Is it a Food Allergy, Sensitivity or Intolerance?

What we eat has become more complicated over the years with the increase of pesticides, food additives, chemicals and just plain sugar.  Many of the foods we feed our families each day that we think are good for us can actually be harmful, causing inflammation throughout our bodies.   This results in worsening health and chronic symptoms. This inflamation can be caused by a food allergy or food sensitivity.   Before we can treat a food allergy, intolerance or sensitivity, it’s important to  identify it first.

 Some of the common symptoms we may see in our kids that can be linked to food is:

• Eczema, hives, itching

• Stomach discomfort, pain, constipation or diarrhea

• Headaches, migraines

• Swelling of the lips, tongue, eyes

• Difficulty breathing, wheezing, sinus congestion

• Brain fog, loss of concentration, dizziness

A Food Intolerance does not have an immune response.  It is a reaction that is often delayed; to a food, beverage or food additive.  It can produce symptoms in one or more body organs and results from a digestive enzyme that is missing entirely or is insufficient.  The best example is lactose intolerance when people can’t digest the milk sugar lactose due to a missing digestive enzyme, lactase, which can result in gas, bloating and belly pain.  Babies are born with digestive enzymes lactase, so it would be rare for an infant to have lactose intolerance.  Lactose intolerance usually develops in teenage or adult years and is most common in Native Americans and people of Asian, African and South American descent.  One can develop a temporary intolerance to lactose if they had stomach flu or similar illness and the small intestine temporarily stops making the lactase enzyme.  There are several tests your doctor can order to determine if you have lactose intolerance but the best one is to eliminate milk/dairy for a few days and see if the symptoms go away.  Lactase enzyme supplements can help with this intolerance.

A Food Allergy is an IgE mediated, immune response known as a type 1 hypersensitivity and affects 4-6% of the population.  This immune response to food is immediate and the reaction will start to occur within minutes to an hour of consumption.  An anaphylactic reaction to peanuts is an example of a serious food allergy.  Diagnostic testing for a food allergy include the IgE RAST and Elisa test, which is 60% accurate.  Skin testing can also be used to determine inhalant allergy but as effective  for food allergy with a 40% predictive value (if tested positive to 10 foods, only actually reactive to 4, so gives 6 false positives).  Food allergies can occur as early as infancy and 26% of children will outgrow their allergy by the age of 5.

The 8 common allergens that cause 90% of food allergies in kids are:

• milk

• eggs

• peanuts

• soy

• wheat

• tree nuts (such as walnuts and cashews)

• fish

• shellfish (such as shrimp)

A Food Sensitivity is a delayed immune response, either a Type 3 or Type 4 hypersensitivity reaction, and is the most prevalent, affecting 30-40% of the population.  Sometimes Food Sensitivities are referred to as non-IgE mediated food allergy and involve IgG, IgA, IgM or sensitized T cells.   With multiple reactive pathways in the immune system, most food sensitivities can occur 4-96 hours after the food is consumed, so it’s the most challenging one to diagnose and treat.  The Elisa IgG, is a common test for food sensitivities, it can only detect the Type 3, which covers only about 25% of food sensitivity reactions.  It also detects if IgG is present in the immune system, which is not necessarily a good or bad thing and does not reliably correlate with inflammation or symptoms.   The Mediator Release Test (MRT), tests for both type 3 and type 4 hypersensitivities and indirectly quantifies how strongly the immune cells react to the foods and food chemicals tested.  I like this test since it measures if an inflammatory response, (release of mediators such as histamine, cytokines and prostaglandins), has occurred to the 150 foods and chemicals it tests.  The MRT has 94% split sample reproducibility making it a reliable test.

Regardless if it’s a food allergy, intolerance, or sensitivity, it can be challenging to figure out on your own.  Having some discussions with your pediatrician or pediatric dietitian can help you determine what testing and treatment could be the best solution to determine the food(s) causing your child’s distress.  A dietitian can help plan a diet to eliminate the foods causing the allergy or sensitivity, which improves symptoms and leads to a healthier and happier child sooner.