Does this sound familiar? You just popped a bit of buttery sweet lobster tail into your mouth. You’ve been looking forward to this and yet, something doesn’t feel quite right. Your mouth feels weird. Maybe itchy? Your stomach is rolling. Is that a hive? Is this an allergic reaction?
How about this – you’ve been feeling off for weeks. It seems to be worse after you’ve had your morning coffee – light and sweet – or a dish of ice cream or that amazing platter of loaded nachos and potato skins dripping with melted cheese and sour cream. Is it a coincidence? A stomach bug? An allergy?
The possible scenarios we could run through are endless, and frankly, the answers aren’t something we can unpack here. The answer to whether the “you” in these scenarios are experiencing an allergic response or something else is something a board-certified allergist should answer after (and only after) a comprehensive medical exam that may include allergy testing.
What is important, however, is to recognize that you probably do know someone that has a food allergy. You probably do know someone that has an intolerance or other condition that may share symptoms with food allergies. The best way to keep those people in your life safe is to understand a bit about allergies, intolerances, and other related conditions.
By the Numbers
According to FARE, 33 million Americans are allergic to at least one food. To put that into context, the average elementary school class in the United States has about 20 students; statistically speaking, the average class would have 1 to 2 students with food allergies. In the US, 1 in 13 children and 1 in 10 adults are allergic to at least one food.
Food Allergies
Allergies (food or otherwise) involve the immune system. Your immune system’s job is to identify and destroy bacteria and viruses that can make you ill. When you have allergies, your immune system misidentifies something harmless as a germ and attacks it. The reaction you may experience is your immune response. Your body is trying to get rid of the allergen.
For example, if you’re allergic to egg, your immune system misidentifies a specific protein in the egg as something that can harm you. Consuming foods with your allergen can trigger an allergic reaction; symptoms can range from hives and abdominal discomfort to trouble breathing, dramatic drop in blood pressure, and loss of consciousness. Food allergies can be potentially life-threatening. You may also see this referred to as an IgE-mediated food allergy.
Food Intolerance
While individuals with food intolerance can experience symptoms if they consume their foods, intolerance is not the same as allergy. It’s not a ‘mild’ allergy. In fact, for some, the physical toll of food intolerance can be quite severe. The difference, however, is rooted in what body system is involved.
Whereas food allergies are a dysfunction of the immune system, food intolerances involve the digestive system and occur when the body cannot properly break down certain foods. As an example, someone that is lactose intolerant lacks lactase, the enzyme that breaks down the sugars in milk. For most of us, these sugars are normally broken down in our stomach. For those who lack lactase, the lactose is broken down in the colon by bacteria and can result in uncomfortable bloating, gas, nausea, and diarrhea.
Celiac Disease
Not to be confused with a wheat allergy (they are two different things), celiac disease involves a reaction to the protein gluten which can be found in wheat, rye, barley, and sometimes other grains that come in contact with gluten. Like an intolerance, it is a disease of the digestive system, yet like a food allergy, it does involve an immune system response.
While anaphylaxis is not a risk for those with celiac, the condition can have a wide range of severe effects on the body if left untreated. The immune response to gluten can damage the lining of the small intestine. Patients may become malnourished, as well as experience joint pain and headaches. Like food allergies, there is no cure or treatment other than avoidance. Individuals with celiac must avoid gluten – including trace levels.
FPIES (Food Protein-Induced Enterocolitis Syndrome)
Typically triggered by milk, soy, or grains, FPIES is another form of non-IgE mediated food allergy that affects the gastrointestinal tract, inflaming both the small and large intestines. Whereas a typical food allergy response can appear within seconds to an hour after exposure, FPIES response may occur within 2-6 hours after eating something containing your trigger by vomiting profusely and sometimes with diarrhea, paleness and lethargy.
Standard allergy testing is not used for diagnosing this one. A board-certified allergist will consider medical history and may potentially suggest an oral food challenge. FPIES is typically something occurring in young children and often resolves by the time a child begins kindergarten.
EoE (Eosinophilic Esophagitis)
EoE is another immune dysfunction that presents differently than typical food allergies. In this case, food triggers can cause damaging inflammation of the esophagus. Eosinophils (white blood cells) can build up in the esophagus in response to exposure of allergens. This not only causes the inflammation, but it can also lead to severely scarred esophageal tissues, as well as other painful symptoms.
Symptoms can vary by patient and age, which can make it difficult to diagnose. In addition to a thorough medical history, a physician will perform an endoscopy and biopsy of pieces of tissue to help diagnose the disease. Identifying which foods trigger inflammation can become a process of trial and error.
