Through many conversations of explaining my complicated dietary issues that I’ve experienced over the past few years, I realized many are not familiar with the difference between an allergy, intolerance, and sensitivity. While some of the adverse food reactions may seem similar, they are all very different, and can all be serious or even deadly.
Defining These Adverse Food Reactions:
"Adverse reactions to food (ARF) encompass food allergies and food intolerances, both of which can result in distressing symptoms and adversely affect health." (1)
Food allergies involve a response from the immune system (usually IgE mediated responses), due to the allergy of a protein within the food. If the food is consumed, individuals usually experience symptoms within minutes, or up to 2 hours, and will most likely have a reaction, even with a small amount ingested. When an individual has a food allergy, the body sees the substance as harmful, and reacts in a way to protect itself. This usually results in dangerous inflammation, digestive issue, skin rashes, or another immune response. Food allergy responses can also be triggered from not only consumption, but even direct contact or airborne. (1,2)
Ex. Dairy Allergy: An “intolerance” to dairy, due to being allergic to a milk protein such as whey.
Food intolerances are reactions to foods that do not involve the immune system, but instead an inability to digest, absorb, or metabolize a certain food, due to the lack of certain agents in the body required for these processes. This often results in digestive complications, but reactions can vary. Often times, individuals with an intolerance can eat a small amount of the food without experiencing symptoms. Symptoms and reactions can occur from 30 minutes to 24 hours after consumption.(1)
Ex. Lactose (dairy) Intolerance: An intolerance to dairy (specifically lactose) due to the lack of producing lactase, an enzyme needed to digest lactose.
“The umbrella generic term food sensitivity is used when it is unclear whether the reaction is immunologically related or due to a biochemical or physiologic defect” (1) Sometimes individuals with food sensitivities may have symptoms similar to a food allergy or food intolerance. A reaction or symptom may take 72 hours (3 days) to appear. This makes “diagnosing” a food sensitivity, extremely complicated and difficult. Often times, these are difficult to link to food because the symptoms could occur such a long time after eating the food. Normally, with a food sensitivity or intolerance, the individual must consume the food in order to have a reaction, whereas an allergic reaction could occur by simply touching the food, or something that had cross contact with the allergen. A sensitivity could be temporary or permanent. Some research has found that environmental factors could trigger a food sensitivity, such as stress, life changing events, toxicity, gut complications such as IBS, SIBO, etc., food poisoning, antibiotic intake, or more.(1,3)
Ex. Dairy-Sensitivity: (This one gets pretty complicated) An individual may eat some dairy one day, then have a migraine or intense inflammation 2 days later.
Ex. Dairy-Sensitivity: An Individual could grow up consuming dairy regularly, but during their first year of college, they didn’t get as much sleep, experienced high amounts of stress, and ended up coming down with regular infections, which required antibiotics. The consistent intake of antibiotics, the chronic stress, and lack of sleep could have lead to an imbalance of gut microbiome, and put the body in a fight or flight (often a weekend state), thus the inability to properly digest many foods. (more about gut health in this blog HERE.)
Misconceptions & Facts!
Misconception: The most common food allergy is peanuts:
False. The most common food allergy may change depending where you live. In the U.S., it is dairy, but in France, latex related foods seemed to be the most common, especially bananas and avocados. Cow’s milk and eggs seem to be the most common across the globe, but many countries experience different levels of the occurrences. While milk is the most common allergen, peanuts are more commonly discussed due to them having high rates of anaphylaxis and death. (4,5,6.)
Misconception: Food allergies become more severe overtime.
False. There is no such thing as a mild, moderate, or severe allergy, however there can be mild, moderate, and severe reactions. While some individuals claim that their reactions become more severe overtime, there is no scientific evidence to back up these testimonies. (2,7)
Misconception: You are born with a food allergy.
False. Allergies are developed after birth, not in the womb. While some infants may develop food allergies, this is uncommon the first year of life. (3,7)
Misconception: If you keep your infant away from a food, he/she is less likely to develop an allergy.
This old method has been proven to cause the opposite results. Studies have found that infants who were exposed to common allergens within the first year of life through airborne, direct contact, or even breast milk, were less likely to develop an allergy. (7,8)
Misconception: Sensitivities and intolerances are not as serious as food allergies
False….kind of….While an allergy may produce a severe reaction right away, sensitivities and intolerances can still be very serious, and could lead to other chronic and dangerous medical issues down the road. (1)
Fact: The U.S. now has 9 top common food allergies:
milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans, and as of 2020 sesame.
Fact: Allergies, sensitivities, and intolerances are not easy to diagnose.
The “golden measure” for testing and measuring food allergies, intolerances, and sensitives, is Oral Food Challenges (OFC). This method is performed under supervision of a health care professional, with the participant consuming small amounts of the food, and documenting symptoms. Self-reporting is another common method used when clients simply report foods they have experienced symptoms/reactions with. The 3rd most common way to measure is IgE testing, however, this is normally only done for food allergies, not sensitives or intolerances. (2,3,7)
What about those sensitivity tests you can buy online?
More on this to come in a later blog, but in short, these are not regulated as well as they should be, and can provide results that may not be 100% accurate or dependable.
Treatment, Management, and Prevention.
The cause of adverse food reaction is not fully understood, and research is just beginning to uncover some of the underlying reasons for the occurrences such as illness, genetic, infancy nutrition, pregnancy nutrition and more. For some, treatment and management of any adverse food reaction can be easy, but often times, it can be a stressful, tedious, and daunting task.
Management and treatment can differ for every individual, and research is constantly being conducted on the best methods for this, as well as methods to prevent adverse food reactions.
In Part 2 of this blog, we discuss what research currently says about prevention, treatment, and management.
Sources:
1. Mahan LK, Raymond JL. Krause's Food & the Nutrition Care Process.; 2017.
2. Woods RK, Abramson M, Bailey M, Walters EH. International prevalences of reported food allergies and intolerances. Comparisons arising from the European Community Respiratory Health Survey (ECRHS) 1991–1994. European Journal of Clinical Nutrition. 2001;55(4):298-304. doi:10.1038/sj.ejcn.1601159
3. Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organization Journal. 2013;6:21. doi:10.1186/1939-4551-6-21
4. Irani C, Maalouly G. Prevalence of Self-Reported Food Allergy in Lebanon: A Middle-Eastern Taste. International Scholarly Research Notices. 2015;2015:1-5. doi:10.1155/2015/639796
5. Kanny G, Moneret-Vautrin D-A, Flabbee J, Beaudouin E, Morisset M, Thevenin F. Population study of food allergy in France☆. Journal of Allergy and Clinical Immunology. 2001;108(1):133-140. doi:10.1067/mai.2001.116427
6. Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy. 2014;69(8):992-1007. doi:10.1111/all.12423
7. Pratap K, Taki AC, Johnston EB, Lopata AL, Kamath SD. A Comprehensive Review on Natural Bioactive Compounds and Probiotics as Potential Therapeutics in Food Allergy Treatment. Frontiers in Immunology. 2020;11. doi:10.3389/fimmu.2020.00996
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