Identifying and avoiding triggers for children with asthma can make a huge difference in their well-being. Members of MyAsthmaTeam have discussed this important topic. One member asked, “What triggers make asthma worse?” and “How do you manage these triggers?”

Common asthma triggers include:

• Respiratory infections
• Dust mite allergy
• Air pollution, including car exhaust and wildfire smoke
• Pests like mice and cockroaches
• Mold
• Disinfectants

What triggers one person’s asthma may not trigger another’s. Members of MyAsthmaTeam have shared their experiences with triggers. One member shared, “Cold air and drinks sometimes cause me to flare. As does super humid warmer air. I’ve recently found that I flare a little bit sometimes after eating foods that contain dairy (I’m not allergic).”

Asthma Attacks vs. Anaphylaxis

Certain foods can provoke asthma symptoms, but this is uncommon. Food allergies, on the other hand, are common, affecting about 1 in 12 children in the United States. Anaphylaxis — a severe allergic reaction that can be caused by food allergies — can resemble an asthma attack. Both can cause wheezing, cough, and shortness of breath. Understanding their differences and triggers is essential for safe asthma and allergy care.

A few characteristics can distinguish anaphylaxis and an asthma attack. Usually, anaphylaxis symptoms develop suddenly, right after exposure to an allergen — a substance that causes an allergic reaction. Anaphylaxis often involves hives — a discolored, raised skin rash — and sometimes digestive tract symptoms like abdominal pain and diarrhea.

Asthma attacks, unlike anaphylaxis, usually involve just the lungs. Symptoms also tend to develop more slowly.

Both anaphylaxis and asthma attacks can be life-threatening. Children with both asthma and severe food allergies who abruptly have difficulty breathing should first receive an epinephrine injection (EpiPen) to treat the possible allergic reaction. Additionally, caregivers should call 911 and give asthma treatment as recommended in their asthma action plan.

People with asthma often have food allergies and are at a high risk of anaphylaxis, and those with food allergies are more likely to have severe asthma. Parents and caregivers of children with severe, difficult-to-treat asthma should consider consulting with an allergy and immunology doctor about food allergies. Sometimes, a pulmonologist (lung doctor) can treat asthma and can work with an allergy doctor to help manage asthma and food allergies.

If your child has asthma and you’re concerned about food allergies as possible asthma triggers, it’s important to know which foods could be responsible.

1. High-Sulfite Foods

Sulfites — types of food additives (chemicals added to food for preservation) — are known to cause asthma and allergy-like symptoms. In people with asthma, sulfites cause wheezing, chest tightness, and coughing. Other reactions can include hives, and in very rare cases, anaphylaxis.

Foods and beverages that may contain sulfites include:

• Dried fruits and vegetables
• Bottled soft drinks, lemon and lime juice, grape juice, and vinegar
• Pickled foods, including pickled onions, pickles, and sauerkraut
• Deli meats, hot dogs, and sausages
• Salads served at restaurants
• Crustaceans (e.g., crab, crayfish, lobster, prawn, shrimp)

About 3 percent to 10 percent of people with asthma have sulfite sensitivity. Inhaling or ingesting sulfite can produce sensitivity symptoms. Scientists aren’t exactly sure why or how sulfite causes respiratory symptoms, but it may be that these additives irritate people’s airways. Although food-related asthma attacks are somewhat unusual, parents and caregivers of children with asthma should use caution with sulfite-containing foods.

The remaining foods on this list are food allergens (foods that cause allergies). They’re more likely to cause a rash and anaphylaxis than sulfites.

2. Cow’s Milk

Cow’s milk is the most common food allergen among infants and young children. This condition is defined by an immune system reaction to proteins in cow's milk. Health experts estimate that in developed countries, 0.5 percent to 3 percent of babies are allergic to cow’s milk by the time they turn one. Cow’s milk allergy is most common in the first year of life and resolves in 80 percent to 90 percent of children by age five.

