The difference between a food allergy and a food intolerance. I recently had an online interactive webinar with “America’s Allergist” Dr. Clifford Bassett to discuss issues with food allergies and children.
One area of focus was determining whether or not the symptoms and condition were a result of a food allergy, or a food intolerance. I asked the question – what is the difference between a food allergy and a food intolerance? Here is how Dr. Bassett explained it…
The bottom of the pyramid is determining the diagnosis – is it a food allergy, or is it really a food intolerance? Many people have the two confused. With a food allergy we’re talking about the immune system. We’re talking about immediate reactions…what are some of these symptoms… we know there are mild symptoms such as tingling in the mouth, little bit of scratchiness, sneezing and so-forth, and it certainly can progress to hives, redness of the skin , flushing, abdominal symptoms – we know with anaphylaxis with food 80%-90% of the time, the skin is involved. The skin is an early warning sign. So, if you have hives, itchiness, flushing… in conjunction with eating a food, particularly a food that your child is known to be allergic to, that’s very disconcerting. And obviously there are more persistent symptoms, worrisome symptoms – throat closure, tightness, shortness of breath and wheezing. And, there’s only one drug that’s available that will attempt to stop the allergic reaction – and that’s epinephrine.
About intolerances, when I talk to my food allergy counseling clients, there’s a lot of confusion because they will get tested by a pediatrician and a blood test will come back saying their child is allergic to 30 foods that they’ve never actually eaten, had any exposure or had any history of an allergic reaction to, and I think that’s where a lot of the confusion comes in. So, I would love to hear a little more about the testing process. There’s a lot of confusion about food allergy testing and it’s very important to get this point across that history of food allergic reaction is the biggest test… that just test alone is not diagnosis.
That’s right. We’re talking about the real world. When we do a diagnostic allergy test, and this is confusing even for physicians that are non-allergists, there are two parts to the testing. Whether it be a blood test…looking for environmental allergies, food allergies… or we’re talking about a skin prick test that’s done generally in an allergist office. If you have a positive test, it indicates what we call allergic sensitization. That means Ige has been produced; the Ige antibody to this particular substance. Whether it be a peanut or tree nut or even something like eggs, and your level is greater than the threshold cutoff. The second part, the most important part, is called the Real World part – is the clinical allergy. e.g. Does your child have any issues when he eats peanuts? Not at all, my child eats peanut butter every day, loves it and has not problems at all. That’s somebody that’s potentially sensitized but there’s no evidence of clinical allergy. That’s so very important in this interpreting the testing accurately so that we can make the right decision for the right child at the right point in time, and not go overboard with things that are unnecessary and also not go underboard with the program that is necessary. So that’s very important to have the right dialogue with a pediatrician and a board certified allergist to make sure you’re getting the right diagnosis in the first place.
Thanks to Dr Clifford Bassett for helping to explain the difference between a food allergy and a food intolerance.