Food Allergies and Intolerance: What You Need to Know

Think You Might Have Food Allergies? Explore Common Food Allergies, Smart Substitutions, and Other Solutions

Food allergies and intolerances: what you need to know. There are food allergies (an immune reaction caused by the release of IgE and histamine by the body in response to certain foods), and there are food intolerances (caused by irritation of the gut by certain foods). These are easily confused. Sometimes symptoms may be similar to both; the following discussion will help differentiate between the two.

Discover the difference between food allergies and intolerance: What you need to know:

Food Intolerance

A food intolerance is actually a digestive problem. These digestive disorders include things like irritable bowel syndrome diarrhea type (IBS-D), gluten sensitivity, celiac disease, reflux (GERD), lactose intolerance, yeast overgrowth, ulcerative and gallbladder disease, as well as the ingestion of toxic foods.

Unlike food allergies, food intolerance usually appears within hours after eating that food. Intolerance involves difficulty in digesting and metabolizing the food, which is not an immune-regulated IgE response. People with digestive problems like IBS are more likely to suffer from food intolerances.

"I Can't Eat That"

Signs and symptoms of Intolerance often include one or more of the following:

• gas

• bloating

• diarrhea (may be similar to an allergy)

• abdominal pain

• headaches

• hives

• itching

• fatigue

• concentration difficulties

Foods that most commonly cause intolerance include the following

• Dairy products, including milk, cheese, and yogurt (lactose) - Usual symptoms of dairy intolerance involve stomach problems. A great example is lactose intolerance.

• Eggs, particularly egg white - The main symptoms are gastrointestinal problems

• Flavor enhancers such as MSG (monosodium glutamate), natural and artificial colors, and preservatives,

• Rye, wheat, barley (gluten)

• Histamine-containing foods (fermented foods and drinks like  headaches or migraine nasal congestion or sinus issues, fatigue, hives, digestive issues, irregular menstrual cycle, GI issues) - alcohol (especially wine), and other fermented beverages - fermented foods and dairy products, such as yogurt and sauerkraut - dried fruits - avocados -eggplant - berries, spinach, processed or smoked meats - shellfish - aged cheese - food additives

• Caffeine (neurologic reactions/overstimulation)

• Strawberries, citrus fruits, and tomatoes

• Wine, particularly red wine (histamines, sulfites, various grains

• Certain carbohydrates (FODMAPS) - These are carbohydrates/sugars that can be found in many different foods, including some dairy products, some fruits, beans, lentils, and wheat. These can cause gas, bloating, abdominal distension, diarrhea, constipation, borborygmi (intestinal sounds), and stomach pain.

• Theobromine (tea, chocolate)

• Tryptamine (tomatoes, plums)

• Tyramine (aged cheese and pickled fish)

• Serotonin (tomatoes and bananas)

• Monosodium glutamate (flavoring) and sodium metabisulfite  (preservative)

How can you tell which food(s) you are intolerant to? Of course, pay attention to the symptoms following a particular meal - keep notes of what you ate before developing symptoms, and try an elimination diet - eliminate certain groups of foods from your diet one at a time. At the same time, keep a check on your digestive symptoms. If you experience relief after eliminating a certain type of food or food group,  that food is likely the culprit of your distress, and you can try eliminating it from your diet.

Do you have a food phobia? A food aversion?

Food Allergy 

A food allergy is an abnormal response by the immune system to a particular type of food. Sometimes, symptoms of allergy are similar to those of food intolerance, but more often than not, the signs and symptoms of food allergy show up in a different body part. These symptoms usually come on several minutes to two hours after ingestion.

Remember that just because you never had an allergy to a substance before, you can develop an allergy to that substance later on in life.

It is imperative that people who have food allergies be read food labels and menus carefully. Question restaurant food content and what it is cooked in if applicable. Those with allergies need to know how to recognize early symptoms of an allergic reaction and how to treat them.

Signs and Symptoms of Food Allergies

• Swelling/itching/tingling of the lips, palate, tongue, and/or throat, altered taste 

• Itchy eyes; runny, stuffy nose; dry

• Wheezing, coughing spasms

• Nausea and vomiting, abdominal cramping, diarrhea (sometimes)

• Hives, rash

• Flushing or pallor

• Stomach cramps, diarrhea, upset stomach, vomiting (this overlaps with food intolerance)

• Lightheadedness, dizziness

• Significantly decreased blood pressure and increased heart rate

• Occasionally, a food allergy will trigger eczema

• TOTAL ANAPHYLAXIS!

