Food Allergy, Intolerance, or Sensitivity: What Triggers Your Symptoms?

If your belly bloats, aches, and sends you running to the bathroom after you enjoy some ice cream, you may assume you’re lactose intolerant or allergic to dairy. 

Bad reactions to food can range from mild abdominal discomfort to life-threatening conditions like anaphylaxis. If you suspect that food is causing you or your child to feel unwell, there are things you can do to help identify the culprit and avoid the symptoms.

What’s the difference between a food allergy and an intolerance?

If you have a true food allergy, your immune system kicks in as soon as you ingest the problematic food or ingredient. Symptoms typically occur within minutes. Eating or even inhaling tiny amounts of the allergen may cause symptoms ranging from mild gastrointestinal distress to a severe allergic reaction.

Common symptoms of a food allergy include, but are not limited to, the following:

• hives (itchy, red rash)
• lip or tongue swelling
• difficulty breathing
• anaphylaxis (shock)
• nausea and/or vomiting 
• abdominal pain
• diarrhea

Common food allergens include tree nuts, peanuts, shellfish, fish, soy, eggs, dairy, and wheat.

Should I get an allergy test?

By measuring specific antibodies (IgE levels) present in your blood, allergy testing can potentially identify the food(s) you may be allergic to. “But, testing is not perfect and may not identify the reason for your symptoms,” says Michelle Pearlman, M.D., a board-certified gastroenterologist with the University of Miami Health System. 

“You can get misleading results from allergy tests. Just because you have an elevated IgE level doesn’t mean you have a true allergy to that particular item. And vice versa, given the presence of non-IgE mediated allergies that can also occur,” Dr. Pearlman says. 

“Experiencing typical allergic symptoms soon after ingestion is a good indicator of a potential food allergy.”

If you eat something and develop an allergic reaction as described above, seek medical attention and take an antihistamine if you have one available.

If you or your child has a known food allergy with more severe symptoms like lip or tongue swelling or anaphylaxis, it’s best to carry an epi-pen with you at all times in case you have an inadvertent exposure.

“My recommendation to patients is the same with or without the confirmation of an allergy test,” she says. “Avoid the foods that bother you. If you’re having a bad reaction to a particular food group or ingredient, rushing to get an allergy test may give you false positives on foods that may not actually be causing you symptoms.”

Can I get rid of a food allergy?

With an epi-pen nearby, allergists can give patients small, controlled doses of a known food allergen and monitor their reaction. If the patient has a severe allergic response, the doctor can inject the patient with the epi-pen to reverse this potentially life-threatening reaction. The allergist then repeats this process again and again to lower the patient’s histamine response to this allergen over time. This desensitization process is called allergen immunotherapy and is often referred to as “allergy shots.”

Are food intolerances and food sensitivities the same thing?

“A food intolerance or sensitivity can trigger symptoms ranging from headaches or heartburn to bloating, diarrhea, and abdominal pain,” Dr. Pearlman says. “But, they are not caused by an immune response like an allergic reaction.” Food intolerances are typically caused by an inability to digest a particular compound. 

A common example of food intolerance is lactose intolerance (caused by the loss or reduction of the lactase enzyme in the small intestine, which is required to break down lactose). Often developed in adulthood, this condition can cause abdominal bloating, discomfort, and diarrhea after the consumption of lactose-containing products like dairy milk and some soft cheeses. 

A food sensitivity is a very non-specific term used to describe any negative reaction to a particular food or ingredient. Food sensitivities can be difficult to identify and vary from person to person. Some people develop bloating and gas after eating foods rich in FODMAPS. FODMAPS are poorly-absorbed carbohydrates that, when digested by gut bacteria, produce gas. FODMAPS are in a wide range of foods that are often considered part of a healthy diet, like broccoli and beans. The ingestion of high-FODMAP foods does not cause an immune response nor intestinal damage. But, it can lead to uncomfortable symptoms, particularly for those with irritable bowel syndrome (IBS). 

What is the elimination diet?

First off, don’t do it. Dr. Pearlman does not recommend the elimination diet for the majority of people complaining of GI distress. People who follow an elimination diet completely avoid all of the common food allergens. The list of possible food triggers is long and leaves few options for “safe” and balanced meals. The idea of the diet is to rid your body of all food irritants for a couple of weeks, then slowly reintroduce certain food groups one at a time to try to identify which items are causing the unwanted symptoms. 

“The problem with the elimination diet is that it can create a fear of eating and guilt around eating certain food groups that are actually part of a healthy, well-balanced nutrition plan,” Dr. Pearlman says. “The last thing I want to do is encourage restrictive eating patterns that lead to malnutrition or disordered eating.” 

Pay more attention to your food and beverage choices.

Keeping a food and symptom diary or using a food tracker app on your phone can help you and your doctor identify potential triggers for your symptoms.

• What time of day do you eat, and how much are you eating per serving?
• Are you using cooking oils? What kind?
• What types of liquids are you drinking?
• How much processed and refined foods do you eat?
• Are you adding certain sauces, artificial sweeteners, or seasonings to your food?

“I’ll review patients’ food diaries,” Dr. Pearlman says, “and help them correlate the negative GI symptoms to specific foods. Once we identify potential triggers, I advise them to reduce or eliminate them from their diet and then reassess their symptoms over time.

“I also have to remind patients to chew their food well and eat slowly. Someone may think that they have a sensitivity or intolerance to a particular food. But, their bloating may occur because they tend to eat their meals rapidly and drink their liquids through straws, all of which introduce excessive air into the intestine.”

If it’s not a food allergy nor intolerance, what else could it be?

Celiac disease, an autoimmune disorder, is often mislabeled as a wheat allergy or gluten sensitivity. Those with celiac disease should not eat any amount of gluten (a protein in wheat, rye, and barley) because exposure to it triggers an immune response that damages their small intestine. This intestinal damage can lead to nutrient malabsorption, low bone density, infertility, and small bowel lymphoma.

Similarly, there are many other medical conditions that can lead to these same symptoms and should be evaluated. These include inflammatory bowel disease (Crohn’s and Ulcerative Colitis), gallstones, small intestinal bacterial overgrowth, and irritable bowel disease. If you suffer from continual or chronic GI symptoms, seek care from an internist or gastroenterologist for evaluation and management.

Dana Kantrowitz is a contributing writer for UMiami Health News.

Tags: Dr. Michelle Pearlman, food allergies, stomach sensitivity