It's Probably Not Allergies: Food Allergies vs. Food Intolerance

Given all the discussion and news about food allergies, many parents may assume that chronic tummy aches and sniffles signal that the child has developed allergies. However, that assumption is often misguided. In fact, most children with persistent runny noses, rashes, and gastrointestinal distress do not have true allergies at all. They may have what is known as sensitivities, or a food intolerance.

Most kids, despite what it may seem, do not have true allergies. Those that do, must avoid that food at all costs. But if they have an intolerance, which many people do have, they can eat that food judiciously: it is about the quantity and frequency of exposure. It does not mean you have to eliminate the food from your child’s diet, it means you have to keep track of how much and how often she consumes it. A perfect example is wheat: People with celiac disease must avoid wheat altogether. But most of us are actually wheat intolerant in this country, because of the way wheat is processed here - compare a fresh baguette in Paris that is stale by the end of the day if not eaten, versus a loaf of grocery food bread that lasts on the shelf literally for months! So if you child eats a bagel for breakfast, has a sandwich for lunch and then attends a birthday party with birthday cake, she might wake up with a crampy stomach ache, or be inexplicably irritable, and say she feels “sick” but really she simply went over her sensitivity threshold by eating too much of a single food group (wheat) that she is intolerant of. Think how often you eat a bowl of pasta and feel like “oh I ate too much” when, calorie-wise, it isn’t necessarily more than usual, but it’s the wheat load.

And, it's not only wheat that is the culprit.

What is an food allergy:

True allergic reactions cause the body’s immune system to develop antibodies against what it perceives to be a foreign invader. The immune system responds to the invader (antigen) by creating specific antibodies called Immunoglobulin E, or IgE. Every time you eat this food again, the body sends IgE antibodies and other chemicals, including histamine (which is why some allergy medications are called antihistamines) out into the bloodstream. Although most antibodies are protective, IgE antibodies can cause a broad variety of inflammatory reactions. These reactions can range from mild to extreme; in the worst case, allergies can be deadly.

Symptoms of a food allergy may include:

  1. Anaphylaxis = Sudden, severe, life-threatening reaction, shock

  2. Chest pain, wheezing, shortness of breath

  3. Itching, rashes, hives, watery eyes

  4. Stomach pains, diarrhea

Allergies can be measured with a blood test or a skin test.

No one knows exactly why some people are allergic. Heredity does play a factor, although it is not the whole story. The usual food triggers are:



Peanuts, Tree nuts

Fish and shellfish

Wheat and Soy

What is a food intolerance?

A food intolerance is not the same as a food allergy. An intolerance is not antibody mediated. Thus there are no direct blood or skin tests for intolerances. It is caused by a problem in the way the body processes a particular food or food additive. For example, a child with lactose intolerance will have stomach aches or pains or diarrhea if they consume a lot of milk products, but this is caused by a lack of lactose enzymes or metabolites, rather than an immune response. Importantly, intolerance does not lead to anaphylaxis (allergic shock) or require that you completely avoid the food. An intolerance means you will feel better if you avoid too much of the food - less bloating, less changes in your stools, less fatigue - but you are not going to end up in the emergency room if you eat the food. You can “ knowingly cheat” when you choose too.

Food allergies can be triggered by even a tiny amount of the offending food, and the reactions are consistent, each time the food is ingested. True food allergies are predictable and generate stereotypic immune responses such as hives, wheezing and possibly the need for epinephrine. With intolerances, symptoms do not usually show up until the person consumes either a large portion of the problem food or eats it frequently over the course of a few days. The symptoms are much less dramatic, and often get misdiagnosed as other illnesses.

Symptoms include:

Bloating, cramps, short-lived diarrhea

Nausea, isolated vomiting, stomach pain

Irritability, fatigue

Excess mucus production, sneezing, runny nose

What to do?

Keeping a food diary is a great way to track symptoms as they relate to food exposure… Although you have a good sense of what your child eats, keeping a simple table of meal time, food, and reaction/symptom for each meal/snack throughout the day, for two weeks. Don’t make a big deal out of it for your child. You do not want your child to become self-conscious. Just record whether the child complains, has bloating or gas, burping, diarrhea.

Because food sensitivities vary with each child, getting them under control requires a more holistic approach rather than the symptom-specific ones used to diagnose allergies. Therein lies the problem: perhaps because of the focused attention to and awareness of allergies, the more subtle diagnoses and treatment of children suffering from intolerances often gets missed. The problem is compounded by the fact that intolerances do not show up on routine “allergy testing.”

The solution to a seemingly elusive set of complaints is in your hands: take a look at the symptom complex: your child may have a runny nose and a stomachache, a rash and a cough, diarrhea and crankiness. Children with these combinations of respiratory, gastrointestinal and skin symptoms have a heightened response to various food-based triggers, causing them to have symptoms that may seem unrelated, but actually can be addressed with nutrition-based healing.

For more on this topic: The Food Cure for Kids: A Nutritional Approach to your Child’s Wellness.

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