If you have an uncomfortable reaction every time you eat a certain food, you might be wondering if you have some kind of food sensitivity. But what is the difference between an allergy and an intolerance, and how can you tell which one you might be suffering from?
It’s easy to get confused as these conditions present themselves in a similar way. Food allergies and food intolerances can occur in response to the same dietary triggers and both result in similar symptoms such as stomach cramps, diarrhea and skin rashes. But the underlying mechanisms behind these conditions could not be more different, and proper diagnosis is essential if you want to receive the right treatment.
In this article, we answer all of your top questions about food allergies and intolerance, from causes to treatment.
What is a food allergy?
According to that American Academy of Allergy, Asthma and Immunology (opens in new tab), a food allergy is a chronic condition that involves an abnormal reaction to a normally harmless substance. Your immune system views the allergen as an invader and sets off a chain reaction to “neutralize” it. It stimulates white blood cells to produce something called IgE antibody, which attach to cells in our body and cause release of powerful chemicals. One of these chemicals is called histamine.
When levels of these chemicals rise rapidly, we experience a range of uncomfortable or even dangerous symptoms. Common signs are itching in the nose, palate, throat and eyes, runny nose and watery eyes. Food allergies can also be accompanied by vomiting, diarrhea and breathing problems immediately after ingesting a substance.
In severe cases, a sufferer can go into anaphylactic shock. This is a potentially life-threatening condition that can be cured with an immediate injection of a drug called epinephrine.
According to a review in Clinical Reviews in Allergy & Immunology (opens in new tab)There are three types of food allergies: IgE-mediated, mixed, and non-IgE-mediated. They have different symptoms and require different diagnostic tests. Non-IgE-mediated food allergies encompass a variety of diseases, such as atopic eczemainflammation of the digestive tract, esophagitis and celiac disease. Symptoms usually appear early, with researchers suggesting that up to 20% of infants may have one of these conditions. The most common food allergies in children are milk, egg, soy, wheat, peanuts, tree nuts, fish and shellfish. Milk and egg allergies usually resolve, but nut allergies usually persist.
Corresponding Data (opens in new tab), at least 26 million US adults have a food allergy. However, they are not evenly distributed across the population. Electronic Health Record (opens in new tab) suggest that the prevalence of food allergies and intolerances may be almost twice as high in women as in men, and that Asian ethnic groups appear to be the most affected group.
What is a food intolerance?
According to the American Academy of Allergy, Asthma and Immunology, a food intolerance occurs when a person has trouble digesting a particular food. This can lead to symptoms such as bloating, abdominal pain or diarrhea. Based on the data from several studies (opens in new tab)Food sensitivities can affect up to 20% of US adults.
Scientists point to pharmacological effects of dietary components, non-celiac gluten sensitivity or enzyme defects as possible causes of this chronic condition. There is also a growing understanding of the role that short-chain fermentable carbohydrates (FODMAPs) can play in triggering symptoms. Food intolerances are often associated irritable bowel syndromebut as a scientist from the Journal of Nutrition (opens in new tab) indicate that there is no conclusive evidence that this is the case.
The three most common food intolerances are lactose intolerance (a type of sugar found in dairy products), intolerance to casein (a type of protein found in dairy products) and gluten Intolerance (a type of protein found in grains such as wheat, rye and barley).
What is a food sensitivity?
Corresponding Harvard Medical School (opens in new tab), Food sensitivities include uncomfortable symptoms that routinely occur after eating certain foods, but they are not related to food intolerance, food allergies, or celiac disease. There is much controversy surrounding these conditions as not much is known about their origins. It appears that exposure to certain foods can trigger a powerful non-allergic immune response, which in turn produces symptoms such as joint pain, stomach pain, fatigue, skin rashes, and brain fog. These symptoms are not life-threatening, but they can significantly affect your quality of life.
