Do I Have a Food Allergy, Sensitivity, or Intolerance?
FOOD ALLERGY
Reactions to foods can be immune-mediated or non-immune-mediated. An allergy is immune-mediated and is reproducible each time a person is exposed to a specific food. The National Institute of Allergy and Infectious Disease (NIAID) defines food allergy as:
“An adverse health effect arising from a specific response that occurs reproducibly on exposure to a given food”
An allergy is a type 1 hypersensitivity with positive findings for immunoglobulin E (IgE). Elevated IgE is a hallmark of allergic disease. The immune response, called an allergic reaction, occurs in 2 parts. Sensitization is the first exposure when the immune system attacks certain food proteins and creates antibodies. Subsequent exposure to the same food protein causes the food to bind to the antibodies triggering mediators like histamines. Histamines are responsible for the classic signs of allergy like rash, respiratory, or gastric distress. The proteins that trigger the reaction are called allergens. There is a lot unknown about food allergies and why the number of persons with food allergies is rising in the world. Some research blames the Western diet and attributes the rise in allergy cases to a worldwide adoption of the Western diet. Research, however, is sparse and lacks the rigor to be able to define causes for allergies Some dietary habits and lifestyle metrics that may impact allergy development are as follows:
Ultra-processed foods
Low omega-3 polyunsaturated fatty acids (PUFA)
Late introduction of solid food to infants
Low vitamin D
Geographical location
Cesarean section
Antibiotic use
Approximately 4-8% of the US population have food allergies. Besides a thorough history and checking blood for IgE levels, the gold standard for diagnosing allergies is an elimination diet. Allergy symptoms emerge shortly after eating but can appear up to 2 hours after IgE-mediated allergies and 4-72 hours after eating for non-IgE-mediated allergies. Here are 9 common allergens:
Milk
Eggs
Fish
Crustacean shellfish
Wheat
Peanuts
Soybeans
Less common but also frequent allergens include celery, sulfites, mustard, lupin, and mollusks.
Food allergen labeling is mandated in over 60 countries. In the US, the top 9 allergens must be labeled on food packages. The labeling must include the common name of the ingredient or in the less common form must include the common name in parenthesis, for example, durum flour (wheat), and albumin (egg). The ingredients must also be listed in order of quantity with the first item listed being the highest quantity.
FOOD INTOLERANCES
Food intolerances are non-immune reactions to certain food components including lactose, histamine, and alcohol. Intolerances occur when someone lacks the digestive enzyme or nutrient for breaking down the food component. Intolerance can cause flushing, cold or flu-like symptoms, inflammation, and general discomfort.
FOOD SENSITIVITY
Symptoms of food sensitivity vary from person to person. Common symptoms are migraines, headaches, dizziness, difficulty sleeping, mood swings, depression, anxiety, unintentional weight change, dark circles under your eyes, asthma, irregular heartbeat, irritable bowels, bloating, wheezing, runny nose, sinus problems, ear infections, food cravings, muscle or joint pain, indigestion, nausea, vomiting, bladder control issues, fatigue, hyperactivity, hives, rashes, dry skin, excessive sweating, and acne.
Food reactions can occur hours or days after exposure to a trigger. The reactions are usually caused in the gastrointestinal system that affects the immune system through “leaky gut”.
Common food sensitivities are developed through exposure to dairy products, eggs, gluten (wheat, rye, and barley), soy, shellfish, and tree nuts. This list is not all-inclusive and food sensitivities can develop towards many things and at varying times of life.
WHAT YOU CAN DO
As with food allergies, the best way to identify food sensitivities or intolerances is an elimination diet. If you or your healthcare provider believe you have a negative reaction to some food or foods, the best way to identify the food is to eliminate those foods, one by one, paying close attention to your body’s reaction. Some laboratory results can be helpful to assess for food sensitivity or intolerance, but the elimination diet is the most accurate way to proceed.
If you feel you may have a sensitivity or intolerance to food, please consider contacting us at Zoi Functional Medicine. We can help you with an elimination diet prescription, a food reintroduction symptom tracker, and a diet, nutrition, and lifestyle journal that will help you on your journey to better health.
References:
Kostova P, Papochieva V, Miteva D, Georgieva B, Mileva S, Shahid M, Lukanov T, Petrova G. Elevated IgE Levels-An Allergy or an Underlying Inborn Error of Immunity in Children with Recurrent Infections? Antibodies (Basel). 2023 Nov 3;12(4):70. doi: 10.3390/antib12040070. PMID: 37987248; PMCID: PMC10660463.
Gupta, R. S., Warren, C. M., Smith, B. M., Jiang, J., Blumenstock, J. A., Davis, M. M., ... & Nadeau, K. C. (2019). Prevalence and severity of food allergies among US adults. JAMA network open, 2(1), e185630-e185630.
https://www.fda.gov/food/food-labeling-nutrition/food-allergies
Food Allergy.org
Rennie, G. H., Zhao, J., Camus-Ela, M., Shi, J., Jiang, L., Zhang, L., ... & Raghavan, V. (2023). Influence of lifestyle and dietary habits on the prevalence of food allergies: a scoping review. Foods, 12(17), 3290.
Hicke-Roberts, A., Wennergren, G., & Hesselmar, B. (2020). Late introduction of solids into infants’ diets may increase the risk of food allergy development. BMC pediatrics, 20, 1-9.
American Gastroenterological Association. Food allergies and intolerances: food allergy vs. food intolerance. https://aga-cms-assets.s3.amazonaws.com/201821420832---All_FAI_2017.pdf. Updated July 2017. Accessed April 2, 2020.
