Food allergy may present with a variety of respiratory tract symptoms that generally involve immunoglobulin E antibody-mediated responses. Exposure is typically through ingestion, but in some cases, inhalation of airborne food particles may trigger these reactions. Upper and lower respiratory tract reactions are often a significant component of multisystem, anaphylactic reactions. However, chronic or isolated asthma or rhinitis induced by food is unusual. It is important to recognize that food allergy in early childhood is a marker indicating an increased risk to develop respiratory allergy. The role of food allergy in otitis media is controversial and probably is extremely rare. Likewise, asthmatic responses to food additives can occur but are uncommon. Studies using blinded oral food challenges have demonstrated that foods can elicit airway hyperreactivity and asthmatic responses. Therefore, an evaluation for food allergy should be considered in patients who are at risk, including those with recalcitrant or otherwise unexplained acute, severe asthma exacerbations, asthma triggered after ingestion of particular foods, and asthma that is accompanied by other manifestations of food allergy (e.g., anaphylaxis, moderate to severe atopic dermatitis).