Food intolerances are not permanent and can subside after a while. It has been suggested that the decrease or increase in symptoms could be due to changes in the functioning of our immune system or the composition of our gut bacteria.
diagnosis of an allergy
Diagnosing an allergy, food intolerance, or food intolerance can involve several steps. Your doctor will likely ask you questions to better understand your personal and medical history. They may do a physical exam, and you may be asked to undergo a pulmonary function test to see how well you’re exhaling air from your lungs. In certain cases, an x-ray of your lungs or sinuses may be needed.
The skin prick test (SPT) can be one of the most accurate and inexpensive ways to confirm your susceptibility to allergens. A small drop of the possible allergen is placed on a patch of skin, which is then gently pricked or scratched with a needle. If you are sensitive to the allergen, you will develop symptoms such as redness, swelling and itching within 15 minutes. You may also see that the affected area is raised and inflamed (the so-called “wheal”). In general, the larger the wheal, the more likely it is that you are allergic to the substance. However, a positive result alone does not mean a diagnosis.
Patch testing is used to determine which allergens may be causing the exposure dermatitis. A small amount of a possible allergen is applied to your skin and then covered with a bandage. Your doctor will check for possible skin reactions after 48 to 96 hours.
Blood tests are typically used if you have a skin condition or are taking medications that interfere with skin tests. Your blood sample is measured by the amount of antibodies your blood cells produce to neutralize the allergen. This test is called a specific IgE (sIgE) blood test (sometimes called the RAST or ImmunoCAP test). While it may sound like a reliable and accurate method, blood tests provide many false positive results and therefore cannot be used alone to diagnose an allergy.
Challenge tests are conducted under the close supervision of a qualified medical professional. You inhale or eat a small amount of the allergen and a doctor monitors your reaction and intervenes if you go into anaphylactic shock. Because provocation tests pose a major health risk, certain conditions must be met before you are allowed to perform them.
The most effective way to avoid food allergy symptoms is to eliminate the allergens from your diet and immediate environment. Under the Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA), US-based food manufacturers are required to clearly state on packaging whether their product contains any of the eight most common food allergens: milk, egg, wheat, soy, peanut, tree nut, and fish shellfish. If a food has been manufactured without the use of these allergens, manufacturers must indicate whether there was any possibility of cross-contamination during the production process.
You must remain vigilant, especially if you have a severe allergy that increases the risk of anaphylactic shock. Be sure to check food labels carefully, learn what to avoid and always ask for a list of potential allergens when eating out. Also remember that you may come into contact with allergens in cosmetics, hair products and other health and beauty supplies.
Going into anaphylactic shock is extremely dangerous and the only effective treatment is an immediate epinephrine (adrenaline) shot. For this reason, many food allergy sufferers are prescribed emergency epinephrine auto-injectors, commonly referred to as EpiPens. It’s good practice to always have two doses on hand, as this severe reaction can recur in about one-fifth of those affected.
Adrenaline must be injected whenever you experience symptoms such as difficulty breathing, coughing, dizziness, hives, tight throat, rash, vomiting, diarrhea or abdominal pain.
Diagnosis and treatment of food intolerance
Managing food intolerances and sensitivities can be more complicated than food allergies. You may need to spend a lot of time observing your body and experimenting with your diet. One strategy is to remove the foods you think are causing side effects for a two to four week period, then reintroduce them to watch for any symptoms.
It is recommended that you have a qualified doctor or nutritionist monitor your progress and guide you on your path to recovery. You may need to stick to a strict diet to ensure your negative symptoms don’t come back.
There is also evidence that the alignment on your gut health could help support your food intolerances. Pay attention to an intestinal-friendly diet and intake probiotics helps many sufferers keep their conditions in check.
According to a published review Critical Reviews in Food Science and NutritionLive bacteria and yeast supplements can help relieve the symptoms of lactose intolerance. There is also evidence that regular consumption of probiotics can help people with gluten intolerance, as stated in the Current opinion in clinical nutrition and metabolic care Diary.
This article is for informational purposes only and is not intended to provide medical advice.
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