Soy allergy: Foods to stay away from

You may not think your child eats many soy foods. But soy is used as a filler, binder, or flavoring in hundreds of products. Foods to stay away from include:

• Any breads, cakes, rolls, crackers, or breading that contain soy flour

• Canned tuna fish that contains soy

• Cold-pressed, extruded, or expeller-pressed soy oil. Ask your child’s healthcare provider whether refined soy oil is safe.

• Any commercial soups that contain soy flour

• Commercially prepared meats such as hamburger that use soy as an extender

• Edamame. These are fresh soybeans cooked in the pod.

• Some fruit drink and hot cocoa mixes. Check the labels.

• Granola, energy, or breakfast bars made with soy

• Ice cream that contains soy flavoring

• Imitation crab or bacon

• Luncheon meats that contain soy, such as pork sausage

• Some medicines. Ask your child's healthcare provider or pharmacist which medicines may contain soy.

• Miso. This is fermented soybean paste.

• Oyster sauce or fish sauce (nam pla or nuoc mam)

• Salad dressings, mayonnaise, prepared sauces, and gravies containing soy products

• Soybeans

• Soy milk, soy cheese, soy yogurt, and soy ice cream

• Soy nut butter and peanut butter that contain soy

• Soy nuts. These are toasted soybeans used as a snack.

• Soy protein, soy flour, and soy grits

• Soy sauces: teriyaki, tamari, and shoyu

• Soybean sprouts

• Tempeh

• Tofu (soybean curd), okara (soybean pulp), and tempeh and natto (fermented soybean products)

• Vegetable shortening and margarine and other butter substitutes

• Vegetarian products and meat substitutes, such as soy-based hamburgers and tofu hot dogs

• Worcestershire sauce

• Soy lecithin. This is often found in candies and other processed foods. Talk with your child's healthcare provider about whether your child needs to stay away from soy lecithin.

• Generic vegetable oil. Note: The risk for an allergic reaction to soy lecithin and soy oils is low. But a reaction can happen. Studies show that most people who have an allergy to soy may eat products that contain soy lecithin and soy oils. This is because these substances are fat-based, and people with allergies react to the protein portion of the food.

What to look for on labels

Soy appears in some form in many packaged and prepared foods you'd never expect to contain it. When in doubt, call the manufacturer’s toll-free number on the label. U.S. manufacturers of packaged food items must state clearly on the label if it contains soy. Always read the entire ingredient label to look for soy. Soy ingredients may be within the list of the ingredients. Or soy could be listed in a “contains soy" statement beneath the list of ingredients. Be alert for these ingredients:

• Hydrolyzed soy protein, hydrolyzed vegetable protein (HVP), hydrolyzed plant protein

• Lecithin. Ask your child’s healthcare provider if this is safe.

• Mono- and diglycerides. These emulsifiers made from soy oil can appear in foods ranging from instant mashed potatoes to chewing gum and ice cream.

• Monosodium glutamate (MSG). This may be made from soy protein.

• Natural and artificial flavoring. These are often soy-based.

• Textured vegetable protein (TPV)

• Vegetable broth

• Vegetable gum and vegetable starch. These are often made from soy.

• Vitamin E, which contains soybean oil

Foods that don't contain soy could be contaminated during manufacturing. Unfortunately, labels like "processed in a facility that also processes soy" or "made on shared equipment" are not regulated by the FDA. They are voluntary. Talk with your child’s healthcare provider about whether your child may eat products with these labels or if your child should stay away from them.

Some foods and products don't have to state if they contain soy. These include:

• Foods not regulated by the FDA

• Cosmetics and personal care items

• Prescription and over-the-counter medicines and supplements

• Toys and crafts

• Pet food

Eating out safely

Because soy products are so common, take extra care in restaurants.

• Take care with Asian cuisines such as Chinese, Japanese, Thai, and Vietnamese. They use many soy-based foods, including oyster sauce, soy sauce, and tofu.

• Be careful in buffets and salad bars, where cross contact with soy foods is likely.

• Ask questions about ingredients, even if your child has eaten them in the past. Don’t rely on menu descriptions, especially in restaurants that use prepared foods.

• Carry a “chef card.” This special card explains your child’s food allergy to restaurant workers. You can make your own card or print one from a website on the Internet.

Create a safety plan

• Always carry epinephrine, such an epinephrine auto-injector or nasal spray, if prescribed by your child's healthcare provider. Always have two doses available. Make sure you and those close to your child know how to use it. If your child doesn’t have epinephrine, talk with your child’s healthcare provider to see if you should carry it.

• Have your child wear a medical alert bracelet or necklace with their allergy information.

• Talk with your child's healthcare provider about making an anaphylaxis action plan in case of an accidental exposure to soy. Go over this plan with everyone who cares for your child.

• Educate your child's teacher, school nurse, and appropriate school personnel, including cafeteria staff, about your child's allergy. Share your child's anaphylaxis action plan and be certain delegated and trained school personnel have emergency access to epinephrine. All students with anaphylaxis must be monitored closely and transported by ambulance to an emergency care center as soon as possible.

Soy allergies in babies

Soy allergies in infants can show up shortly after birth. It may be a cause of loose stools, colic, and poor growth. Breastfeeding only for your baby's first 6 months is best. But if you are unable to breastfeed, your baby's healthcare provider may prescribe special formula.

If your child has any of the symptoms listed below, act quickly!

Use epinephrine right away if it has been prescribed. Then call 911.

• Trouble breathing or cough that won’t stop

• Swelling of the mouth or face

• Dizziness or fainting

• Vomiting or severe diarrhea