How can you know the difference and why it matters
By Deborah Jeanne Sergeant
Food allergies, intolerances and sensitivities can perplex those not affected by them.
Some people may even try to “slip in a little” of the offending food in a dish thinking that the person with a special diet is being overly picky for avoiding it.
Beyond being disrespectful of others’ wishes, this is a dangerous line of thought.
Bodily responses to restricted foods can range from skin issues to GI upset to anaphylaxis and death. To better understand why food allergies, intolerances and sensitivities are so important, it’s vital to recognize the differences and similarities among them.
“Many people have adverse reactions to various foods they eat,” said Haidy Marzouk, ENT, otolaryngologist and allergist at St. Joseph’s Health. “This can vary from bloating and heartburn to life threatening reactions and there is a spectrum of symptoms in between. Many can term these events as intolerance or allergy, but the two are quite different.
“When we talk about food allergies, it is a term very specific to an overactive immune response from the body to a food item that it should not consider to be foreign,” Marzouk said. “These reactions are most often fairly immediate after ingestion but can range to a few hours after ingestion. They will usually involve IgE antibodies to the food. Symptoms of this type of reaction can involve swelling, hives, difficulty breathing and abdominal symptoms. These reactions can progress to be life threatening in some cases.”
Common food allergens include peanut, shellfish, wheat, tree nut, eggs, dairy, sesame seed, peach, banana, avocado, kiwi fruit, passion fruit, celery, strawberry, garlic, mustard seed, aniseed and chamomile. According to Food Allergy Research and Education, about 33 million people in the US have a food allergy. Some of these will be outgrown; others are lifelong.
For those that have a food allergy that’s not outgrown, the patients who experience anaphylaxis must continue to completely avoid the food and using medication such as epinephrine, antihistamines and corticosteroids can help in case of accidental exposure. Those who have a non-life-threatening response such as digestive issues should also avoid the reactive food and can manage responses with different medication and strategies in case of exposure.
Some food allergies can be minimized with medication. It may not mean the patient is free to eat the allergenic food, but the medication can offer protection in case of accidental ingestion.
Healthcare providers can use medical tests to confirm allergies. It’s not as cut-and-dried with intolerances, but more like trial and error. Using an elimination diet and food journaling can help patients detect when symptoms appear. Patients can also learn their limits and triggers. For example, someone with lactose intolerance may not be able to drink a milk shake but can have a small amount of cheese.
“Food sensitivities can have other mechanisms involved that do not involve an immune response,” Marzouk said. “For example, people can lack digestive enzymes needed to digest certain foods resulting abdominal symptoms and/or brain fog, as in the case of lactose intolerance or non-celiac gluten sensitivity. Other people can be more sensitive to chemical irritants in the GI tract, such as caffeine. Although these reactions are uncomfortable, they are not considered allergies.”
As with food allergies, people with food intolerances should also avoid the offending foods. For lactose intolerance, patients can take over-the-counter enzyme supplements such as Lactaid with their first bite of dairy to aid in its digestion.
Wheat allergy triggers a systemic response to exposure. However, celiac disease, triggered by eating wheat and some other grains, is an autoimmune disease that over time causes damage to the small intestine and can impact things like nutrient absorption. Patients may have bloating, flatulence, constipation, headaches, depression, fatigue, gastrointestinal pain and joint pain. Healthcare providers can test for celiac disease.
People with non-celiac gluten sensitivity (NCGS) or gluten intolerance or gluten sensitivity may test negative for celiac but by the process of elimination find that they feel better when they avoid or at least minimize gluten in their diet. NCGS isn’t an immune disorder.
Whether a person experiences a food allergy, intolerance or sensitivity, the hardest foods to eat safely are those with complex ingredient lists. Some ingredients go by different names than many consumers are accustomed to. Potluck dinners can feel like minefields. Most people find it’s easiest to bring their own dishes so they know that it has been prepared without cross contamination from foods that harm them.