Food Intolerance OR ALLERGY? 

Food Intolerance or food allergy- they are often used interchangeably which can be very confusing. There is also a lot of overlapping symptoms.

 

However, there are some important differences due to the fact that allergy involve the immune system while food intolerance does not. 

FOOD ALLERGY CLUES

  • ​Symptoms of food allergy typically include hives (urticaria), swelling around the mouth, and vomiting, usually within 30 minutes of eating a food, although cell mediated allergies can be more delayed

  • Even tiny amounts of the trigger food will cause reactions

  • There are 2 types of true allergies: one is IgE allergy which shows on on testing, and the other is cell mediated allergies which do not show up up on testing

  • Can be life threatening (anaphylaxis)- rarely happens and IgE only.

  • Symptoms of severe allergic reactions (anaphylaxis) affect breathing and/or our heart and may include: difficult/noisy breathing, swelling of tongue, swelling/tightness in throat, difficulty talking/hoarse voice, wheeze or persistent cough, persistent dizziness and/or collapse, and becoming pale and floppy in young children. 

  • Food allergy is more common in people who have other allergies such as allergic rhinitis (hay fever), asthma or eczema.

More than 90% of food allergies are caused by the following protein foods: peanuts, tree nuts (eg macademia), fish, shellfish, cow's milk, eggs, soy, wheat,  sesame and lupin. However, any food has the potential to be allergenic as all food contain even small amounts of protein.

In Australia, the most common food allergens are egg, peanut and cow's milk in children and tree nuts and seafood in adults.

The Food Standards Code requires these foods to be declared on labels whenever they are present as ingredients or as components of food additives or processing aids.

If you are have food symptoms (adult), chances are you are more likely to be suffering from food intolerances than a food allergy.

  • Up to 2% of adult Australians have foods allergies

  • It is thought that at least 10% of the population have intolerances.

If you have a food allergy as an adult then there is a 70% chance that you will also also suffer from food intolerances.

Allergies should be considered in babies or children with food symptoms. Allergies to milk, egg, wheat and soy are more common in  babies than older children and adults:

  • infants less than 12 months of age (10%)

  • children 1 - 5 years of age (4 - 8%) 

  • older children 10-14 years (5%)

 

Milk, egg and soy allergies commonly resolve with age. Most young children grow out of their milk allergies by the 3-5 years of age, with 85% grown out of it by the age of 5. Roughly 50% of children grown out of their egg allergy by the age of 6 years. Peanut, tree nut, sesame, fish and shell fish allergies usually persist.

FOOD INTOLERANCE CLUES

  • ​Symptoms to offending foods is dose related. This means that trace or tiny amounts of the problem foods are unlikely to set of symptoms, and you will only react when there is a build up in your system and your personal threshold is crossed

  • This means that a food may cause a problem one day but not cause a problem another day. This is very typical of food intolerance reactions.

  • Symptoms only subside when the chemicals are able to be broken down and removed from the body which can take from days to weeks.  Symptoms will not subside however if the offending food(s) continue to be eaten.

  • Reactions are usually not life threatening (rarely  for food chemical intolerance and never for FODMAPs) although you may feel very unwell

  • Does not show up on allergy testing

Food Allergy?

If you suspect a food allergy (especially in a child) then you need to see an Allergy or Immunology Medical Specialist. See your GP for a referral.

IgE allergies can be diagnosed through IgE blood tests (RAST tests) or skin prick tests (SPT) and oral food challenges which must be done under medical supervision due to the potential seriousness of the reactions. This is very important if you have life threatening or severe reactions. These tests are often carried out on adults and children but are less reliable with young babies.

Many people with positive allergy tests do not actually have an allergy. For this reason, it is really important that only trained medical professionals perform and interpret the test. 

Cell-mediated allergies  do not show up on any testing and their reactions tend to be more delayed. 

 

Treatment involves complete avoidance of the problem foods, as even minute amounts of the offending food can provoke reactions.

Allergies and food intolerance often co-exist. 

Food Intolerance?

There are different types of food intolerances (FODMAPs or food chemicals or whole foods)- data such as family history, types of foods thought to bring on reactions, types of symptoms  can indicate which is most likely. They often occur together.

 

It is advisable to check with your doctor to eliminate any other causes of your symptoms including Coeliac Disease. Think of checking for Coeliac Disease before gluten is eliminated as gluten needs to be in the diet at least 4-6 weeks prior to the tests. It can be hard to put it back in once removed from the diet.

 

No matter the current fad, there are no scientifically valid tests for food intolerances as food intolerances do not involve the immune system which means they do not involve the IgE anti-bodies. 

 

FODMAP or FOOD CHEMICAL elimination diets are the only way of diagnosing food intolerances.

 

Based on your unique reaction profile, a properly constructed diagnostic diet is put together to match your individual dietary requirements to help you identify what is causing your food symptoms and how to best manage your diet to minimise symptoms throughout the rest of your life.

References

  1.  Lesley Clarke, Jenny McQueen, Ann Samild, Anne Swain. Dietitians Association of Australia review paper: The dietary management of food allergy and food intolerance in children and adults. Aust J Nutr Diet, 1996. 53: 89-98. Retrieved 2017-4-22.

  2. Australasian Society of Clinical Immunology and Allergy. (2016). Food Allergy. Retrieved 2017-3-9.

  3. Sicherer SH, Wood RA, Vickery BP, et al. The Natural History of Egg Allergy in an Observational Cohort. The Journal of allergy and clinical immunology. 2014;133(2):492-499.e8. doi:10.1016/j.jaci.2013.12.1041.

  4. Better Health Channel. Food Allergy and Intolerance. 2013-July. Retrieved from: 

  5. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/food-allergy-and-intolerance. Retrieved on: 2017-4-22.

  6. Ascia. Information for Parents, Consumers and Carers. Food intolerance. www.allergy.org.au. 2014-Jan. Retrieved from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Food_intolerance_2014.pdf. Retrieved on  2017-4-23.

  7. Anderson, J. Food-sensitive babies, dietary investigation for breastfed babies. 2017, Specialist Dietitian and Lactation Services.

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