Common Foods Which Can Cause Allergies

Some of the most common food allergies

Eggs

• Milk - mostly in kids

• Eggs

• Fish (e.g., bass, flounder, cod, salmon) - more likely in adults

• Crustacean shellfish (e.g., crab, lobster, shrimp) -mostly in adults

• Tree nuts (e.g., almonds, walnuts, pecans, pine nuts, Brazil nuts)

• Peanuts

• Wheat (barley, rye, oats)

• Soybeans

• Sesame

​​​Common fruit allergies:

•  Apples

•  Peaches

•  Strawberries

•  Kiwi

•  Bananas

•  Tomatoes (yes, they are a fruit)

•  Papayas

People who have a food allergy to citrus fruits are advised to avoid pineapple, oranges, plums, muskmelons, limes, and lemons.

Common vegetables causing allergies (particularly if they are raw):

•   Celery                                            

•   Sweet corn 

•   Eggplant                                         

•   Potato

•   Beetroot                                           

•   Pepper

•   Cabbage                                         

•   Onion 

•   Carrot         

•  Mushrooms                    

• Celery                                         

•   Cucumber                                       

•   Garlic   

• Lettuce                  

Interestingly, If you have a latex allergy, you may be allergic to one or more of the following fruits: Apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato, and tomato because of cross sensitivities.

According to research, most kids grow out of food allergies when they are around five years old, especially milk, wheat, egg, and soy; however, some have certain food allergies forever. If the allergy is severe as a child, it is more likely to continue into adulthood. If you have any questions or concerns about it, it is best to consult with an allergist.

Persons with a known food allergy or those who begin to experience progressive symptoms while or after eating a food should initiate treatment immediately and go to a nearby emergency room if symptoms progress. People with known food allergies should carry an Epi-Pen at all times. Ask a healthcare provider for a prescription.

General Approaches to Food Allergies

Try to adapt your diet. Find smart substitutions at the Allergy and Asthma Network

Conventional Over-the-Counter Medicines That May Help Food Allergies     

Antihistamines may be helpful unless the allergic reaction comes on rapidly with severe symptoms. Some of the more commonly used antihistamines include Cetirizine (Zyrtec), diphenhydramine (Benadryl), fexofenadine (Allegra), and loratadine (Claritin).

Supplementing one of the above antihistamines with the stomach medication, Tagamet (another type of antihistamine which hits different histamine receptors), may be even more beneficial.

Note: If you have serious allergic reactions to foods, speak to your healthcare provider to see if any over-the-counter medications are appropriate. Particularly if you have serious allergic reactions.

Alternative/Herbal Approaches to Food Allergies

While some of these may help prevent minor food allergies with long-term use, some can cause allergies as well. They are likely not appropriate in an acute allergic reaction, but may help ward it off.

• Probiotics ( There is some evidence that probiotics can help reduce symptoms of milk allergies (1). Probiotics may not be appropriate in some people with certain immunocompromising conditions.

• Lemon

• Green Tea (While some people may have an allergy to green tea, it may help others with certain food allergies such as soy)

• Apple Cider Vinegar

• Quercetin - Has antihistaminic properties

• Vitamin C

  
  

Note: If you have serious allergic reactions to foods, speak to your healthcare provider to see if of the supplements (above) might be appropriate for use. This is particularly important if you have serious allergic reactions. They may not be effective enough.

Prescriptive Treatment of Food Allergies 

• ​Montelukast/Singulair - This medication works differently than the antihistamines. It is a leukotriene inhibitor that  helps decrease inflammation in allergies.

• Epinephrine - This is an injectable emergency medicine (an EPI-PEN) prescribed for to you to carry in case you eat something you are allergic to. It is also given in the ER when allergy symptoms are advancing fast and furiously. Epinephrine reverses anaphylaxis by increasing the blood pressure (which is often significantly lowered during a severe allergic reaction) and helps open the breathing passages. Healthcare providers encourage all patients with potentially severe allergies to carry one of these around.

• An Allergist - This is an important approach if you have serious allergies - they can give you allergy "shots" or allergy drops over time to create some "immunity" to your allergy. Over the course of several treatments, you will gradually develop a tolerance.

The allergist can also determine what your allergies are if you believe you have allergy symptoms but cannot figure out the cause. They will test you with a blood test or a skin prick test to determine the cause of your allergy symptoms.

