I chose to do this particular post because I kept hearing people often confuse being intolerant to something to actually being allergic to something. They are not the same thing and in my opinion should not be treated as such. Food reactions are common, but most are caused by a food intolerance rather than a food allergy. I have a food intolerance to whey and soy and a rare spice allergy to Italian Seasonings (Rosemary, Basil, Thyme, Marjoram, and Oregano). Both of my younger daughters have an intolerance to artificial additives, salicylates, nitrates, nitrites, and MSG (ADD/ADHD) and my middle daughter has an allergy to pineapple. Educate yourself and know what to do. I was able to save my daughter’s life by knowing what to look for, what to do, and when to get her to the nearest Emergency Room.
Here’s the difference…
A food intolerance is when you cannot properly digest a substance in certain foods, often due to an enzyme deficiency. In other words, a food can contain a molecule that your body has difficulty breaking down or is not digested properly, causing an intolerance response as that molecule is allowed to continue down your intestinal tract. Food intolerance symptoms generally come on gradually, usually several hours (even up to 48 hours later) after ingesting the offending food or compound and may even persist for several hours or days. Food intolerance is a chemical reaction that doesn’t involve the immune system.
Foods most commonly associated with food intolerance:
- Dairy products
- Grains that contain gluten
- Foods that cause intestinal gas buildup, such as beans and cabbage.
According to Medical News Today (MNT), the most common causes of food intolerance are the following…
- Absence of an enzyme needed to fully digest a food. Lactose intolerance is a common example.
- Irritable bowel syndrome. This chronic condition can cause cramping, constipation and diarrhea.
- Food poisoning. Toxins such as bacteria in spoiled food can cause severe digestive symptoms.
- Sensitivity to food additives. For example, sulfites used to preserve dried fruit, canned goods and wine can trigger asthma attacks in sensitive people.
- Recurring stress or psychological factors. Sometimes the mere thought of a food may make you sick. The reason is not fully understood.
- Celiac disease. Celiac disease has some features of a true food allergy because it does involve the immune system. However, symptoms are mostly gastrointestinal, and people with celiac disease are not at risk of anaphylaxis. This chronic digestive condition is triggered by eating gluten, a protein found in wheat and other grains.
- Natural occurence of histamine in some foods. Some foods, such as fish that has not been stored properly, can have an accumulation of histamine as they “rot”. A number of people are particularly sensitive to this naturally-occurring histamine and develop skin rashes, abdominal cramps, diarrhea, vomiting and nausea.
- Salicylates present in many foods. This is also known as salicylate sensitivity. It occurs when somebody reacts to normal amounts of ingested salicylate. Salicylates are derivatives of salicylic acid, which occurs naturally in plants as a defense mechanism against harmful bacteria, fungi, insects and diseases. Salicylates are present in most plant-sourced foods, including the majority of fruits and vegetables, spices, herbs, tea and flavor additives. Mint-flavoring, tomato sauce, berries, and citrus fruits have particularly high levels of salicylates. Processed foods with flavor additives are usually high in salicylates as well.Most people can consume salicylate-containing foods without any adverse effects, but a number of people suffer symptoms after eating large amounts. Salicylate intolerant individuals should avoid foods that are high in salicylates.
- Food additives.Food additive intolerance has been a steadily-growing problem over the last thirty years, because more and more foods contain additives. Even so, food additive intolerance is not estimated to affect more than 1% of people. Food additives are used to enhance flavors, make foods look more appealing, and to increase their shelf life.
Examples of food additives include:
- Artificial colorings
- Artificial flavorings
- Flavor enhancers
The following food additives are known to cause adverse reactions in people:
- Nitrates – known to cause itching and skin rashes. Processed meats are generally high in nitrates and nitrites.
- MSG (monosodium glutamate) – used as a flavor enhancer. Known to cause headaches.
- Sulfites – used as a food preserver or enhancer. Commonly used in wines.
- Some colorings – especially carmine (red) and annatto (yellow).
