Food Allergy vs Food Intolerance- What is the difference

What happens when your food is not compatible with your body? Do you experience gastrointestinal issues or bloating and fatigue when you eat? Or maybe you suddenly get skin rash or migraines when you eat your beloved takeout? Don't worry; you are not alone. 

Statistics show that up to 26 million Americans may suffer from a food allergy vs a food intolerance, and over 65 million may suffer from a food intolerance. However, these statistics may be on the low side because some people are not properly diagnosed. 

The symptoms of a true food allergy vs a food intolerance are different from those caused by an intolerance. Allergies can be severe and life-threatening, involving the immune system. Food intolerances are generally milder and do not involve the immune system. Food intolerances usually involve the cells, digestive system, or a deficiency in a particular enzyme, which means that particular food isn't being broken down and digested properly by the body. Lets look at the key differences between an allergy vs a food intolerance. 

What is a food allergy?

A food allergy can cause severe symptoms in some people, such as anaphylaxis. Allergic reactions can occur even from the smallest amount of the offending food item, triggering a range of immediate responses. Food allergy reactions can take seconds to minutes to show signs and symptoms. 

What are the symptoms of a food allergy vs a food intolerance?

Milder allergic reactions to a trigger can be: 

• Coughing
• Wheezing 
• Itching
• Runny or stuffy nose
• Watery red or puffy eyes

More severe allergic reactions to a trigger can be: 

• Tingling in the mouth
• Swelling of the lips, tongue, face, or throat
• Hives
• Anaphylaxis

Anaphylaxis symptoms: 

• Constriction and tightening of the airways
• Shock with a severe drop in blood pressure 
• Dizziness or lightheadedness and sometimes a loss of consciousness
• Fast racing heartbeat or pulse

It is essential to rule out allergies first by consulting your medical professional.

Why do allergies develop? 

Food allergies can develop at any time. However, they are more common in young children and usually can be lifelong. Scientists do not yet fully understand why or how someone develops allergies. The most common foods which may cause allergies: 

• Wheat 
• Soy 
• Eggs 
• Dairy
• Peanuts
• Shellfish or fish 
• Tree Nuts 

When to see a doctor 

See your allergy specialist or doctor if you notice symptoms resembling a food allergy. However, you must seek urgent emergency treatment if you start to develop signs or symptoms of anaphylaxis.  

How is an allergy tested vs a food intolerance test?

Allergies are usually identified via a blood sample, skin prick, or scratch test. A blood sample is required to identify the immune system's response to the suspected trigger. The allergy test will determine the reaction of your immunoglobulins (IgG, IgE, IgM, IgA) in the blood when that particular trigger item is mixed. Doctors may also use blood tests to help identify immunodeficiencies (i.e., when the immune system isn't working as it should).

 What is food intolerance or food sensitivity?

Intolerances, commonly referred to as food sensitivities, can have delayed response time and usually involve the digestive system or cellular reaction to a particular trigger. Reactions can take between hours or days to show signs. The delayed onset of responses from a food intolerance may mean that food intolerances may be harder to identify due to the many different single items a person may have been exposed to or consumed within that period. 

What are the symptoms of food intolerances?

Food Intolerance symptoms may range from:

• Digestive issues, such as constipation, bloating, flatulence, gas, and diarrhea
• Excess mucus in the throat or nose
• Joint pain or inflammation of the muscles
• Skin conditions, such as acne, rosacea, psoriasis, and eczema
• Weight gain, or water retention
• Decrease energy and lethargy 

How is a food intolerance tested?

Food intolerances may be tested in various ways:

Hydrogen breath test 

The hydrogen breath test is a medical test measuring hydrogen gas levels (H02) in a person's breath. When the body is not breaking down sugars from lactose (milk protein), glucose (sugars from carbohydrates), or fructose (sugar's from fruits), it is then fermented by bacteria in the small intestine and the colon. 

The hydrogen is absorbed from the intestines, carried through the bloodstream to the lungs, and exhaled. This is an excellent option for people who want to target dairy, gluten, and fruit intolerances. 

Food Diary / Self-Elimination Diet 

An elimination diet involves noting down all the food and drinks consumed daily and monitoring any reactions that may occur over a few hours to a few days. You can buy a food diary online or use food diary apps to track every item to start a food diary. 

Food Sensitivity or Intolerance Test

At-home food sensitivity testing kits require a person to submit a sample, which could be:

• blood from a skin prick test
• strands of hair
• a mouth swab

It may take up to several weeks to receive the results.

Why do food intolerances develop? 

The most common reason food intolerances develop is the absence of a particular enzyme, which can cause improper digestion and uncomfortable symptoms. Every food item which is consumed requires a certain enzymatic process to break down that food fully and then absorb the nutrients from that food. For example, the lactose found in milk cannot be broken down if there is a lactase deficiency. The sugar found in lactose remains undigested and intact, causing the bowels to ferment the sugar found in lactose resulting in bloating and gas. This fermented process can often trigger a lactose intolerance. 

Lactose intolerance has been found to be very common in North America. Research has found that through evolution, the population is genetically programmed to lose their lactase enzymatic ability after a certain childhood age. There is still hope! Depending on the level of symptoms, you may still be able to ingest lactose-based foods (such as milk and cream) if a lactase digestive enzyme is consumed with every lactose-based meal to help break down the lactose. 

