Food Allergy or Food Intolerance – There IS a Difference.

Image by sweenpole2001 via Flickr

I was just sent an email from a reader asking what the difference between a food allergy and a food intolerance was. After sitting and thinking about that question for a while it dawned on me that many people may not know that there actually is a difference between them. So, let me see if I can explain both of them, so that you will be able to understand the differences between them.

Food Intolerance –

A food intolerance is a digestive system response to a food It occurs when a food irritates a person’s digestive system or when a person is unable to properly digest or breakdown a food. Intolerance to lactose, which is found in milk and other dairy products is the most common food intolerance however there are many more foods that people can be intolerant to.

The symptoms of food intolerance can include:

• Nausea
• Stomach pain
• Gas, cramps, or bloating
• Vomiting
• Heartburn
• Diarrhea
• Headaches
• Irritability or nervousness

People that have food intolerances often lack the chemicals, or enzymes necessary to properly digest certain proteins found in the food. This can sometimes be overcome with medication such as Lactaid for people with lactose intolerance. People with food intolerance in many cases will not have symptoms unless a large amount of the offending food has been consumed or the food has been consumed frequently.

Treatment for a food intolerance is based on avoiding or reducing your intake of problem foods and treating symptoms when they arise. Celiac Disease is a form of a food intolerance.

Food Allergy –

A food allergy is an immune system response. It occurs when the body’s immune system mistakingly believes a an ingredient in a food (usually a protein) is harmful to the body and creates a defense system (antibodies) to fight it. The immune system treats the food as though it were a virus or bacteria and releases antibodies to fight it. Food allergy symptoms develop when the antibodies are fighting off the “invading” food.

The most common food allergies include peanuts, tree nuts (macadamia nuts, walnuts, almonds, pecans, etc.), fish, shellfish, milk & dairy products, eggs, soy beans & products, and wheat although other foods may also cause an allergic reaction in certain individuals. These foods are often thought of as the “Big 8” when referring to food allergens and by law must be listed in plain terms on the list of ingredients of any food sold in the United States. For instance, even though lactose is a very common food intolerance, since it is also one of the “Big 8” food allergens, its common term must now be used (Milk or Dairy Products).

Symptoms of a food allergy can be mild to severe, and the amount of food necessary to trigger a reaction can vary from person to person. In many people with severe allergies, merely the microscopic proteins of the food are enough to trigger an allergic response. For instance a person allergic to peanuts can have an allergic reaction merely by someone handling peanuts, then preparing their food without washing their hands and thoroughly cleaning their equipment first. Even though no visible peanuts are on the persons hands or equipment.

When a person first ingests a food that they are allergic to the bod’s immune system creates antibodies (immunoglobulin E, or IgE). When you eat the food again it triggers the release of IgE antibodies and another chemical called histamine to fight off the “invading” protein from the body. Histamine can affect the cardiovascular system, respiratory system, gastrointestinal tract or skin. The specific symptoms that a person develops depend on where the histamines is released into the body. Many people develop a combination of symptoms as the food is eaten and moves through the body as it is digested.

The most common symptoms of a food allergy include:

• Rash or hives
• Abdominal pain or cramping
• Abnormal (high-pitched) breathing sounds
• Anxiety
• Confusion
• Cough
• Diarrhea
• Difficulty breathing
• Difficulty swallowing
• Fainting, light-headedness, dizziness
• Hives, itchiness
• Nasal congestion
• Nausea, vomiting
• Palpitations
• Skin redness
• Slurred speech
• Wheezing
• Itchy skin
• Shortness of breath
• Chest pain
• Swelling of the airways to the lungs
• Anaphylaxis

A person may “grow out of” an allergy to a food as they grow older, or they may suddenly become allergic to a food that they previously had no allergy to and have eaten many times in the past.

Because a food allergy reaction can affect the cardiovascular and respiratory system it can, and often does result in death. There is no way to determine when a particular food allergy will cause a mild or severe reaction. A person that normally only has mild reactions to a particular food allergy could suddenly and without warning have a severe life-threatening reaction where their body goes into what is known as anaphylactic shock. If anaphylactic shock is not treated immediately it can result in sudden death within just a few minutes of onset.