- Stomach pain
- Abdominal cramps
- Asthma-like symptoms
- Dark circles under the eyes
- Dry cough
- Irritable bowel
- Joint pains
- Mouth ulcers
- Nasal congestion
- Night sweats
- Throat irritations
- Irritability or nervousness
The best current treatment for food intolerance is to either avoid certain foods or eat them less often and in smaller amounts, as well as taking some supplements that may help digestion. Some people find that if they stay away from the culprit for a while, they have no reaction when eating it again.
A food allergy is an abnormal response to a food that is triggered by the immune system. Web MD breaks it down the best. Food allergies involve two features of the human immune response. One is the production of immunoglobulin E (IgE), a type of protein called an antibody that circulates through the blood. The other is the mast cell, a specific cell that occurs in all body tissues but is especially common in areas of the body that are typical sites of allergic reactions, including the nose and throat, lungs, skin, and gastrointestinal tract.
The ability of a given individual to form IgE against something as benign as food is an inherited predisposition. Generally, such people come from families in which allergies are common — not necessarily food allergies but perhaps hay fever, asthma, or hives. Someone with two allergic parents is more likely to develop food allergies than someone with one allergic parent.
Before an allergic reaction can occur, a person who is predisposed to form IgE to foods first has to be exposed to the food. As this food is digested, it triggers certain cells to produce specific IgE in large amounts. The IgE is then released and attaches to the surface of mast cells. The next time the person eats that food, it interacts with specific IgE on the surface of the mast cells and triggers the cells to release chemicals such as histamine. Depending upon the tissue in which they are released, these chemicals will cause a person to have various food allergy symptoms. If the mast cells release chemicals in the ears, nose, and throat, a person may feel an itching in the mouth and may have trouble breathing or swallowing. If the affected mast cells are in the gastrointestinal tract, the person may have abdominal pain, vomiting, or diarrhea. The chemicals released by skin mast cells, in contrast, can prompt hives. Only about 5% of children have clinically proven allergic reactions to foods. In teens and adults, food allergies occur in about 4% of the total population. While there’s no cure, adults usually do not lose their allergies, but children often outgrow their food allergies over time. A higher percentage of children have food allergies than adults, because their immune systems are not yet fully developed.
Types of Food Allergies:
According to the American Academy of Allergy, Asthma & Immunology or AAAAI for short, Being allergic to a food may also result in being allergic to a similar protein found in something else. For example, if you are allergic to ragweed, you may also develop reactions to bananas or melons. This is called cross-reactivity. Cross-reactivity happens when the immune system thinks one protein is closely related to another. When foods are involved it is called oral allergy syndrome (OAS).
Oral Allergy Syndrome (OAS)
According to the AAAAI, the proteins found in some fruits and vegetables are very similar to those found in particular pollen. These proteins can confuse the immune system in people with food or outdoor allergies. The result is called oral allergy syndrome (OAS).
If someone has a life-threatening allergic reaction to a certain food, the doctor will counsel the patient to avoid similar foods that might trigger this reaction. For example, if someone has a history of allergy to shrimp, testing will usually show that the person is not only allergic to shrimp but also to crab, lobster, and crayfish as well. This is called cross-reactivity.
Another interesting example of cross-reactivity occurs in people who are highly sensitive to ragweed. During ragweed pollination season, these people sometimes find that when they try to eat melons, particularly cantaloupe, they have itching in their mouth and they simply cannot eat the melon. Similarly, people who have severe birch pollen allergy also may react to the peel of apples.
The most frequent reaction involves itchiness or swelling of the mouth, face, lip, tongue and throat. Symptoms usually appear immediately after eating raw fruits or vegetables, although the reaction can occur more than an hour later.
Rarely, OAS can cause severe throat swelling or anaphylaxis in a person who is highly allergic.
