Are your symptoms a food allergy vs food intolerance?
Why is it important to know if you have a food allergy vs food intolerance?
Many people have problems with food, and many doctors seem to just tell you to “avoid it.” But don’t you deserve better than that? Especially since one is caused by a potentially life threatening immune response and the other potentially causes you to feel absolutely miserable. If nobody has clarified this for you, then read this article because I will help you figure out whether your symptoms are caused by a food allergy vs intolerance.
Is it a food allergy vs food intolerance?
This week, 40% of my patients have had at least one food concern and their question is always the same: am I having a food allergy vs food intolerance? Of this week’s patients, there are three who I thought would be a good example for this post:
Beth is a woman who saw me because she has been having increasing abdominal pain with multiple foods. She had been unable to find the cause and has recently become gluten and dairy-free as an attempt to solve this pain on her own. When that didn’t help, she came to see me to try and find out whether she had a food allergy vs food intolerance.
Yousef is a 4 year old I saw who recently stopped eating foods. He said that yogurt caused a stomach ache and when he ate peanut butter it “caused his mouth to hurt.” He had never had any swelling of the tongue and no rash, but now was avoiding any new food and was only eating cereal (with milk), spaghetti and fruit. Yousef’s mom wanted to know if this was a food allergy vs intolerance or if he was just being picky about new foods.
Finally, Michael came to see me just 2 days ago. He has a history of a shellfish allergy since he was a child and told me that when he ate it he would “swell up like a balloon” and get hives. He had always been able to eat fish without a problem but recently had “a small rash” across his face and chest after eating fish. He was worried that he had developed a new fish allergy.
As you can guess, multiple times a day I see people who want to know if they have a food allergy vs food intolerance. It is the RIGHT question to ask and each of them were correct in wanting to find out the answer.
The common “treatment” for food allergy vs food intolerance
Unfortunately, many people (and sadly, many doctors) tend to associate ANY food reaction with an allergy and give the advice “just avoid it.”
That advice is as bad as the classic “it hurts when I do this” doctor joke.
But your symptoms are no joke and it’s time to stop treating them like one.
Trying to determine if a reaction is a food allergy vs intolerance is an important one regardless of the trigger because the treatment for food allergy is very different than that of food intolerance. And it is important to get the right treatment for YOU and not just some generalized advice.
I have written this article (which, as a warning, is long) because I want to help everyone determine their symptoms are truly a food allergy vs food intolerance.
NOTE: If you don’t have time to read this article now, you and save it for later.
What are different causes of food allergy vs food intolerance?
First, we need to talk about the cause of each type of reaction. This is important because it’s how I, as an allergist, know how to interpret your symptoms, know what tests to order for you and, ultimately, know how to create your long term plan.
This step is also the step skipped by most medical providers.
The result: bad treatment plans. But we can fix that today by discussing the causes of food allergy vs intolerance:
Food Allergy: An allergy is an IgE antibody mediated immune system response to a specific trigger (in this case, a food).
- The main problem is that your body thinks the food is attacking it
- As a result, you body reacts as if the food were bacteria or viral infection
- This leads to true inflammation and activates a full immune response
Food Intolerance: As a general rule, if a food causes a symptom that is not a food allergy, it is a food intolerance. This means the majority of reactions are actually food intolerance. It also means there are many different causes of food intolerance:
- Foods can directly irritate your skin or body
- Foods can be processed into something that irritates your skin or body
- Foods can cause a chemical response that is undesired
- Foods can cause a normal response that is undesired
- Foods can cause a type of inflammation that activates the basic immune system (innate system)
- This can cause mild inflammation, typically not as severe as an allergy
- This does not activate the full immune system.
What are the symptoms of food allergy vs intolerance?
The MOST IMPORTANT thing I can do when I am trying to figure out if you have a food allergy vs food intolerance is to LISTEN TO YOU. By listening to you describe your symptoms, usually the answer can be figured out.
Did you know that a medical provider will interrupt you within 12-18 SECONDS?
Worse, 23% of patients aren’t able to say their full concerns BECAUSE of doctors interruption!
With food allergy, you NEED to be heard. It is the most important step in your diagnosis!
If nobody else is listening, please ASK ME! I will listen and help you figure out food allergy vs intolerance the RIGHT way!
As a general rule a doctor should have about 80-90% certainty of your diagnosis after just talking (and more specifically, listening) to you. As a result, I spend more time listening to symptoms than anything else.
So what are the typical food allergy vs food intolerance symptoms?
Food Allergy: Allergy symptoms tend to be relatively predictable. Typical food allergy symptoms might include:
- Hives / welts – these skin reactions happen in about 90% of patients with an allergy.
Pro-tip: if you have a rash, take pictures!
Cell phones and the ability to take pictures has made it so much more accurate to distinguish between allergy vs intolerance.
- Hives tend to be itchy welts with individual lesions lasting < 24 hours
- Although the total rash itself might come and go over more than a day
- Swelling – there may also be swelling (angioedema) of the mouth, face, hands, feet, or groin area.
- You can get abdominal pain, nausea, vomiting or loose stools.