As you can see, there is a big difference between a food intolerance and a food allergy, one that could have a deadly outcome. If a person tells you that they are intolerant of a specific food be considerate of their feelings and make sure to avoid that food when preparing their meals.

If a person tells you that they are allergic to a particular food, make absolutely sure that there is no possible way that the ingredients in, or utensils used to prepare the food can cause an allergic reaction for them. Their death will be on your hands.

Source: PubMed Health, WebMD, 

What is it that restaurants don’t get about food allergies?

It amazes me that even today with all of the talk about food allergies, and all of the training on food allergies available to them food allergy incidents in restaurants still happen quite frequently.

I have a food allergy myself, although it is not one of the most common food allergens known as the “Big 8”. I am allergic to dill. So when I order at a restaurant I am very careful to notify them when I am placing my order of my allergy to dill. Unfortunately since I do not trust them to take proper care of my special food order, as a backup I also carry 2 Epi Pens strapped to me in an ankle-holster when I eat out. Thankfully yesterday I had my Epi Pens on me.

I was in a hurry so I decided to stop at a local Mc Donald’s to grab something to eat, I ordered 2 “plain cheeseburgers” and notified them that I was allergic to dill and dill pickles. The counterperson read my order back to me for 2 plain cheeseburgers and I again reminded her of my allergy to dill and dill pickles.

A few minutes later I received my order. The counterperson read off the order again to me as 2 plain cheeseburgers with out pickles. I read the grill slips attached to each one of the cheeseburgers that showed to be a special order and said that it was a plain cheeseburger. I thanked her and went on my way.

Since I was in a hurry I decided to eat as I drove into Honolulu for a meeting. Since I was almost at my destination I decided to save the second cheeseburger until after the meeting.

A few minutes into my meeting I noticed that I was starting to itch and saw a faint red rash starting to appear on my arms. Recognizing the symptoms of an allergic reaction right away I apologized and rescheduled the meeting.

Image via Wikipedia

I reached my car just as my face started swelling and I was starting to feel like my throat was closing off making it difficult to breath. I grabbed one of the Epi Pens from my ankle-holster, opened it and stabbed myself in the thigh with it. I readied the second auto injector just in case the first dose of Epinephrine was not enough.

Within seconds I was breathing easily again and the intense itching had subsided. Thankfully I only had a minor reaction this time and did not have to spend hours in the Emergency Room being treated for a severe reaction.

I then opened the second “plain cheeseburger” to investigate what happened. Sure enough I could see the telltale imprint of pickles left in the cheese. Instead of making my order from scratch as should have been done to make sure that my food did not come in contact with the dill pickles, the lazy cook merely removed the pickles from the sandwiches.

Removing the offending item from the food may be good enough if the customer merely does not like the item, but it does absolutely nothing if a person is allergic to it.

To have an allergic reaction to a food the food item itself does not have to be present itself, merely the microscopic proteins from the food allergen that are left behind are enough to cause a severe allergic reaction. Be removing the dill pickles from the cheeseburger the cook may have made the cheeseburger “look better” and changed the taste of the cheeseburger to my liking, but it was still an allergic reaction waiting to happen. Once a food is contaminated with the proteins from a food allergen, there is no way to remove them. That food must not be served to a person with a food allergy.

Apparently I did not make myself clear enough about my food allergy when I placed my order to the person at the counter. Perhaps I should have worded it differently.

Here’s a thought, from now on maybe I should word it something like this: “I am severely allergic to dill, dill pickles, and anything containing dill. If I have an allergic reaction to the food that you serve me after I clearly warned you that I had a severe food allergy, if I live through it I will come back with my gun and see if you and the cook are allergic to lead“.

Perhaps something like that is what it takes to get through to people how serious food allergies can be, and how serious they should be in taking your order and verifying that your order is safe for you to eat. People with food allergies have a life or death worry every time they eat out, perhaps if the people taking their orders and making their food had the same worry the food would be safer for them.

Fortunately for the staff at that Mc Donald’s we live in a civilized society where people don’t go around shooting other people for getting their food orders wrong.

Mc Donald’s themselves had a 10 million dollar law suit filed against them back in 2007 concerning food allergies, apparently that was not enough to get through to them.

What is it going to take to get through to people working in restaurants and foodservice operations that food allergies are a serious, and in many cases a life-threatening concern?