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Topic of the Month: Food Allergies, Sensitivities, & Intolerances

Dec 01, 2022 10:35AM ● By Editor
From Sawtooth Mountain Clinic and Cook County Public Health and Human Services • December 1, 2022

In December's Topic of the Month you'll find:
  • The differences between a food allergy, sensitivity, and an intolerance
  • How to manage and treat them
  • Whether direct-to-consumer tests are reliable, valid, or worth the money
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If you’re lucky, you can gobble up any food you like without concern about allergies, sensitivities, or intolerances.  For about 4-6% of children and 4% of adults though, consuming the wrong foods or drinks can result in uncomfortable, or even life-threatening, reactions. 

Allergy vs. Intolerance vs. Sensitivity

Allergies, sensitivities, and intolerances happen in different systems of the body.  Allergies happen in the immune system.  For unknown reasons, the body will identify a food as an allergen and then treat it like a dangerous invader.  The body mounts an attack and produces antibodies called Immunoglobulin E (IgE). These antibodies then cause other cells to release chemicals that cause an allergic reaction.  Allergic reactions to a food can be caused by consuming even a minuscule amount, touching it, or just inhaling microscopic particles from the air.  Symptoms usually start within minutes of consuming that food. 

Allergic reactions can include:

  • Skin reactions (hives, itchiness, swelling)
  • Vomiting or diarrhea
  • Respiratory symptoms (shortness of breath or wheezing)
  • Anaphylaxis - a life-threatening reaction that may include:  Difficulty breathing, dizziness, or loss of consciousness.  Injected epinephrine and medical care are required immediately.

The symptoms of food allergies happen most commonly in babies and children, but they can appear at any age.  It’s even possible to develop an allergy to a food that has been eaten for years without any problems.
 
Food sensitivities can cause immune reactions that generate symptoms across body systems joint pain, stomach pain, fatigue, rashes, and/or brain fog.    Some people may be “cross-reactive,” meaning they react to foods that are related, while other people are comfortably able to consume similar foods. 

Food intolerances happen in the digestive system and occur when someone’s body can’t properly digest a food.  This can happen because their body doesn’t produce enough of a certain enzyme or because their body is reacting to a specific chemical in the food (either one that’s there naturally or one that’s been added). Symptoms of intolerances may take hours to show up as the food moves through the digestive tract. 
 
They may be inconvenient, but unlike allergies, intolerances aren’t immediately dangerous.  Many people with intolerances can eat small amounts without having problems. 
 
Symptoms of a food intolerance can include:

  • Abdominal (belly) pain, gas, or bloating
  • Diarrhea or constipation
  • Headaches or migraines
  • Heartburn
  • Nausea or upset stomach
  • Skin rashes

The most common types of food intolerances are:

Lactose - Worldwide, only about 35% of people over the age of 7 or 8 can digest dairy products.  As most people get older, their bodies make less lactase, the enzyme that processes lactose (the naturally-occurring sugar in milk).
 
Histamine - This occurs naturally in foods such as cheese, pineapples, bananas, avocados, chocolate, red wine, and some white wines.  People that are histamine intolerant don’t make enough of the enzyme diamine oxidase.
 
Gluten - This protein is found in wheat, rye, and barley.  Some people have a hard time digesting it and are referred to as being “gluten intolerant.”  Celiac disease, on the other hand, is a complex autoimmune disorder, in which the immune system causes damage to the small intestine after a person eats gluten.

Management and Treatment of Intolerances, Allergies,  & Sensitivities
 
Allergies
The primary way to manage food allergies is to avoid consuming foods that cause a reaction. This involves diligent label-reading, but not all consumables are required to list potential allergens, such as  meat, poultry, certain egg products, distilled spirits, wine, and beer.  Additionally, some cosmetics, shampoos, and other health or beauty items may contain tree nut extracts or wheat proteins, but aren’t required to disclose them.
 
Eating out can be especially challenging.  Restaurant staff may not know all the ingredients of every dish that they serve.  Depending on a person’s level of sensitivity, even walking into a restaurant could cause a reaction.
 
Not only can it be difficult to know what allergy-causing ingredients are in foods, but sometimes it can be difficult to gauge the danger of foods.  The severity of allergic reactions can be unpredictable.  Someone that has previously experienced only mild symptoms can, without warning, experience anaphylaxis.  This a life-threatening reaction that can impair breathing and cause blood pressure to fall to dangerously low levels.  People with diagnosed food allergies should have an epinephrine auto-injector with them at all times.  It is the only treatment for anaphylaxis.
 
Sensitivities
Elimination diets can help identify food sensitivities.  This is the process of carefully experimenting, observing, and documenting both foods and the reactions that they may cause.  Over a period of weeks, foods are first removed, and then reintroduced - one by one.  This is best done with the guidance of a physician or registered dietician.  They can help you understand the limitations of this experiment and avoid potential difficulties.
Intolerances
Identifying food intolerances is also done by using an elimination diet.  Some people may be able to consume small amounts of a food and have only minor reactions.  The symptoms may be tolerable or helped by taking over-the-counter medications such as lactase enzymes, antacids, or antidiarrheals. Dietary changes may need to happen for intolerances to be properly addressed. 
 
What have I got?
 While some of the symptoms of allergies, sensitivities, and intolerances can be similar, because allergic reactions can be life-threatening, it’s important to know which one you have.  Food allergies are diagnosed based on a history of reactions AND a positive skin or blood test to confirm the allergy.  If there’s only a positive skin or blood test but no history of reactions, this can mean that a person is sensitized, but not necessarily allergic.
 
There are no accurate, validated tests to identify intolerances, but keeping a food diary can help to single out problem foods. 
IgG Food Sensitivity and Other Tests
 
There are direct-to-consumer tests that claim to be able to spot food sensitivities by checking for immunoglobulin antibodies, typically one called IgG.  These have not been shown to pinpoint either food allergies or food sensitivities with any reliability.  A positive IgG test simply shows that someone has been exposed to that food in the past; it doesn’t show an allergy to food.
 
There are many other tests that allege to be able to identify food allergies or sensitivities (even “hidden” ones - whatever that means).  They have 
no scientific validation, lack quality control, and should not be used to diagnose food allergies. Examples of invalid and unreliable tests include the ones below.  You can learn more about each of these tests by clicking on the previous links.

1. ALCAT, ELISA, ACT, and NuTron Tests
2. Applied Kinesiology or NAET Test (Nambudripad’s Allergy Elimination Technique)
3. Basophil/Leukocyte Histamine Release Test
4. Cytotoxic Assay Tests
5. Electrodermal Test
6. Patch Test
7. Provocation/Neutralization Test
8. Skin End-Point Titration Test
9. Lymphocyte Stimulation Test
10. Facial Thermography Test
11. Gastric Juice Analysis Test.
12. Endoscopic Allergen Provocation Test
13. Hair Analysis Testing
14. Mediator Release Assay
15. Pulse Test
 
If you have questions, contact your SMC provider! 218-387-2330
Want some help with those pesky labels?  Then you'll want to read Decoding Nutrition Facts Labels.  Learn how to "cut the CRAAP" and separate medical facts from fiction in Informational Winnowing.

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