Dealing with food sensitivity or intolerance can disrupt your daily routine and affect your general health. Enjoying your favorite meals might come with unwanted consequences, leading to anxiety when dining out. Although symptoms of food sensitivity or intolerance in adults are typically mild to moderate, food allergy reactions can be severe, posing potential life-threatening risks.
If you suspect you’re experiencing adverse reactions to certain foods, accurately identifying whether it’s a food allergy is crucial for your safety, well-being, and overall quality of life. However, distinguishing between a food sensitivity, intolerance, or a genuine food allergy can be challenging as their symptoms may overlap. It’s essential to understand the distinctions between an allergy and an intolerance.
In this blog post, Dr. Tyler Basen delves into the distinction between food allergies and food intolerances, aiding you and your loved ones in understanding the nuances and ensuring a healthier dietary experience.
What is Food Sensitivity or Intolerance?
Often used interchangeably, food sensitivity is synonymous with food intolerance. Approximately 20% of the global population experiences some form of food sensitivity/intolerance. These conditions primarily affect the digestive system but can also manifest in skin or respiratory issues, such as rashes or nasal congestion.
Various factors can contribute to food intolerance. Enzyme deficiencies, sensitivities to food additives, environmental allergies, or naturally occurring chemicals in foods can all hinder the body’s ability to properly ingest or digest certain foods or ingredients.
One of the most prevalent forms of food sensitivity is lactose intolerance. Individuals with lactose intolerance lack the enzyme lactase, necessary for breaking down lactose found in milk and dairy products. Symptoms typically involve digestive discomfort, including gas, nausea, and abdominal pain.
Similarly, individuals with gluten intolerance (non-celiac gluten sensitivity) struggle to digest wheat, barley, or rye, leading them to avoid foods like cereals or breads. Symptoms of gluten intolerance vary widely, encompassing bloating, constipation, joint pain, anemia, and even depression and anxiety.
Irritable Bowel Syndrome (IBS) is another common example of food intolerance, although its connection to food sensitivity and intolerance is not entirely understood. Research suggests that IBS flare-ups often occur after consuming specific foods and beverages, such as wheat, dairy, milk, and carbonated drinks. Recent evidence indicates that IBS symptoms may be triggered by underlying intolerances. Seeking a thorough diagnosis from a gastroenterologist or specialized nutritionist can aid in understanding the causes, symptoms, and management strategies for IBS.
Symptoms of Food Sensitivity/Intolerance
The symptoms of food sensitivity or intolerance can vary significantly from person to person, influenced by the type of sensitivity and its severity. Common symptoms include:
- Stomach Pain
- Gastrointestinal discomfort
- Bloating
- Excessive gas
- Diarrhea
- Vomiting
- Nausea
- Fatigue
- Acid reflux/heartburn
- Skin flushing
- Irritability or anxiety
- Headaches
These symptoms typically worsen as the quantity of the offending food consumed increases. They may manifest suddenly or develop gradually over hours, occasionally persisting for days afterward.
Other Health Conditions That Can Cause Food Reactions
Certain health conditions can lead to adverse reactions to food, posing challenges in diagnosis. Examples include:
- Eosinophilic Esophagitis (EoE) – inflammation of the esophagus, stemming from various causes.
- Food Protein Induced Enterocolitis Syndrome (FPIES) – a rare, potentially severe reaction to food proteins characterized by delayed vomiting and diarrhea.
- Food Protein-Induced Allergic Proctocolitis (FPIAP) – primarily affecting healthy infants, presenting with mucus or blood in stool, often triggered by milk or soy proteins in breast milk, typically resolving by 12 months of age.
- Celiac Disease – a genetically predisposed condition wherein gluten ingestion leads to small intestine damage.
- Eczema – a skin condition resulting in itchy, rough skin, influenced by various factors.
- Oral Allergy Syndrome (OAS) — a pollen-associated food allergy syndrome, often due to cross-reactivity between plant proteins from pollen and fruits or vegetables, rarely leading to anaphylaxis.
- Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) – certain foods are well-tolerated unless consumed around exercise, potentially triggering severe, life-threatening allergic reactions.
Understanding the Distinction Between Food Allergy and Sensitivity/Intolerance
Differentiating between food sensitivity and a true food allergy isn’t always straightforward, as symptoms may overlap. However, two key factors aid in diagnosis:
Reaction Location
Sensitivities typically manifest in the digestive system or gastrointestinal tract, resulting in various forms of stomach discomfort.
Threshold
In food sensitivity, small quantities of the offending food can usually be consumed without causing symptoms.
Although food sensitivity/intolerance can disrupt daily life, it’s not life-threatening. It won’t induce anaphylaxis, regardless of the amount ingested. Conversely, a food allergy triggers an immune response, releasing antibodies (IgE) and prompting the body to perceive the food as a threat — even trace amounts can provoke severe or life-threatening reactions.
The critical disparity lies in the potentially life-threatening nature of food allergies, necessitating individuals to carry two epinephrine autoinjectors (such as an EpiPen) at all times. It’s advisable for those with diagnosed food allergies to establish an anaphylaxis treatment plan for family and friends to facilitate swift action in case of accidental exposure. Consulting a board-certified allergist can aid in determining whether your symptoms stem from a food sensitivity or a more serious allergic reaction.
How Food Intolerance/Sensitivity is Diagnosed
Presently, there are no established or dependable diagnostic tests for food sensitivities or intolerances. However, a board-certified allergist can assess whether testing for food allergies would be beneficial to rule out the possibility of a life-threatening condition, ascertain if referral to another specialist is warranted, or suggest an elimination diet supervised by a registered dietitian.
Diagnosing Food Allergy
When symptoms suggestive of a food allergy, such as hives, swelling, or respiratory problems, arise, the standard diagnostic procedure consists of four crucial steps. It commences with a comprehensive clinical history, elucidating the reactions occurring upon intentional or accidental ingestion of the suspected food. Subsequent steps involve skin prick testing and blood tests to measure specific IgE antibodies indicative of allergic response. Following a thorough review of patient history and test results, if deemed appropriate by the clinician, an oral food challenge may be proposed to ascertain the individual’s ability to consume the food safely.
What if Symptoms are Attributed to Another Medical Condition
In cases where a food allergy specialist discerns that symptoms may not be solely linked to a particular food but could signify an underlying medical condition, various possibilities exist. Autoimmune diseases, gastrointestinal disorders, and dermatological conditions are among those that can present symptoms resembling a food sensitivity. In such instances, a food allergy specialist can offer a referral to another specialist, such as a gastroenterologist, dermatologist, or general allergist, for further evaluation and management.
How Nutrition Counseling Aids in Sensitivity Diagnosis
Employing an elimination diet, where specific foods are temporarily eliminated from the diet, can serve as a valuable diagnostic method to pinpoint food triggers associated with certain sensitivities. However, embarking on an elimination diet without the supervision of a qualified clinician can pose risks such as nutrient deficiencies, adherence challenges, and inconclusive outcomes. Seeking guidance from a registered dietitian proficient in elimination diets ensures a safe and effective process, facilitating accurate diagnosis and optimal management of food sensitivities.
If you have more questions about the difference between food allergies and food intolerance, please contact us. Pacific Allergy & Asthma would be more than happy to assist and answer any questions today!
