Food allergies affect as many as 6% of young children, most of whom 'outgrow' the sensitivity, and about 2% of the general population. Although any food may provoke a reaction, relatively few foods are responsible for the vast majority of food allergic reactions: milk, egg, peanuts, tree nuts, fish, and shellfish. Many of these food allergens have been characterized at a molecular level, which has increased our understanding of the immunopathogenesis of many responses and may soon lead to novel immunotherapeutic approaches. Food allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and may be due to IgE-mediated and non-IgE-mediated mechanisms. A systematic approach including history, laboratory studies, elimination diets, and often food challenges will lead to the correct diagnosis. Currently, management of food allergies consists of educating the patient to avoid ingesting the responsible allergen and to initiate therapy in case of an unintended ingestion.