Food allergy or food sensitivity?
cropped view of doctor in white coat and latex gloves holding marker pen near marked female hand
A growing number of individuals suffer with digestive problems and reactions they attribute to the foods they eat.
These symptoms range from bloating, nausea, fatigue and pain to hay fever-like symptoms, such as sneezing, rashes or itchy eyes.
If, indeed, your symptoms are food related, the question is whether it is truly an allergic reaction or if you simply have a sensitivity to certain foods.
A recent study by the Institute for Public Health and Medicine revealed that while nearly 1 in 5 adults in the U.S. believe themselves to be food allergic, the number who are food allergic is actually closer to 1 in 10. The same study revealed that only 1 in 20 are estimated to have a physician-diagnosed food allergy.
Further, the report concluded that approximately half of all food-allergic adults developed at least one allergy as an adult, suggesting that adult-onset allergy is common in the United States.
“Some of the symptoms of food intolerance, food sensitivity and food allergy are similar,” said Dr. Lyda Cuervo Pardo, assistant professor at the University of Florida’s Department of Medicine. “However, a food allergy can cause a serious or even life-threatening reaction.”
Dr. Angela K. Pham, MD, also of the UF medical department, said, “Food sensitivity and food intolerance is much more common than actual food allergy. Food allergy is an adverse response produced by your body’s immune system to certain foods.”
She explained that food allergies cause your immune system to react in a way that leads to hives, swelling of your airways and trouble breathing, and without medical attention it can be life-threatening. The most common food allergies include shellfish, fish, soy, sesame, wheat, milk, eggs, peanuts and tree nut allergies.
On the flip side, intolerance is difficulty digesting or metabolizing a certain food and the amount eaten is directly related to the severity of the symptoms. The most common example is lactose intolerance.
“As we age, we produce less lactase, the enzyme that helps us digest a sugar present in dairy,” explained Cuervo Pardo. “In this case, most frequently symptoms are related to the gastrointestinal (GI) track.”
According to Pham, without enough lactase to break down dairy products, you end up with undigested dairy in your digestive tract, which can cause diarrhea and gas.
“Everybody has different tolerance to lactose,” she advised. “Some people eat a little bit of cheese or ice cream and notice symptoms almost immediately.”
The more you eat, the more severe the reaction, she offered, adding that if any person was to drink a gallon of milk or similarly large quantity of dairy products at one sitting, it would overwhelm their system.
Another common food sensitivity that she diagnoses is gluten sensitivity. The formal term for this is “non-celiac gluten sensitivity” to avoid confusion with celiac disease or grain allergy.
“This is a condition in which someone has symptoms related to eating wheat products, but do not have any blood tests, genetic tests, endoscopy findings, or biopsy findings to confirm a diagnosis of celiac disease or wheat allergy,” said Pham. “However, these folks will find that avoidance of wheat products improves their quality of life and prevents symptoms that include bloating, abdominal pain, diarrhea, fatigue, brain fog, and inability to concentrate.”
Both doctors advise that you should let your symptoms be the guide to who to turn to for answers.
“If you are having serious symptoms such as breathing difficulties, seek medical attention immediately,” Pham said. “If your symptoms are GI-related, such as bloating, diarrhea or abdominal pain, it would be reasonable to seek evaluation by a gastroenterologist after initial consultation with your primary care doctor to make sure there are not concerns regarding your general health, since sometimes thyroid disorders, diabetes, or cardiac concerns can have GI manifestations. If your symptoms are more related to itching, rashes, or skin issues, it is reasonable to seek evaluation from an allergist first.”
Both also agree that keeping a detailed food diary of your symptoms following consumption of various foods can be helpful in finding culprits and can help the doctors as they begin your work up. They also believe that eliminating certain foods for a short period, while maintaining your food diary, can reveal potential issues.
“Sometimes if no specific disease process is diagnosed by the specialist, they may diagnose you with a condition called irritable bowel syndrome (IBS),” Pham said. “IBS symptoms often will respond to an elimination diet called the low FODMAP diet. The other big culprits that cause GI symptoms are lactose and gluten, and GI specialists will sometimes recommend that you try eliminating dairy and wheat from your diet to see if your symptoms improve.”
She offered the caveat that you should not eliminate wheat from your diet before seeing your gastroenterologist.
“For some tests, you need to have been exposed to wheat recently to get an accurate diagnosis, and thus gastroenterologists will often request that you resume eating wheat for the two weeks preceding your blood test and/or endoscopy.”