Zero Tolerance Policy

We draw the line between a food intolerance and a food allergy.
food allergy
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Every time you eat [insert problematic food here], your body riots. Does that mean you have an allergy? An intolerance? Something else entirely? We chatted with Doctor Russell Settipane, MD, a clinical professor of medicine at Brown University’s Alpert Medical Center and an allergist at the Allergy and Asthma Centers of Rhode Island, to unpack the differences.

What is a food intolerance?
This term can cover anything that happens to your body when a food doesn’t agree with you. If you don’t tolerate the food, that often means you don’t digest it properly. One example would be lactose intolerance, where you lack enough lactase enzymes to digest milk sugars (a.k.a. lactose), so you get symptoms like excessive gas and bloating whenever you drink milk. Sometimes, though, we don’t know exactly why people don’t tolerate certain foods — intolerance can also mean that no one ever really figured out why your body reacts this way. It’s really a non-specific term.

How do you treat it?
It depends on the intolerance. Some people just cut the food out of their diet, while others try to work around it. In fact, if you go on Amazon, there’s a huge market for pancreatic enzymes right now. Many people are treating themselves and taking these supplemental enzymes with meals to help with digestion and diminish their gastric intolerance to the disagreeable foods. It might be a good solution for some, but the key thing is to have your condition investigated by a medical professional in the first place, in case it’s something more than an intolerance.

Is there a reason why more and more intolerances seem to be popping up nowadays?
Good question. There’s definitely more awareness — just walk down any grocery aisle today and you’ll see tons of dairy-free or gluten-free products. In the past, there must have been people who suffered in silence for years, but now they know to bring it up to the doctor and say, “Do you think it could be a gluten sensitivity? Can you test me for Celiac?” I think public awareness has led to increased awareness in the medical care system, and that’s why we’re addressing it more. I also think diagnostic testing has gotten better, and there are more ways to evaluate old and new diseases.

What is a food allergy?
Sometimes you’ll hear people say they’re allergic to something when, technically, they aren’t. In common parlance, people use “allergy” very loosely. In the medical field, it means that your body produced an allergic antibody (a.k.a. an IgE antibody). Once your body has decided to make that antibody, generally it will make it for the rest of your life (except in rare circumstances). So, if you eat that food again, the antibody will react, and it’s often more severe than a food intolerance. Symptoms can include shortness of breath, facial swelling, hives and rash. It can be life-threatening; anaphylactic shock — when your airway narrows and your blood pressure drops — is the worst case scenario.

How do you treat it?
Once you know what is causing the allergy — which most people figure out either through trial and error or by getting a skin test from an allergist — you should, of course, avoid the food all together. But, especially in more severe cases, you should still consult a doctor because you might need an anaphylaxis care or management plan. You might need a prescription for an epinephrine device and then you’ll need someone to show you how to use the device. Plus, there are four different devices on the market now, and you will need to know what’s on your plan, what you can afford and what are the different characteristics of each one. The exciting piece, though, is that there are new therapies for allergies being developed, including products that will hopefully help desensitize people with peanut allergies to peanuts over time.

Is there anything people can’t be allergic to?
When people are allergic to food substances, they’re allergic to the protein component. So, when you’re reading the ingredient labels, you know you’re not going to be allergic to the sugar or the carbohydrates. There’s also lot of confusion when it comes to food additives. People often blame additives like BHT, BHA, sulfites and/or MSG for their allergies, but, it’s exceedingly rare. I will say that MSG can cause flushing, redness and headaches, but we’d classify that as an intolerance, not an allergy.

The Gray Areas

Celiac Disease is when your body produces an immune response to gluten. It’s called an IgA transglutaminase antibody, but it’s not an allergic antibody (IgE). There’s a blood test that can determine if you actually have it. Most people usually don’t have the disease, but for some reason they just feel so much better off of gluten. So, they stay off of it.

Food protein-induced enterocolitis syndrome (FPIES) is when someone eats a certain food and then hours later experiences severe vomiting and/or diarrhea, much like the symptoms of food poisoning. There’s no blood or skin tests that can prove someone has FPIES, but if it happens repeatedly with a particular food, then that’s probably it.

Eosinophilic esophagitis is when people have difficulty swallowing due to swelling of their eisonophill, or the lining of their esophagus. About 50 percent of these patients see improvement just from removing four foods from their diet: milk, eggs, wheat and soy. It’s not necessarily an allergy, but somehow these foods are contributing to the presence of this inflammation. It’s an issue we weren’t even aware of fifty years ago.