- You might get lightheaded, feel dizzy or about to pass out
- Allergic reactions also carry with them the risk of death! (anaphylaxis)
Food Intolerance: Since a food intolerance is caused by many different factors, the symptoms are less predictable. One of the keys to diagnosing food intolerance is to make sure it’s NOT an allergy. So read through the allergy symptoms again. If none of it sounds like you, then you more likely have a food intolerance.
Typical symptoms might include one or many of the following:
- Rash – not a hive rash, but a red rash that may/may not be itchy and tends to last for > 24 hours
- There is rarely swelling
- There is often abdominal pain, nausea, possibly vomiting, constipation or loose stools. This is a very common symptom with food intolerance.
- Headaches sometimes happen. But feeling lightheaded, dizzy or passing out is very unusual for a food intolerance.
- May feel fatigued or decreased energy
- Weight gain or weight loss is not a usual symptom of intolerance although it can happen. It is always important to search for more common causes of weight changes is this is the only problem.
- An intolerance should not kill you. It might make you feel miserable… and I’ve heard a few symptoms that sound worse than death (figuratively), but the risk of death is an allergy.
If you want to figure out whether you have a food allergy vs intolerance RIGHT NOW, download and fill out this quiz! Then continue reading to learn about testing and the long term treatment plan.
What tests are used to diagnose a food allergy vs intolerance?
In my daily practice, by just listening I get a pretty good idea whether you have a food allergy vs food intolerance BEFORE I order any test. This is what all medical providers should do for you as well. In addition, your provider should have a plan for both if the labs are positive and if the labs are negative.
Unfortunately, it is far too common that a medical provider does testing and then confidently tells you “what it isn’t” but doesn’t have a plan to determine “what it is.”
I HATE this!
It’s bad doctoring… and very annoying.
As a general rule, testing should CONFIRM the doctor’s suspicion of food allergy vs food intolerance. The lab test BY ITSELF does not determine whether you have a food allergy or intolerance.
Food Allergy: Allergy testing can be performed with either a skin test or a blood test.
- A skin test should cause a hive to the food in question.
- A blood test should have a positive IgE reading
- If one of these tests is negative/normal and the suspicion is high for allergy, the other should be done.
- There is always the option for an allergist to have you eat the food/use the product and “see what happens.”
- This is not a preferred option and usually an ingestion challenge is reserved for when you’ve outgrown an allergy or when we are finding a safe alternative.
- It is not standard practice to do an ingestion challenge to cause a reaction.
Food Intolerance: There is no standardized testing for intolerance. For some specific types of intolerance, there are some tests (lactose tolerance test, celiac test) but a “general test” does not exist.
- Most of the time the first step is to rule out an allergy, so we often do an allergy test expecting it to be normal.
- For many people with food intolerance, the test is simple:
- Remove the trigger and the symptoms should go away
- Return the trigger and the symptoms should return
- Remove them again and the symptoms should go away, and then keep avoiding
- Ideally, this would be done as a “blinded” test where you don’t know if you are exposed to the trigger or not.
- This eliminates confirmation bias.
- Of course, this needs to be done with your knowledge. Someone just doing this test secretly to you is not a nice person.
The reason to care about food allergy vs food intolerance
The reason I take a good, long history and then confirm with testing is for one reason: to create your long term treatment plan.
The long term treatment plan is VERY DIFFERENT in food allergy vs intolerance:
Food Allergy: Remember when you were a kid and got vaccines so that your immune system would protect you against polio, pertussis, diphtheria, etc? Well, a food allergy is also an immune response… and your body thinks it is now “protecting” you against the food. *Yay immune system* (read in a sarcastic voice). The problem is that food allergy is often a life long problem.
As a result, the long term plan for food allergy is:
- Avoid the product (likely for life, since your body will always protect you from that food)
- Accidental exposure could result in death
- You will likely need an injectable epinephrine pen, school forms for strict avoidance, and an anaphylaxis action plan.
Food Intolerance: Intolerance is different. An intolerance might be lifelong (lactose or celiac disease) or it might be temporary. If it’s temporary, there is no good way to tell when it is ok to bring back the food. You just have to try and see. For this reason, the general plan for intolerance is:
- Avoid the food (for now)
- Wait an amount of time. Possibly 3 months, 6 months, a year (discuss this with a medical provider).
- At some point, consider bringing back the product.
- If you can tolerate it again — Great! No more problem.
- If not then remove it again for another 3, 6, 12 months.
- Accidental ingestion will likely trigger your symptoms but will not cause a risk of death.
- There is no need for an epipen or school forms
I know this was a long post.
But as you can see, distinguishing food allergy vs food intolerance is very important because they ultimately have VERY different treatment plans.
And when it comes to figuring out your health, there should be no shortcuts in deciding whether you have a food allergy vs intolerance.
Since it was so long, I have also included the so you can download it and read it later.
And if you have any questions, or think you might not be getting the care you deserve, please let me know and I might be able to help!
- If you have a story similar to those above, share them in the comments below. I think the more stories (both good and bad) that are shared, the more it can help people struggling with this problem.
- As always, if you KNOW someone who is having a difficult time with food allergies vs food intolerance, PLEASE SHARE this page with them on Facebook, Twitter, Google+ or pin this article on Pinterest. Be a good friend or family member and help them get the right answer.
- Finally, if this article helped you figure out your own symptoms, share what you had below! I’ll track the results and post them as a follow up in the future.