Alison Powell, ACUTE Dietitian
Monday, August 7, 2017
Allergies and intolerances can be difficult to differentiate between. Looking at different reactions that can occur with eating food as well at the severity of the body’s response is what distinguishes them. True allergies cause the body’s immune system to react harmfully. Intolerances are less critical and may be able to be included in the diet in small amounts. On some occasions there are also medications that can aid in absorption or tolerance of that food.
So what is an allergy? Allergies occur when your immune system reacts to a foreign substance (in this case a food) that normally doesn’t cause a reaction in people. Your immune system then produces antibodies to fight that particular food even though it’s not harmful. Then when you eat that food your immune system reacts in different ways, from making a person itchy or swollen, to closing their airways, or going into anaphylaxis. Medication can help lessen the severity of the reaction. Like with over the counter medications or eye drops with everyday allergens such as pollen or dander. However if the reaction is severe the best thing to do is avoid that allergen all together as this can be life threatening. Even small amounts of an allergen will show effect; this is another way to differentiate this from an intolerance.
What is an intolerance? An Intolerance normally takes longer to show effect than an allergy, from hours after a meal to 48 hours following. The most common symptoms include: bloating, coughing, headaches, stomach ache, irritable bowel, runny nose, or even hives. When consumed in very small amounts these foods do not normally show any effect which helps to separate these foods from being a true allergen.
There are a couple causes of food intolerance:
1) The most common cause being that the person is lacking an enzyme needed to fully digest a food. Like those whose are lactose intolerant lack the enzyme lactase, this breaks down lactose so it may be absorbed. Taking lactase enzyme pills (Lactaid) can help with digestion luckily.
2) There can also be chemicals in foods causing the intolerance, such as amines in cheeses or caffeine in coffee, tea or chocolates. Some people are more sensitive to these chemicals than others causing intolerance.
3) Sensitivity to food additives such as sulfites, sweeteners, nitrates, MSG, artificial colors or preservatives are the culprits for more than 1% of people with intolerances.
4) Psychological causes though unclear can also manifest as intolerance. The mere thought of food can make a person sick or the belief that they cannot tolerate that food may make them feel sick after eating it.
Testing can be done to help differentiate between an allergy and intolerance though this can be difficult as a lot of symptoms overlap. A skin prick test can be used by placing a small amount of that food on the persons back or forearm. The skin is then pierced with a needle to introduce the food in; if allergic the skin will react with a raised bump. A blood test can also be used to measure the amount of antibodies present however neither test is 100% reliable. Using elimination diets (only under the care of a dietitian or medical professional) can be utilized to pinpoint harmful foods. Utilizing this method you remove that food item for two weeks seeing if symptoms change, if there is a positive effect that food is slowly reintroduced to see if symptoms return. However this can continue to be attempted as months pass to see if the food can again be reintroduced.
The main goal on ACUTE is to reintroduce as many foods as possible to better nourish the body. Including all macro and micronutrients to provide a well-balanced diet and avoid any deficiencies. If documentation is not provided of an allergy or intolerance upon admission those foods are normally slowly introduced to expand the patient’s options and bring new foods to light that may have been avoided for years. This can be frightening at first but as tolerated has led to patients being happier with food options upon discharge. Being open to trying new foods is important, especially when being cared for in a controlled and safe environment such as Denver Health’s ACUTE center. Nevertheless being aware of a true allergy is vital and following a body’s limitation, thus finding that allergy or intolerance is crucial to provide the best care.