Food Protein-Induces Enterocolitis Syndrome (FPIES)
FPIES is sometimes referred to as a delayed food allergy. According to the AAAAI, it is a severe condition causing vomiting and diarrhea. In some cases, symptoms can progress to dehydration and shock brought on by low blood pressure and poor blood circulation. Much like other food allergies, FPIES allergic reactions are triggered by ingesting a food allergen. The most common culprits include milk, soy and grains. Most children with FPIES have only one or two food triggers, but it is possible to have reactions to multiple foods. FPIES often develops in infancy, usually when a baby is introduced to solid food or formula.
The differences that set FPIES apart from a typical food allergy, is that most food allergy reactions happen within minutes or shortly after coming in contact with a food allergen. FPIES allergic reactions are delayed, occurring within hours after eating the trigger allergen. Also in most allergies, the immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. FPIES reactions are thought to involve cells of the immune system rather than IgE antibodies.
Eosinophilic Esophagitis or (EoE)
EoE is an allergic condition causing inflammation of the esophagus. The esophagus is the tube that sends food from the throat to the stomach. Most research suggests that the leading cause of EoE is an allergy or a sensitivity to particular proteins found in foods. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, dermatitis or food allergy.
Exercise-induced food allergy
Some people have an allergic reaction to a food triggered by exercise. Eating certain foods may cause you to feel itchy and lightheaded soon after you start exercising. In serious cases, an exercise-induced food allergy can cause reactions such as hives or anaphylaxis. Not eating for a couple of hours before exercising and avoiding certain foods may help prevent this problem.
Pollen-food allergy syndrome
In many people who have hay fever, fresh fruits and vegetables and certain nuts and spices can trigger an allergic reaction that causes the mouth to tingle or itch. In some people, pollen-food allergy syndrome — sometimes called oral allergy syndrome — can cause swelling of the throat or even anaphylaxis. This is an example of cross-reactivity. Proteins in fruits and vegetables cause the reaction because they’re similar to those allergy-causing proteins found in certain pollens. For example, if you’re allergic to ragweed, you may also react to melons; if you’re allergic to birch pollen, you may also react to apples. Cooking fruits and vegetables can help you avoid this reaction. Most cooked fruits and vegetables generally don’t cause cross-reactive oral allergy symptoms.
Common cross-reactivity between pollens and fruits and vegetables:
|If you are allergic to||Birch pollen||Ragweed pollen||Grasses||Mugwort pollen|
|You may also have a reaction to:||Apples
(cantaloupe, honeydew and watermelon) Tomatoes
Some spices (caraway seeds, parsley, coriander, anise seeds, fennel seeds)
Foods most commonly associated with food allergies:
According to the WHFoods.org, over a 140 different foods have been identified as causes of allergic reactions. According to a recent report by the U.S. Centers for Disease Control, 90% of food allergies are associated with 8 food types.
According to Web MD the most common food allergies are as follows:
In adults, the most common foods allergies include
- Cow’s milk
- Hen’s eggs
- Soy foods
- Crustacean shellfish (such shrimp, prawns, lobster, and crab)
- Tree nuts (such as almonds, cashews, walnuts, pecans, pistachios, Brazil nuts, hazelnuts, and chestnuts)
In children, the food allergy pattern is somewhat different. The most common food allergens include
Children are more likely to outgrow allergies to milk, eggs, or soy than allergies to peanuts, fish, or shrimp. The foods that adults or children react to are those foods they eat often. In Japan, for example, rice allergy is more frequent. In Scandinavia, codfish allergy is more common.
Symptoms typically appear within minutes to several hours after eating the food to which you are allergic.
FARE. org (Food Allergy Research and Education) breaks down food allergy symptoms the best.
