IgE-mediated food allergy is common, affecting up to 10% of the population. Ingested allergens bind to IgE antibodies that are attached to surface receptors on mast cells and basophils, triggering release of mediators including histamine. Symptoms develop within minutes to a few hours and most commonly affect the skin, mucous membranes, respiratory, and gastrointestinal tracts. Diagnosis is based on history, with testing used judiciously to confirm the diagnosis. While interventional therapies to mitigate food-induced allergic reactions have begun to emerge, management continues to focus on allergen avoidance and emergency preparedness with prompt treatment of severe reactions with intramuscular epinephrine.