Other conditions of a food sensitivity or a food intolerance: 

• Caffeine Sensitivity - when people produce less of a liver enzyme called CYP1A2. This plays a role in how quickly the liver metabolizes caffeine.
   
• Sulfite Sensitivity - this is when people may have a partial deficiency of the enzyme sulfite oxidase, which helps break down sulfites in food items such as dried apricots, canned fruits, wine, and cereals.
  
  
• FODMAPS - when a group of sugars ferments in the digestive tract due to an imbalance in bacteria. Enzymes such as amylase and glucoamylase, cellulase, lactase and invertase, and other enzymes break down FODMAPs. FODMAP foods include beans and lentils, some vegetables such as onions, garlic, and cauliflower, some fruits such as apples, cherries, and mango.
   
• Sucrose intolerance - Sucrose intolerance or genetic sucrase-isomaltase deficiency (GSID) is the condition in which sucrase-isomaltase, an enzyme needed for proper metabolism of sucrose (sugar) and starch (e.g., grains), is not produced or the enzyme produced is either partially functional or non-functional in the small intestine. Sucrose is found in sugar, sugary drinks, fast food, and baked goods.
   
• Fructose intolerance - alterations in the ALDOB gene can cause hereditary fructose intolerance. The ALDOB gene provides instructions for making the aldolase B enzyme. This enzyme is found primarily in the liver and is involved in fructose breakdown (metabolism), so this sugar can be used as energy. Fructose is found in most fruits.
  
  
• Sugar alcohol sensitivity (sorbitol, mannitol, maltitol, lactitol, isomalt) - this is when a series of sugar alcohol enzymes are deficient in the body, causing bloating and gastrointestinal distress. Sugar alcohols are found in most jellies, candies, ice creams, chocolate, chewing gums, protein powders, prunes, and berries. 

Updated Testing for Food Intolerances

New technologies are emerging to better diagnose food intolerances. The hydrogen breath test, which is widely used for lactose and fructose intolerances, has now been adapted for additional food triggers like sorbitol and gluten. Newer versions of this test are more accurate and quicker, offering an improved patient experience. Advances in lab-based food sensitivity testing also allow for more precise identification of non-immune-related food triggers. These advancements are expected to make diagnosis and personalized treatment plans more accessible.

Impact of Modern Diets on Food Sensitivities

Changes in modern diets, including an increased consumption of processed foods and sugars, have been linked to the rising prevalence of food intolerances. An article from The Lancet highlighted that the overuse of artificial additives, preservatives, and food colorings might be contributing to the global increase in food sensitivities and allergic reactions. Additionally, higher intake of refined carbohydrates and low fiber content may alter gut bacteria, making individuals more susceptible to food intolerances.

Food Intolerance: The Role of Gut Microbiome

Recent research has shown that food intolerance, especially in relation to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), may be closely linked to the gut microbiome. A study published in Nature found that the imbalance in gut bacteria might be responsible for some symptoms of food intolerance, including bloating, gas, and diarrhea. This growing area of study suggests that managing food intolerances may benefit from targeted probiotics or dietary adjustments aimed at restoring healthy gut flora

Emerging Research on Food Allergies

Recent advancements in food allergy treatments have made a significant impact. For example, oral immunotherapy (OIT) is showing promise in desensitizing patients to specific allergens like peanuts. A clinical trial published by the New England Journal of Medicine suggests that OIT can increase a patient's threshold for tolerating the allergen, providing more flexibility in daily life.

Additionally, biologic drugs such as omalizumab (Xolair), which were initially developed for asthma, are now being approved for managing severe allergic reactions. These medications block IgE antibodies, reducing the frequency and severity of allergic responses. The FDA’s recent approval for food allergy treatments offers new hope for patients who previously had limited options.

What’s Next in Food Allergy and Intolerance Management?

Looking ahead, research into personalized medicine for food allergies and intolerances is set to expand. Genetic testing and microbiome analysis could provide valuable insights into an individual’s predisposition to certain food sensitivities. The future may see more customized treatment options based on genetic markers and gut health, leading to more effective management for sufferers of food allergies and intolerances.

When to Seek Medical Advice: A Growing Concern

With the increasing recognition of food intolerances and allergies in the medical community, patients are encouraged to seek professional help earlier in the process. Many food-related issues, from digestive discomfort to more severe reactions, can often be misdiagnosed as unrelated conditions. Working with a medical professional who specializes in allergies and intolerances can help identify the root cause of symptoms and offer strategies for managing these conditions.

The Takeaway 

There are significant differences between food allergies vs intolerances to be aware of. Food allergies affect the immune system, and food intolerances involve the cells and the digestive system. While food intolerances may not be life-threatening, food allergies can be, and this is why it is essential to rule out allergies first and foremost. 

It may also be possible that you may not be allergic to a certain food item but intolerant, and vice versa. This is because the immune system can react differently to the digestive system and cells of the body. 

Food allergies can happen quickly and can be triggered even by the smallest portion of food. In contrast, food intolerances vs allergies, may require more significant amounts of that food intolerance trigger and can take between hours and days to show signs or symptoms.

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