Some allergists believe that the ultimate slow introduction of a substance, especially in childhood, may help a person's body tolerate certain foods. This gradual introduction instead of restriction may help  (2). However, if someone has a known allergy to a food, it is imperative that they do this with a healthcare provider. For example, some people do not give their child cow's milk. If they withhold milk from their child, this might, in fact, foster the development of an allergy to milk because the child has never developed a normal immune system. If the child is given small quantities of milk over time, that child will be less inclined to develop an allergy.

According to the  American College of Asthma, Allergy and Immunology, "allergies to milk, eggs, wheat and soy may disappear over time, while allergies to peanuts, tree nuts, fish and shellfish tend to be lifelong" (3)

Common Questions About Food Allergies

What about all those gluten allergies that people talk about? 

Gluten is found in foods barley, wheat, rye, semolina, malt, and bulgur, among others. Gluten can also be found in other products to include:

• Some starches, preservatives in food stabilizers, bullion, some candies, chips, some medications, vitamins, herbal remedies, toothpaste and mouthwash, lipstick, some deli meats, beer, and more. The lists are extensive. It is not a requirement for producers to list it on their labels.

  
  

There are three conditions that people may have when it comes to gluten.

The first is an inherited autoimmune reaction to gluten or celiac disease. This disease causes inflammation of the small intestine. Only about 1% of the population has this condition (4). It is important that a person has this treated because it can cause a whole host of potentially serious problems (like osteoporosis, cancer, infertility, spleen problems, among others (5). It is demonstrated by skin problems, headaches, fatigue, stomach issues   (nausea, vomiting, diarrhea, bloating, constipation) which typically begin two to three days after consumption, headaches, joint pain, mental cloudiness, and weight loss. Blood tests and gastric procedures can aid in making this diagnosis. 

The second problem is a true gluten allergy where the body produces excessive IgE, which triggers an inflammatory allergic response in response to gluten (especially wheat). Those symptoms would be one or several of the food allergy symptoms mentioned earlier under general food allergies. It is very rare.

There are those who do not have the allergy IgE marker yet suffer the very similar symptoms - this would be a gluten intolerance or gluten sensitivity. It is often confused with Celiac Disease. It is fairly common. Symptoms of this can be very similar to celiac disease: 

• Constipation or diarrhea.

• Excessive bloating.

• Headache.

• Joint pain.

• Stomach ache.

• Fatigue.

• Unexplained mood changes.

• Lack of ability to think clearly (sometimes called “brain fog”)

Can red dye cause ADHD and other personality changes?

Studies have shown that a number of dyes, color additives, Blue 1 and 2, Green 3, Red 3, Yellow 5 and 6, Citrus Red 2, and Red 40 can trigger unusual behaviors in some kids. Red dye number 40 and yellow dye number 5 in children reportedly cause restlessness, aggressiveness, hyperactivity, and actually ADHD symptoms (6), and other related behavioral changes. Memory and learning may be affected in conjunction with changes in the neurotransmitters in the brain and microscopic changes in brain structure (7).

Some food colorings cause a number of other potential. While kids just love those very colorful desserts, if you have any question about food coloring having an effect on your child's behavior, eliminate it for a while and see if the behavior changes.

Why do so many kids with peanut allergies these days?

peanut allergies have been growing at an alarming rate. According to the Mayo Clinic, the incidence of peanut allergies has tripled over the last few decades. There are several possible explanations for this. Some scientists believe that genetics is the cause. But another widely held belief (the hygiene hypothesis) contends that the immune system learns how to respond with more discretion when it is exposed to different things during our formative years. When this hypothesis is applied to peanut allergies,  it would mean that a child who has little exposure to peanut products (for example, peanut butter and peanut oil) will not develop the immunity needed to prevent allergy. Therefore may develop an allergy to peanuts.

This hygiene hypothesis applies to a lot of things - to illness (bacteria and viruses) and to asthma as well (hyperactive immune response to various substances). The body overreacts with an allergic inflammatory response because it thinks that certain particles are foreign and wants to fight it off. I once had a patient who was a kindergarten teacher. She said that there was a standing joke amongst the teachers that the healthiest kid in their class was a child who "licked the bottom of his shoes". It may be funny, but that statement may have some truth

By the way, this does NOT imply that you should have your child lick his or her shoes, and does NOT mean that you should feed a baby peanut butter!!!!

For many people, peanut allergies may be a lifelong problem. About 1/5 of those people will outgrow them, but what kind of a chance do you want to take?

In summary, managing symptoms starts with clear knowledge. For a deeper understanding, explore Food Allergies and Intolerances: What You Need to Know and how they impact your health and daily choices.