We often misuse the terms food allergy, intolerance, and sensitivity in conversation. Knowing what type of food reaction you’re experiencing is key for making appropriate dietary choices that address the underlying problem and foster overall health long term.
Food allergy
Food allergy is a pathological immune reaction against normally harmless proteins in foods, which can be life-threatening. This immune reaction can trigger acute symptoms in the gut, skin, respiratory tract, cardiovascular system, and neurological system.
Common food allergens include dairy, egg, fish, shellfish, tree nuts, peanuts, soy, and wheat.
Food intolerance
Food intolerance is a non-immune mediated reaction arising from an insufficiency of enzymes required to break down a specific component of food. This reaction commonly causes gastrointestinal symptoms such as diarrhea.
Common causes of food intolerance include lactose, gluten, FODMAPs (a group of short-chain carbohydrates), additives, and biogenic amines such as histamine.
Food sensitivity
A food sensitivity is an adverse reaction to food that is not related to food allergy, food intolerance, or celiac disease. Food sensitivities can cause digestive issues in addition to widespread symptoms such as chronic joint pain, fatigue, rash, and brain fog. If you’re dealing with chronic health concerns, it may be beneficial to investigate unidentified food sensitivities.
Diagnosis and management
Begin by asking your family doctor for a referral to an allergist, which will allow you to pursue allergy testing. Skin prick tests and blood tests are commonly used to identify IgE immunoglobulin mediated food allergy. Food allergy is best managed with complete avoidance and emergency medication.
If your allergy testing comes back normal, then you might want to consider intolerance or sensitivity as the cause of your symptoms. While testing options may include hydrogen breath testing for lactose intolerance and blood testing for IgG food sensitivities, Harvard Health considers the elimination diet to be the gold standard for identifying problematic foods.
Speak with a naturopathic doctor or nutritionist for support during an elimination diet and how to implement new dietary habits to accommodate food intolerance and sensitivity. Ask about natural supports for gut healing using minerals, amino acids, and herbs.
Dos for dining out
- Learn hidden sources of your food allergen (sauces, oils) and common sources of cross-contamination (deep-fried foods).
- Choose a restaurant that uses whole, rather than processed, foods.
- Call the restaurant ahead and ask if they have an allergy-friendly menu.
- Tell your server about your concerns and ask for recommendations.
- Bring reinforcements in case of allergen exposure, whether that’s an epinephrine autoinjector (EpiPen), digestive enzymes, or peppermint tea.
Embracing new food habits
- Google common alternatives to your favorite foods.
- Borrow allergen-free cookbooks from the library.
- Prep meals on Sundays for a smooth work week.
- Involve the family in cooking dinner.
- Challenge your friends to try new cuisines and restaurants that cater to your needs.
By Dr. Cassie Irwin, ND
