Defin­ing Dif­fer­ences

When your body mis­fires against seem­ingly in­no­cent foods, could it be the start of a food al­lergy or an in­tol­er­ance?

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IN A TIME when gluten-free op­tions grace menus, schools are nut-free zones, and peo­ple boast about their dairy-free di­ets, we’re more aware than ever about food al­ler­gies and in­tol­er­ances. But they are two very dis­tinct con­di­tions.

“A food al­lergy is an im­mune re­sponse where the body pro­duces an­ti­bod­ies called IGE in re­sponse to a par­tic­u­lar pro­tein in the food,” ex­plains Ge­or­giana San­ders, MD, an as­so­ciate pro­fes­sor at the Univer­sity of Michi­gan Mary H. Weiser Food Al­lergy Cen­ter. The body at­tacks these typ­i­cally harm­less pro­teins, trig­ger­ing an al­ler­gic re­ac­tion, which can ap­pear within sec­onds or hours of ex­po­sure. To be di­ag­nosed, you must ex­hibit symp­toms such as hives; wheez­ing; runny nose; itchy eyes; or lip, throat, or tongue swelling; plus a pos­i­tive blood test or skin prick show­ing the pres­ence of an­ti­bod­ies.

Fif­teen mil­lion Amer­i­cans have food al­ler­gies, and 9 mil­lion of those are adults. And it’s not your imag­i­na­tion: Al­ler­gies are on the rise in chil­dren and adults. Food al­ler­gies in kids spiked by 50% be­tween 1997 and 2011, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Pre­lim­i­nary re­search pre­sented in 2017 at the Amer­i­can Col­lege of Al­lergy, Asthma, and Im­munol­ogy found that 45% of adults with food al­ler­gies de­velop them in adult­hood, most com­monly to shell­fish and tree nuts. There are two plau­si­ble the­o­ries to ex­plain this in­crease in food al­ler­gies: the hy­giene hy­poth­e­sis (in essence, we live in a too-ster­ile en­vi­ron­ment), and the idea that de­lay­ing in­tro­duc­ing cer­tain foods to in­fants (par­tic­u­larly peanuts) may pre­vent bud­ding im­mune sys­tems from ma­tur­ing prop­erly.

A food in­tol­er­ance (also called a sen­si­tiv­ity) oc­curs when you have dif­fi­culty di­gest­ing a food, lead­ing to gas, ab­dom­i­nal dis­com­fort, or di­ar­rhea, but there’s no im­mune re­ac­tion or an­ti­bod­ies pro­duced. The most com­mon in­tol­er­ances are to lac­tose (a su­gar found in milk), gluten (a pro­tein found in wheat), and cer­tain com­plex car­bo­hy­drates (from beans and cab­bage). It’s best to talk to your doc­tor if you sus­pect a spe­cific food is rou­tinely caus­ing di­ges­tive woes. Avoid­ing foods un­nec­es­sar­ily can lead to a nu­tri­ent short­fall in your diet, par­tic­u­larly if you re­move mul­ti­ple foods in a blind ef­fort to heal symp­toms. If you do have to steer clear of a type of food—for in­stance, dairy—a di­eti­tian can help you plan your diet so that you’re get­ting other sources of cal­cium and vi­ta­min D (like for­ti­fied nut milk).

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