be labelled 'gluten free'.

I have been diagnosed as severely lactose intolerant. How can I tell which foods I need to avoid?

Lactose is the main sugar found in milk. When someone is lactose intolerant it means their body can't digest lactose because they don't have enough of the enzyme lactase in their small intestine.

Lactose is included as an ingredient in many ready meals and other pre-packed foods, so always check the ingredients on food labels for lactose and other ingredients that might contain it, such as whey powder and dried skimmed milk.

Since 25 November 2005, all pre-packed foods sold in the UK, and the rest of the EU, have had to show clearly on the label if they (or their ingredients) contain milk, or any of the ingredients of milk. This should make it easier for you to choose foods that are suitable for you.

Some people with lactose intolerance find that they can cope with small amounts of milk in their diet, such as a milk glaze on pastry, or one or two pieces of chocolate, but the amount that someone can tolerate varies from person to person.

Milk and dairy products with reduced lactose are available from some supermarkets and health food shops. You can also use soya, oat or rice drinks instead of milk - it's a good idea to choose one with added calcium.

It is also possible to get the enzyme lactase as drops or tablets that you can add to milk products or take with meals, to help your body break down lactose. You can buy these over the counter from pharmacies, but don't give them to children without asking your doctor or dietitian for advice.

Are autism and schizophrenia related to gluten sensitivity?

Some people have suggested that gluten in food might be one of the factors that cause autism. A number of studies have been carried out on this topic, but the results haven't been conclusive and so it's still not clear what role, if any, food might play in relation to autism. However some people with autism are very sensitive to gluten.

Some people have also suggested that schizophrenia might be made worse, or even caused, by an abnormal sensitivity to gluten. But although a number of studies have been carried out, the precise causes of schizophrenia aren't clear and no clear link between gluten and this condition has been shown.

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a disorder of the gut with similar symptoms to food intolerance. It affects 8 to 22% of the population and is more common in women. The symptoms include abdominal pain and bloating, excessive wind and irregular bowel movements.

We don't know exactly what causes IBS or how it might be linked to food intolerance. It could be caused by food not being broken down properly in the colon, which might happen when the balance of bacteria naturally present in the gut is disrupted. We don't know why some people have IBS and others don't, but many people who have IBS have a history of food intolerance.