Symptoms of cow’s milk allergies don’t always appear immediately — they can develop days or even weeks after a child has cow’s milk. This timing depends on whether the allergy is IgE-mediated or non-IgE-mediated — that is, whether the reaction is caused by antibodies called immunoglobulin E reacting to the milk protein.

Antibodies are proteins made by the immune system to attack foreign substances. When mast cells — cells that interact with IgE antibodies and allergens — attach to an allergen, they release chemicals called histamines. Histamines cause the symptoms of allergic reactions.

An IgE-mediated cow’s milk allergy — one that’s caused by IgE reacting to milk protein — causes symptoms within an hour of milk being consumed. These symptoms include:

• Asthma-like symptoms (coughing, breathing difficulties, and wheezing)
• Hives
• Itching or tingling around the mouth
• Lip, tongue, or throat swelling
• Nausea or vomiting
• Stomach pain
• Diarrhea
• Decreased blood pressure
• Anaphylaxis

These symptoms are shared by other IgE-mediated food allergies.

Symptoms of a non-IgE-mediated cow’s milk allergy — that is, an immune system reaction unrelated to IgE antibodies — can take hours or days to start. They generally relate to the gastrointestinal tract, including:

• Vomiting (sometimes with blood in the vomit)
• Diarrhea
• Bloating
• Stomach cramps
• Belly cramps
• Colic (uncontrollable crying by an infant with an unclear cause)

Non-IgE-mediated cow's milk allergy is often mistaken for lactose (milk sugar) intolerance. Lactose intolerance doesn’t involve the immune system. Rather, it’s caused by the body’s inability to break down lactose.

3. Eggs

After cow’s milk allergy, egg allergy is the second most common food allergy among young children in the United States. It affects 0.8 percent of all children and 1.3 percent of children under 5, according to a study called Egg Allergy in U.S. Children. As with cow’s milk allergy, children usually outgrow egg allergy — it goes away in about 70 percent of kids by age 16, according to the study.

Egg allergy is defined by the immune system’s reaction to egg yolk or egg white proteins and is usually IgE-mediated. Symptoms typically develop within minutes of consuming eggs but can be delayed by up to two hours.

Importantly, researchers have found that egg allergy is the most common cause of anaphylaxis in infants brought into emergency rooms. Because of this risk, health experts recommend that children who might have an egg allergy avoid eating them until they can have an appointment with an allergist.

4. Peanuts

Peanut allergy is one of the most common food allergies among children of all ages. As of 2021, 1 percent to 2 percent of children in the Western world have a peanut allergy. Children with a peanut allergy are less likely to outgrow the condition than those with cow’s milk or egg allergies.

Like egg allergy, peanut allergy is usually IgE-mediated. Symptoms typically first appear between the ages of 14 and 24 months. Peanut allergy is one of several food allergies more likely to cause severe symptoms, including life-threatening anaphylaxis. It’s also the most common cause of fatal food reactions.

Exposure to peanuts can happen through:

• Direct contact — Eating peanuts or peanut-containing food
• Cross-contact — Eating foods that have been exposed to peanuts during processing
• Inhalation — Breathing in dust or aerosols, such as peanut flour or peanut oil cooking spray

Direct contact is the most common cause of peanut allergies. That said, given the higher risk for severe symptoms, it’s important to keep these other causes in mind.

Talk With Your Doctor

Understanding the connection between your child’s asthma and food allergies is a good starting point. Although these conditions are related, parents and caregivers should keep in mind that most foods won’t trigger asthma.

To prevent exposing your child to asthma triggers, it’s important to discuss their symptoms with their pediatrician. They’ll help identify possible triggers and give recommendations on how to avoid them.

It can also be helpful to start tracking your child’s meals and symptoms. This information will help your pediatrician better understand your concerns. If they suspect food allergies, they may order allergy testing and prescribe an EpiPen.

Find Your Team

On MyAsthmaTeam, the social network for people with asthma and their loved ones, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Are you living with asthma and food allergies? Do you know your triggers? Share your experience in the comments below, or start a conversation by posting on your Activities page.