Mild symptoms may include one or more of the following:
- Hives (reddish, swollen, itchy areas on the skin)
- Eczema (a persistent dry, itchy rash)
- Redness of the skin or around the eyes
- Itchy mouth or ear canal
- Nausea or vomiting
- Stomach pain
- Nasal congestion or a runny nose
- Slight, dry cough
- Odd taste in mouth
- Uterine contractions
Severe symptoms may include one or more of the following:
- Obstructive swelling of the lips, tongue, and/or throat
- Trouble swallowing
- Shortness of breath or wheezing
- Turning blue
- Drop in blood pressure (feeling faint, confused, weak, passing out)
- Loss of consciousness
- Chest pain
- A weak or “thready” pulse
- Sense of “impending doom”
How a child might describe a reaction:
Children have unique ways of describing their experiences and perceptions, and allergic reactions are no exception. Precious time is lost when adults do not immediately recognize that a reaction is occurring or don’t understand what a child is telling them.
Some children, especially very young ones, put their hands in their mouths or pull or scratch at their tongues in response to a reaction. Also, children’s voices may change (e.g., become hoarse or squeaky), and they may slur their words.
The following are examples of the words a child might use to describe a reaction:
- “This food is too spicy.”
- “My tongue is hot [or burning].”
- “It feels like something’s poking my tongue.”
- “My tongue [or mouth] is tingling [or burning].”
- “My tongue [or mouth] itches.”
- “It [my tongue] feels like there is hair on it.”
- “My mouth feels funny.”
- “There’s a frog in my throat.”
- “There’s something stuck in my throat.”
- “My tongue feels full [or heavy].”
- “My lips feel tight.”
- “It feels like there are bugs in there.” (to describe itchy ears)
- “It [my throat] feels thick.”
- “It feels like a bump is on the back of my tongue (throat).”
Symptoms of Anaphylaxis:
Anaphylaxis often begins within minutes after a person eats a problem food. Less commonly, symptoms may begin hours later. About 25 percent of patients have a second wave of symptoms one to several hours after their initial symptoms have subsided. This is called biphasic anaphylaxis.
Anaphylaxis is highly likely to be occurring when any ONE of the following happens within minutes to hours after ingestion of the food allergen:
1. A person has symptoms that involve the skin, nose, mouth or gastrointestinal tract and either:
- Difficulty breathing, or
- Reduced blood pressure (e.g., pale, weak pulse, confusion, loss of consciousness)
2. A person was exposed to a suspected allergen, and two or more of the following occur:
- Skin symptoms or swollen lips
- Difficulty breathing
- Reduced blood pressure
- Gastrointestinal symptoms (e.g., vomiting, diarrhea, or cramping)
3. A person was exposed to a known allergen, and experiences:
- Reduced blood pressure, leading to weakness or fainting
Other symptoms of anaphylaxis are:
- A rapid fall in blood pressure
- Abrupt fear, a feeling of apprehension
- An itchy, tickly throat
- Respiratory problems, which often become progressively worse
- Skin is itchy. A rash may spread rapidly and cover much of the body
- Streaming nose and eyes
- Tachcardia (accelerated heartbeat)
- The throat, lips, face and mouth swell rapidly
- The patient may lose consciousness
Emergency treatment is critical for anaphylaxis. Untreated, anaphylaxis can cause a coma or death.
When to see a doctor:
Proper diagnosis of food allergies is extremely important. Skin tests and blood tests are often ordered. A food challenge under the care of your allergist/immunologist may also be needed to confirm an allergy.
See a doctor or allergist if you have food allergy symptoms shortly after eating. If possible, see your doctor when the allergic reaction is occurring. This will help your doctor make a diagnosis.
Seek emergency treatment if you develop any signs or symptoms of anaphylaxis, such as:
- Constriction of airways that makes it difficult to breathe
- Shock, with a severe drop in blood pressure
- Rapid pulse
- Dizziness or lightheadedness
Best treatments and drugs according to the Mayo Clinic:
The only way to avoid an allergic reaction is to avoid the foods that cause signs and symptoms. However, despite your best efforts, you may come into contact with a food that causes a reaction.
For a minor allergic reaction, over-the-counter or prescribed antihistamines may help reduce symptoms. These drugs can be taken after exposure to an allergy-causing food to help relieve itching or hives. However, antihistamines can’t treat a severe allergic reaction.
