Let’s Discuss: Food Allergies, Intolerances, & Hypersensitivities

We often hear about food allergies, intolerances, and hypersensitivities through television, social media, podcasts and mainstream media in general. Maybe you know someone with a gluten intolerance, lactose allergy, or you may have just been diagnosed yourself. Let’s look at the similarities and differences of the three to better our understanding.

 Food Allergies  

For a person to be diagnosed with a food allergy, there has to be an immune response after coming into contact or ingesting that specific food. The immune response can present by producing antibodies, activating specfic immune cells, or both with the goal of fighting to destroy the food once it enters the body. This may cause the release of histamine, which will show as an allergic reaction like hives, itchy mouth or throat, swelling of the lips or in sometimes fatal cases, anaphylaxis. Anaphylaxis is a sudden, severe, life-threatening allergic reaction that results in the airway closing and blocking breathing, nausea, vomiting, skin rash, a drop in blood pressure, and without treatment is often fatal. Anti-histamine medications can help take away these symptoms and use of Epi-pens are needed for highly allergic reactions that result in anaphylaxis. For example, if a person diagnosed with Cow’s Milk Protein Allergy (CMPA) ingests cow’s milk they may have a sudden onset skin rash or anaphylaxis within minutes; GI issues like GERD, constipation, diarrhea, etc. resulting in a few hours; or GI disturbances, eczema/skin rash, or respiratory symptoms presenting after several hours/days.

Food Intolerance/Hypersensitivity

 A food intolerance is an adverse reaction to food that does NOT involve the immune system and occurs due to the body’s inability to digest, absorb, or metabolize the food or component of food. Hypersensitivity is a general term used to define an adverse reaction to food that is neither an immune response or an intolerance. Having a food intolerance is more common than having a food allergy. This is because there are more categories for cause of an intolerance including:

·      Food toxicity/contamination

·      Food additives (i.e. MSG, caffeine)

·      Gastrointestinal disorders (i.e. lactose intolerance, inflammatory bowel disease)

·      Psychological disturbance (i.e. eating disorder)

·      Genetic metabolic disorders

·      Unknown causes

A common food intolerance or sensitivity is lactose intolerance. Unlike CMPA, lactose intolerance does not result in an immune reaction causing swelling, breathing problems or anaphylaxis. Instead, a person who is lactose intolerant has trouble digesting the sugars in milk known as lactose. If they are deficient or do not produce enough of the lactase enzyme that breaks down lactose they cannot digest it. This results in uncomfortable GI symptoms like gas, bloating, diarrhea, etc.

References:

1. McLendon K, Sternard BT. Anaphylaxis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 26, 2023.

2. D’Auria E, Salvatore S, Pozzi E, Mantegazza C, Sartorio MUA, Pensabene L, Baldassarre ME, Agosti M, Vandenplas Y, Zuccotti G. Cow’s Milk Allergy: Immunomodulation by Dietary Intervention. Nutrients. 2019; 11(6):1399. https://doi.org/10.3390/nu11061399

3. Raymond, J. & Morrow K. Krause and Mahan's Food & the Nutrition Care Process.16th ed. Elsevier; 2023.