Food allergies and food intolerance, what’s the difference?
Food allergy is an abnormal immune response to food, whereas food intolerance is a detrimental reaction, often delayed, to a food, beverage, food additive, or compound found in foods that produces symptoms in one or more body organs and systems, but generally refers to reactions other than food allergy.
Before six months of age, your baby should be having the best milk available, either breast milk or baby’s formula. Starting around six months of age, the goal is to have your child grow and enjoy all the foods that are regularly enjoyed around that age group and progressing to support their growth and development.
Current recommendations are that any foods (except honey) can be given to a child around six months of age – as long as an infant doesn’t have a reaction, of course.
As you introduce new foods to your child, keep an eye out for signs of food allergies.
The most common food allergens include milk, eggs, peanuts, tree nuts (almonds, brazil nuts, cashews, coconuts, hazelnuts, macadamia nuts, pecans, pistachios, pine nuts, and walnuts), fish, shellfish, soy, wheat and sesame.
Food Allergy Symptoms
Common food allergy symptoms include:
- Mild wheezing or coughing
- Itching or tingling mouth, lips or throat
- Urticaria (rash/hives)
- Gastrointestinal symptoms (e.g. stomach pain, nausea, vomiting and diarrhea)
- Facial edema (swelling)
- Feeling very hot or very cold
- Pale or flushed appearance
- Dyspnea (difficult or labored breathing)
- Croup/choking cough
- Circulatory collapse
if you suspect that your child has a food allergy, schedule an appointment to see your pediatrician. Keep a log of all specific symptoms and what your child had eaten or drank within two hours before the symptoms started.
It’s important to know, and to remember, that food allergies can be life-threatening. Some children are so allergic that eating a tiny piece of one peanut could kill them, while others just develop eczema. If you have a child with food allergies, you must let everyone in her life know. This includes family members, caregivers, teachers, coaches, friends’ parents, and anyone else who watches your child. In cases of a severe nut allergy, it is recommended that you keep a nut-free home, to ensure that your child doesn’t accidentally eat a nut. Some kids wear a MedicAlert bracelet to let everyone know of their serious food allergy.
Food Allergy Management
Your pediatrician may refer you to an Allergist for further testing, if your child has a food reaction. Allergy testing can be very helpful in determining which foods to avoid, which foods to serve, and how to treat future reactions.
If your child has a food allergy, you will become familiar with certain medications that you must carry everywhere and give to your child’s daycare, school, family, friends, and neighbors. Ask your pediatrician for a written action plan so that you know which medications to use, how and when to use, and how to call for help.
The recommended method for diagnosing food allergy is to be assessed by an allergist. The allergist will review the patient’s history and the symptoms or reactions that have been noted after ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, he/she will perform allergy tests.
A tiny board with protruding needles is used. The allergens are placed either on the board or directly on the skin. The board is then placed on the skin, to puncture the skin and for the allergens to enter the body. If a hive appears, the person is considered positive for the allergy. This test only works for IgE antibodies. Allergic reactions caused by other antibodies cannot be detected through skin-prick tests.
Skin-prick testing is easy to do and results are available in minutes. Different allergists may use different devices for testing. Some use a “bifurcated needle”, which looks like a fork with two prongs. Others use a “multi test”, which may look like a small board with several pins sticking out of it. In these tests, a tiny amount of the suspected allergen is put onto the skin or into a testing device, and the device is placed on the skin to prick, or break through, the top layer of skin. This puts a small amount of the allergen under the skin. A hive will form at any spot where the person is allergic. This test generally yields a positive or negative result. It is good for quickly learning if a person is allergic to a particular food or not because it detects IgE. Skin tests cannot predict if a reaction would occur or what of reaction might occur if a person ingests that particular allergen. They can, however, confirm an allergy in light of a patient’s history of reactions to particular food. Non-IgE mediated allergies cannot be detected by this method.
It is used to determine if a specific substance causes allergic inflammation of the skin. It tests for delayed food reactions.
It is another way to tests for allergies, however, it poses the same disadvantage and only detects IgE allergens and does not work for every possible allergen.
Radioallergosorbent testing (RAST)
It is used to detect IgE antibodies present to a certain allergen. The score taken from the RAST is compared to predictive values, taken from a specific type of RAST. If the score is higher than the predictive values, a great chance the allergy is present in the person exists. One disadvantage of this test is that it can test many allergens at one time.
It tests for allergens other than those caused by IgE allergens. The allergen is given to the person in the form of a pill, so the person can ingest the allergen directly. The person is watched for signs and symptoms. The problem with food challenges is that they must be performed in the hospital under careful watch, due to the possibility of anaphylaxis.
To avoid an allergic reaction, a strict diet can be followed. It is difficult to determine the amount of allergenic food required to elicit a reaction, so complete avoidance should be attempted. In some cases, hypersensitive reactions can be triggered by exposures to allergens through skin contact, inhalation, kissing, participation in sports, blood transfusions, cosmetics, and alcohol.
The mainstay of treatment for food allergy is total avoidance of the foods identified as allergens.
If the food is accidentally ingested and a systemic reaction (anaphylaxis) occurs, then epinephrine should be used. A second dose of epinephrine may be required for severe reactions. The person should then be transported to the emergency room, where additional treatment can be given. Other treatments include antihistamine and steroids.
Food intolerance or sensitivity and food allergy can have similar symptoms, but it is important to know that they are not the same thing. A common example is lactose tolerance, which is not the same as a milk allergy.
True food allergies trigger an allergic immune system reaction in your body, which causes symptoms such as hives and trouble breathing.
Food intolerance or sensitivity on the other hand is not IgE mediated, which means it is not an allergic reaction. With food intolerance or sensitivity, either the body cannot properly digest a specific food (such as dairy products containing lactose), or the digestive system is irritated by a specific substance. Symptoms of food intolerance nausea, gas, cramps, abdominal pain, diarrhea, irritability, nervousness, and headache.
Food intolerance symptoms generally come on gradually and in some cases your child may be able to eat very small amounts of the offending food without trouble. You may be able to take steps help prevent a reaction. For example, if the child has lactose intolerance, the child may be able to drink lactose-free milk or take lactose enzyme pills that aid digestion.
Always talk to your pediatrician if your baby or child seems sensitive to a specific food. After evaluation and possible allergy testing, your pediatrician may refer you to a pediatric dietitian to ensure that your child gets proper nutrition if you need to remove an offending food or beverage from your child’s diet.
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