For a severe allergic reaction, you may need an emergency injection of epinephrine and a trip to the emergency room. Many people with allergies carry an epinephrine autoinjector (EpiPen, EpiPen Jr, Twinject). This device is a combined syringe and concealed needle that injects a single dose of medication when pressed against your thigh. If your doctor has prescribed an epinephrine autoinjector:
- Carry it with you at all times. It may be a good idea to keep an extra autoinjector in your car or in your desk at work.
- Always be sure to replace epinephrine before its expiration date, or it may not work properly.
- Be sure you know how to use the autoinjector. Also, make sure the people closest to you know how to administer the drug — if they’re with you in an anaphylactic emergency, they could save your life.
Elimination diet – One of the keys to preventing an allergic reaction is to completely avoid the food that causes your symptoms. Many patients will need to see a dietitian after being diagnosed with a food allergy. It is important if food needs to be eliminated from one’s diet, that it is done in a way that does not undermine the individual’s health. If your allergy is just to peanuts, there will be no health consequences if you never touch peanuts again. However, an allergy to milk means seeking out other important sources of calcium.
Elimination does not only mean not eating the offending substance or food, it also includes never inhaling it, touching it or eating foods with traces of it inside. Cutlery, crockery, cooking surfaces and chopping boards must be free of the allergen.
Even some soaps, pet foods, glues and adhesives may have traces of a food allergen.
Patients will need to read food and/or drink labels carefully.
- Don’t assume. Always read food labels to make sure they don’t contain an ingredient you’re allergic to. Even if you think you know what’s in a food, check the label. Ingredients sometimes change. Food labels are required to clearly list whether they contain any common food allergens. Read food labels carefully to avoid these top eight sources of food allergens: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.
- Involve caregivers. If your child has a food allergy, enlist the help of relatives, baby sitters, teachers and other caregivers. Make sure they understand how important it is for your child to avoid the allergy-causing food and that they know what to do in an emergency. It’s also important to let caregivers know what steps they can take to prevent a reaction in the first place, such as careful hand-washing, and cleaning any surfaces that might have come in contact with the allergy-causing food.
When eating out you may need to be especially careful.
- When in doubt, say no thanks. At restaurants and social gatherings, you’re always taking a risk that you might eat a food you’re allergic to. Many people don’t understand the seriousness of an allergic food reaction and may not realize that a tiny amount of a food can cause a severe reaction in some people. If you have any suspicion at all that a food may contain something you’re allergic to, steer clear.
- Antihistamines – these will come in the form of gels or tablets. They are usually effective for patients with mild or moderate allergies. Histamines are proteins which cause most allergy symptoms, antihistamines block their effects.
- Epinephrine (adrenaline) – this is used for more severe cases, such as anaphylaxis. Epinephrine keeps your blood pressure up by constricting the blood vessels, as well as easing the airways. The patient will probably be given an auto-injector pen.
People who have had severe allergic reactions should carry an epinephrine autoinjector with them.
To recap (FARE says it best)
Learn all you can about avoiding allergens. Read food labels carefully and don’t hesitate to ask questions when eating away from home. Vigilance is your first line of defense against anaphylaxis.
- Have your medication with you wherever you go.
- Talk to your allergist about when and how to use emergency medications.
- Make sure prescriptions are up-to-date.
- Wear medical identification (e.g., bracelets, other jewelry) at all times.
- Don’t delay using your epinephrine while waiting to see if your symptoms improve! Use your emergency medications as prescribed.
- Get to an emergency room for evaluation and further treatment right away – even if your medication has stopped the reaction.
- Epinephrine is not a “foolproof” treatment. Don’t take chances by eating a problem food.
Again ALWAYS read food labels to ensure that you don’t eat foods that contain foods you are allergic to. Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends. If you are unsure about an ingredient, don’t eat it.
Want to learn more about allergies and see where I did a lot of my research and information on the subject….Check out these links: