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.
“Food allergy is mediated by the immune system,” said Shahzad Mustafa, allergist and immunologist with Rochester Regional Health. “It can put you at risk for anaphylaxis.”
Immune responses can also include hives, swelling of the tongue, mouth or face, low blood pressure, vomiting, diarrhea, stomach pain, hives, faintness, coughing, wheezing and hoarseness. The body responds this way because the immune system perceives the offending food as a threat, even though most people don’t have this response.
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.
“It’s more trial and error,” Mustafa said. “We don’t have testing. Reactions are reproducible. Intolerances can be inconsistence as it’s more dose dependent.”
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.
“An intolerance isn’t always mediated by the immune system and there’s no risk of anaphylaxis,” Mustafa said. “It’s not enjoyable but not life-threatening.”
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 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.