The symptoms of food intolerance can impersonate the symptoms of allergies. Here, are the differences between the two that allergists need you to know.

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Does your stomach get upset every time you drink milk? Or do you get bloat every time you eat bread? Or after having peanut butter, you feel itchy and tingly? You may think that you have an intolerance to that food or are possibly allergic to it. But the answer still isn’t clear.


Before jumping into any conclusion, we first need to clear the difference between food allergy and food intolerance.

David Stukus, MD, allergist, director of the Food Allergy Treatment Center at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the American College of Allergy, Asthma, and Immunology (ACAAI) states that true food allergies are when the immune system grows sensitized and overreacts to a specific element of a food. He also says that this exaggerated immune response can be activated by eating even a small amount of the food and heads to signs including digestive issues, swollen airways, hives, and in some cases, death through anaphylactic shock.


Food-related anaphylaxis is a life-threatening whole-body response to an allergen that kills about two adults each day in the U.S. According to ACAAAI, symptoms of anaphylaxis involve trouble in breathing, swelling in the throat, a sudden fall in blood pressure, pale skin or blue lips, fainting, and dizziness.

Person taking a spoonful from ceramic bowl


In the past recent years, doctors are noticing an escalation in illnesses of food intolerances, where people feel ill after eating particular foods but the symptoms don’t grow to the level of an allergy or are different altogether. Rabia De Latour, MD, a gastroenterologist and assistant professor at the NYU School of Medicine says, “These people can have some of the same symptoms of a food allergy but may have additional symptoms and usually don’t show any of the physiologic changes associated with a food allergy.”


Food intolerances are considered to be the outcome of an impotence to digest a certain food, rather than being the result of an overactive immune response. Dr. De Latour says they are not life-threatening, cannot provoke anaphylaxis, and can differ widely in severity. Signs of a food intolerance can be similar to those of a food allergy and/or other symptoms like brain fog, hyperactivity, depression, stomach pain, irritable bowel syndrome, bloating, acne, hair loss, weight gain or loss, exhaustion, and anxiety.


Food allergies are comparatively easy to diagnose and treat. While on the other side, food intolerances, usually aren’t recognized as an official medical diagnosis. They are much more difficult to explain, have a broad variety of symptoms, exist on a spectrum, may have a psychical component, and have many possible treatments beyond avoiding the allergen, says Dr. De Latour.


This enigma is complicated by the extensive amount of bad information about food allergies, intolerances, and sensitivities on the Internet, which is usually the first-place people go for knowledge, states Dr. Stukus. He explains, “People will spend hundreds of dollars for some at-home test or consultation only to be sent a long list of foods they are reportedly ‘sensitive’ to, and they’re told to avoid the foods.” and further continues, “But the results are meaningless and may lead to malnutrition or other health problems.”


This vagueness, and the fact that food intolerances appear to run in trends, can influence some doctors to write them off entirely but this is a mistake, Dr. De Latour explains. “Food intolerance is not well understood in the medical community but it shouldn’t be dismissed as psychological or just a fad,” she states. “People are clearly suffering even if their tests don’t show a clear pathology.”


Determining the answer to this question can be complex and confusing for both doctors and patients, Dr. De Latour states. “You can test for allergies but a food intolerance is a diagnosis of exclusion, meaning you just have to rule out every other possibility,” she emphasizes. “It can be incredibly frustrating not to have a clear answer but it is important to go through the process. Either way, your doctor should be able to help you find relief.”

Doctor showing something to her patient on a tablet


Relying on self-diagnosis is never a safe option. Says, Dr. Stukus. “There is so much misinformation and it has a negative impact on people’s medical decisions,” he states. “Make an appointment with an allergist. They have accurate tests to help you get the right diagnosis and are able to help you find a good treatment plan.” He says, when you register the appointment, request for additional time for questions, and then come to your appointment prepared with a listing of your symptoms and a list of questions you have, including things you may have seen on the internet.


An allergist can diagnose true food allergies and irritabilities. They may do a “scratch” test where they draw a grid on your back and place some of each possible allergen on the skin, each in its square, to see if it produces a reaction. Morton Tavel, MD, internist, clinical professor emeritus of medicine, Indiana University School of Medicine, and author of Health Tips, Myths, and Tricks: A Physician’s Advice says, “A positive result, a red, raised area called a wheal, means you reacted to a substance in a potentially allergic way. Such a positive result means the symptoms you are having are likely due to exposure to that substance.” He further states, “In general, the stronger the response, the greater the chance of allergy to that given substance.”


It is reasonable to receive a false positive or false negative on an allergy skin test and they are most trustworthy for diagnosing allergies to airborne bodies, such as pollen, pet dander, and dust mites, he describes. He says, “Skin testing may help diagnose food allergies but because food allergies can be complex, you may need additional tests or procedures.”


According to Dr. Tavel, there are blood tests to examine for antibodies that may show an allergy but these have high rates of false positives. He then adds, “The most common test, allergen-specific serum testing (for IgE antibody), is most useful for ruling out a food allergy.” There are various different types of blood tests that your doctor may require based on your individual condition.


For food intolerances, there are no tests so far. Alternatively, a food intolerance is a diagnosis of exclusion. After managing out an allergy, your doctor may examine you for sicknesses that can cause comparable symptoms, like thyroid disease or autoimmune illnesses like celiac disease, rheumatoid arthritis, or lupus, Dr. De Latour states. Your doctor also may order a blood panel to watch your overall well-being.


The easiest thing you can do to observe if you have a food intolerance is to totally eliminate the food from your intake for a least of one month and notice if your symptoms enhance, Dr. De Latour, states. This is simple but it isn’t certainly comfortable. You have to read every label and be more cautious when feasting out. For people who surmise various food intolerances, they can try an elimination diet, which excludes the most common culprits. She states, adding these are properly done under the direction of a doctor.


If you are still uncertain of what is generating your symptoms, even after attempting all of these tests, it may be time to think other non-medical circumstances, Dr. De Latour states. The brain and the body are very coherent so things like depression and anxiety can have physical displays that impersonate food intolerances, like gastrointestinal problems, headaches, fatigue, and brain fog, she says. Food allergies can also cause extreme physical responses.

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