Jewish life is lived around the table. The Friday-night challah, the kiddush after services, the Seder that stretches into the night, the camp dining hall on Shabbat: our most treasured moments involve food, and food is exactly what worries families raising a child with a food allergy. Imagine a mother watching her son, allergic to egg, reach for the Seder plate, or a grandfather passing a plate of kugel to a granddaughter who is allergic to tree nuts. These are ordinary scenes for many families, and with a little planning they need not be frightening.
Food allergy is common enough that nearly every synagogue, school and camp community includes someone who lives with it. The good news is that the traditions we cherish can be shared safely. It begins with knowing where allergens hide.
Start with Passover, when the Seder table holds an unusual number of common allergens. The roasted egg on the Seder plate is a symbol, not something anyone has to eat, but eggs also appear in matzah ball soup and kugel. Charoset is often made with walnuts or other tree nuts. Matzah itself is made from wheat or another of the five traditional grains, which matters for families managing wheat allergy. Gefilte fish is a fish dish, and the proteins can become airborne during cooking, which can be a concern for a fish-allergic child in a busy kitchen. Even macaroons, a Passover staple, are made with coconut or almonds, and some wines are clarified with fish-derived products. None of this means giving up the Seder. Many families simply make a nut-free charoset with apples, cinnamon and grape juice, keep a plain version of each dish aside from sauces, and set a separate plate for the allergic child before the meal begins.
Shabbat brings its own considerations. Challah often contains egg and wheat, and it may be topped with sesame or poppy seeds. Since January 2023, sesame has been the ninth major food allergen that must be labeled on packaged foods in the United States, a change that has helped many families. Still, not every product on a store shelf reflects the newer labeling, and homemade or bakery items carry no label at all. The kiddush table deserves special attention. Cookies, cakes, herring, salads, and kugels are laid out together, serving spoons wander from dish to dish, and small children roam freely. A synagogue can help by asking volunteers to label dishes, keeping a nut-free table or plate available, and letting families know what will be served.
Kosher labels deserve a careful reading of their own. Many people assume that a kosher symbol also means a food is safe for an allergic child, but kosher and allergen-free are different things. A product labeled pareve contains no meat or dairy ingredients and was not made on dairy equipment, yet pareve certification is a statement about kashrut, not a guarantee about allergens. The Orthodox Union makes clear that pareve certification alone does not verify allergen safety for someone with a milk allergy. Families should read the full ingredient list and the “Contains” statement on every package, every time, rather than relying on a symbol.
Camps and schools present the greatest challenge, because children spend long days away from their parents in large, noisy dining halls. Families should speak to the camp director, nurse and kitchen staff well before the first day. Ask how allergens are managed at meals, snacks and Shabbat celebrations, how staff are trained to recognize a reaction, and where epinephrine is stored. A written emergency action plan should travel with the child, and an auto-injector should be easily reachable at all times. If a serious reaction occurs, epinephrine is the first treatment, followed by a call to emergency services.
Children, too, have a part to play. As soon as they are old enough, they can learn to say no politely to food they have not checked, to ask what is in a dish, and to tell an adult if they feel unwell. Hosts and fellow congregants can make a big difference by asking, in advance, what a guest needs, and by treating an allergy as an ordinary part of hospitality. Welcoming the stranger has always been a core Jewish value, and at an allergic child’s table it means making sure that child has something safe and delicious to eat.
Communities also differ on customs such as kitniyot, the legumes and seeds some families avoid at Passover. Anyone unsure about a substitute for a family recipe should consult both an allergist and a rabbi. Medicine and tradition can work together.
As an allergist, we spend much of our time thinking about how physicians can support one another and their patients. The same spirit applies at every family table. A little preparation, a well-read label and a welcoming attitude allow every child, allergic or not, to sit down, ask the Four Questions, and enjoy the holiday.
Jonathan Bernstein, M.D., is executive vice-president and past chairperson of Allergists For Israel and a physician at the University of Cincinnati.
