The New York Times recent reporting on a medical paper claiming that most food allergies were not real has caused an uproar among those us who understand what it means to live with physical discomfort that is directly related to the foods that we eat. it makes me think that it’s time for a little clarification between food allergies, food intolerances, and food sensitivities.
While there is no doubt that people can be allergic to certain foods, with reproducible responses ranging from a rash to a severe life-threatening reaction, the true incidence of food allergies is only about 8 percent for children and less than 5 percent for adults, said Dr. Marc Riedl, an author of the new paper and an allergist and immunologist at the University of California, Los Angeles.
Yet about 30 percent of the population believe they have food allergies. And, Dr. Riedl said, about half the patients coming to his clinic because they had been told they had a food allergy did not really have one.
Dr. Riedl does not dismiss the seriousness of some people’s responses to foods. But, he says, “That accounts for a small percentage of what people term ‘food allergies.’ ”
Now, reading this you might actually believe that people don’t have unpleasant reactions to the food they eat nearly as often as they do. I’ll be you probably even know someone who runs to the bathroom all the time, or suffers from migraines, or has acid reflux. You yourself might even steer away from foods that you already know don’t agree with you.
I believe what we have here is a case of word choice. If one-third of the population believes that something that they are eating is contributing to their illness or malaise, but Dr. Riedl says that fewer than 1 in 10 people actually have “food allergies,” than what does he think is making the rest of those people sick?
While Dr. Riedl mentions food intolerance as an alternative to an actual allergy, he doesn’t even suggest that these people might be suffering from food sensitivities, the type that are implicated in Type III and Type IV non-Ige-mediated immune reactions.
Let’s put it in perspective by understanding the terminology of food reactions correctly.
Food Allergy A food allergy is a Type I Hypersensitivity reaction that causes anaphylaxis and is marked by the presence of IgE antibodies. It is immune-mediated, meaning it involves the immune system. Peanuts are a common source of food allergies. IgE antibodies can sometimes be found by doing a scratch test.
Food Intolerance Food intolerances are often due to an enzyme deficiency causing incomplete digestion of certain foods. They are commonly seen with dairy products. A food intolerance does not trigger the immune system but usually causes great discomfort soon after eating those problem foods that lasts until they are expelled.
Food Sensitivity Called Type III Immune Complex Mediated Hypersensitivity and Type IV Cell Mediated/Delayed Hypersensitivity Reactions, food sensitivities happen when our immune systems react to the foods and additives we eat by releasing cell mediators like histimines and cytokines that cause systemic inflammation around the body. Due to the inflammation, various symptoms may arise.
Since food sensitivities don’t create IgE or IgG antibodies, the only way that we can tell exactly which foods or chemical additives are causing the problems is to look at if there has been a release of mediators like histamine, cytokines, proglandins, etc. when the allergen is present.
Each of these food issues can be dose dependent, meaning that you may do fine with only a little bit but start reacting when you have a lot, and food sensitivites in particular can have reactions delayed up to 96 hours after ingestion, so I can understand the confusion in the general public and the media, and the tendency to label every food-related issue as a “food allergy.”
As Dr. Reidl noted in his paper (but wasn’t widely reported), food allergies may not be as common as people believe, but that doesn’t mean that your food may not be making you sick.
If you suspect your malaise is connected to what you’re eating, you’re likely right. Just like with food allergies, the trick to feeling better from food sensitivities is to be able to identify the culprits and remove them from your diet. The more you eliminate the guesswork, the more quickly you’ll heal and go on to lead a normal life.
Just don’t say you have “food allergies.”