Food allergies affect an estimated 15 million Americans and, for unknown reasons, have increased by 50% in the pediatric population between 1997 and 2011. Food allergies occur when the body’s immune system mistakes the food (the trigger) as harmful and produces an antibody (immunoglobulin E or IgE) that reacts with the allergen and releases chemicals in the body that cause the allergic reaction. Symptoms of an allergic reaction can include hives and swelling, nausea, vomiting and abdominal discomfort, wheezing and shortness of breath, and lightheadedness and a feeling of impending doom. The most common foods causing allergic reactions include peanut/tree nuts, egg, milk, soybean, wheat and fish/shellfish. Because of the potential severity of reactions, proper diagnosis, typically by allergy skin and/or blood testing is paramount. Strategies for food allergen avoidance and the development of an emergency plan, including the use of an Epi-pen or Auvi-Q in the event of a severe food allergic reaction, are also crucial. In some cases, especially with egg and milk allergy, the allergic sensitivity is thankfully lost; in-office oral food challenges are essential in determining when this has occurred.