Allergic or Intolerant? Dietitian Explains Troublesome Foods

We all need food to survive, but sometimes certain foods turn meal planning into a struggle. Whether it’s an allergy to shellfish or a lactose intolerance, the food sometimes presents us with challenges. Lisa Bishop, registered dietitian, Park Avenue Medical Center, NEMG, offers insight into the differences between intolerances and allergies and what you can do to win the food wars.

“The first thing to address is the difference between a food allergy and a food intolerance because people often confuse the two,” Bishop said. “A food allergy is an abnormal immune response to eating a certain food. Sometimes there are tests that can confirm the allergy. A food intolerance often results in some uncomfortable symptoms, but they tend to be less severe. Also, there are no tests that can say for certain that you have an intolerance to a certain type of food.”

According to the Centers for Disease Control and Prevention (CDC), there is no cure for food allergies. People are advised to avoid trigger foods completely because the reaction can sometimes be life-threatening. The most severe allergic reaction to food is anaphylaxis, which can cause breathing difficulties, increased heart rate and a drop in blood pressure. 

The U.S. Food and Drug Administration lists nine foods that trigger allergic reactions or intolerances more than others: 

• Eggs
• Fish
• Lactose (the sugar in milk)
• Peanuts
• Sesame
• Shellfish
• Soy
• Tree nuts
• Wheat

Peanut allergies are often in the news as they pose a threat to children in settings like day care centers and schools. Peanut allergies usually show up during childhood according to the American Academy of Allergy, Asthma and Immunology, which recommends epinephrine injectors, or EpiPens, be readily available in case of accidental exposure to peanuts and other trigger foods. An EpiPen delivers a dose of adrenaline to treat anaphylaxis.

Lactose intolerance is very common and known to produce bloating, gas, nausea and diarrhea among people who have difficulty digesting the sugar (lactose) in milk. Bishop said that, while uncomfortable, the symptoms are not usually serious and go away when the person avoids lactose. 

“This shows the big difference between an allergy and an intolerance,” she said. “The allergy is much more severe.”

It’s recommended that people who think they have an allergy ask their primary care clinician about getting tested because of the dangers they present. “You’ll likely get a referral to an allergist who will give you what’s known as a skin prick test,” Bishop said. “The doctor will place a very small amount of the food in-question on the tip of a small needle and scratch the skin with it. If there’s a reaction on the skin, that suggests there’s an allergy.”

The American Academy of Allery, Asthma and Immunology urges people to seek an allergy test only if they have symptoms or their clinician thinks they may have an allergy or, the test results may be inaccurate. 

While many people assume each type of food comes with a unique allergic reaction or intolerant symptoms, Bishop said that isn’t the case.

“I find the symptoms are unique to the person rather than the food,” she said. “Take sulfites as an example. You find those in dried fruits and frequently as general food preservatives. One person who is sensitive to sulfites might experience sneezing or throat closure when exposed, while another person who is sensitive to them may develop a rash.”

Despite the prevalence of food-related intolerances, Bishop said the time has never been better to find tasty substitutes. “Even just 10 years ago the selection of foods for people with intolerances was very limited,” she said. “Today we have non-dairy milks, cheeses and creamers. There are so many varieties of gluten-free breads now. And the quality is so much better. Restaurants are offering much more for people with allergies and intolerances too.”

Bishop also recommends over-the-counter supplements and medications, as they can be helpful in reducing and sometimes eliminating food intolerance symptoms. She added that Lactaid® is effective for lactose intolerance while antacids and antidiarrheals can help with symptoms from other intolerances. 

She called attention to improvements in food labeling too. 

“You see potential allergens listed on most food labels now,” she said. “That makes it so much easier for people to make decisions about what they should or shouldn’t eat. People who have food allergies or intolerances have more options today that can help them achieve a better quality of life.”