Food Allergy vs. Intolerance: Know the Difference

Jenna Hilton
July 17, 2024

Many people suffer from gastrointestinal problems, and these numbers seem to be increasing. Some try to diagnose the condition without medical help and only aggravate the problem. Others seek help and often find that they have a specific food sensitivity.

This article compares food allergy and intolerance, pointing out their differences and helping the reader learn how to recognize and treat the condition.

Food allergy vs. intolerance

‌What Is a Food Allergy?

A food allergy is our body’s immune reaction to a certain protein in food. Though the food is harmless, the immune system perceives it as toxic, making antibodies to protect itself and releasing histamines – chemicals that regulate inflammatory processes. High histamine levels cause allergic reactions, such as hives, bloating, and diarrhea. Sometimes, food allergy symptoms are severe and, in rare cases, life-threatening.

The FDA identifies nine most common allergens in food. These are wheat, milk, eggs, tree nuts, peanuts, soybeans, fish, crustacean shellfish, and sesame.

There is no cure for food allergies. Patients need to eliminate offending foods from their diet. In some cases, they outgrow the condition.

‌What Is a Food Intolerance?

A food intolerance is the body’s non-immunologic, chemical reaction to certain foods, which causes gastrointestinal distress. The symptoms are unpleasant but not life-threatening.

Foods and ingredients that typically cause an intolerance include gluten, lactose, histamine, fructose, and fermentable carbohydrates.

There is no cure for food intolerance, but patients learn to manage the symptoms.

‌What Is the Difference Between Intolerance and Allergy?

Many food allergy and intolerance symptoms overlap, so medical professionals sometimes have difficulty making a diagnosis. However, the two conditions differ in many ways. The following table sums up the differences.

Food AllergyFood Intolerance
SymptomsSkin rash, hives, itching, coughing, sneezing, vomiting, diarrhea, stomach pain, dizziness, difficulty breathing, swelling of the face, tongue, and throat.Bloating, gas, diarrhea, nausea, body tremors, heart palpitations, headaches, skin rash, mood changes, joint pain, nasal congestion, eczema.
CausesImmune reaction to food mistakenly perceived as harmful.Chemical reaction to food involving the digestive system.
Patients more at riskChildren up to age five.People of any age with genetic or acquired enzyme deficiencies and certain medical conditions involving the digestive system.
TestsSkin prick test, blood (antibody IgE) test, food elimination diet.Skin prick test, blood (antibody IgG) test, food elimination diet.
TreatmentElimination of allergens, auto-injectable epinephrine, antihistamines, corticosteroids.Avoiding trigger foods, enzyme supplements, stress management.

Symptoms of Allergy vs. Intolerance

Food allergy and intolerance symptoms are similar and include the following.

Allergy

Symptoms of food allergy
  • Skin rash
  • Hives
  • Itching
  • Swelling of the face, tongue, or throat
  • Difficulty breathing or swallowing
  • Coughing
  • Sneezing
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Increased heart rate
  • Weak pulse
  • Dizziness
  • Loss of consciousness

A food allergy can lead to anaphylaxis – a condition involving a sudden drop in blood pressure, difficulty breathing and swallowing, fainting, and shock. It is a rare but life-threatening event that potentially leads to coma and death.

Intolerance

Symptoms of food intolerance
  • Stomach pain
  • Bloating
  • Gas
  • Diarrhea
  • Vomiting
  • Constipation
  • Headache
  • Depression
  • Fatigue
  • Anxiety
  • Heart palpitations
  • Joint pain
  • Itching
  • Swelling
  • Eczema
  • Difficulty breathing
  • Sneezing
  • Nasal congestion
  • Rash

Causes of Allergy vs. Intolerance

Scientists continue to look for answers regarding what causes food allergies and intolerances. They know that allergies trigger the immune system, while intolerances can affect the digestive system, skin, and immune function. They also found the following distinctions in causes and risk factors.

Allergy

  • Family history of food allergies, asthma, or eczema
  • Passive smoking
  • Environmental pollution
  • Late introduction to allergens (after the baby has turned six months)
  • Early introduction to solid foods (before the baby has turned four months)
  • Antibiotics’ overuse

Intolerance

  • Family history of food allergies, asthma, or eczema
  • Enzyme deficiencies
  • Digestive disorders
  • Overuse of certain medications
  • Radiation therapy

Who Can Have a Food Allergy and Food Intolerance?

Anyone can be born with or develop a food allergy or intolerance.

Food allergies primarily affect young children (up to five years of age). Most of them outgrow milk, egg, and wheat allergies. Only 20% of patients outgrow peanut allergies. Seafood allergies typically remain for life.

Food intolerances affect all age groups, and they are usually lifelong. However, patients can often consume small amounts of offending foods without experiencing symptoms.

Allergy vs. Intolerance Test

Food allergies and intolerances have similar symptoms and patients don’t always report them as they appear, so it is challenging to accurately diagnose the condition. Furthermore, many patients wrongly self-diagnose an allergy and stop eating certain foods, causing more damage than good because they unnecessarily avoid essential nutrients.

Medical providers have different strategies for diagnosing food sensitivities.

Allergy

Healthcare providers first perform a physical examination and ask the patient to describe symptoms, when they appeared, how the food was prepared, what ingredients were used, etc. If they suspect an allergy based on the patient’s account, they order a skin prick or a blood test.

The skin prick test involves putting the potentially offending food extract on the skin and making tiny scratches, so that the food penetrates it. If a sign of an, such as redness or a bump, allergy appears on that spot, it may be a sign of a food allergy.

A blood test involves drawing a small amount of blood from the patient’s vein and analyzing it for antibodies (immunoglobulin E or IgE). If antibodies are present, it may be a sign of food allergy. However, it can also indicate some other infection. The absence of antibodies is a strong indicator that the patient doesn’t have an allergy.

There are also food allergies that don’t involve the production of IgE antibodies. In those cases, the only way to diagnose an allergy is to eliminate suspect foods and reintroduce them under medical supervision, monitoring the reaction.

Intolerance

The elimination diet is the most used diagnostic for establishing a food intolerance. Doctors may also use skin prick tests and blood tests for immunoglobulin G or IgG.

Lactose and fructose intolerances have more a straightforward test. The hydrogen breath test involves breathing into a balloon and doctors analyzing the exhaled gas. The presence of hydrogen indicates an intolerance.

Allergy vs. Intolerance Treatment

There is no permanent cure for food allergies and intolerances. However, patients can manage the conditions and lead quality lives.

Allergy

Patients with food allergies need to fully eliminate allergens from their diet to avoid life-threatening situations, such as anaphylactic shock. They must always carry an adrenalin auto-injector with them.

Antihistamines can help with itching, sneezing, and congestion. Corticosteroids can help with swelling.

Intolerance

Patients with food intolerances should avoid offending foods to reduce symptoms and improve their quality of life. They may eat small amounts of such foods without experiencing symptoms.

Enzyme supplements, probiotics and prebiotics can help break down deficient enzymes and aid digestion. Stress management may also help reduce symptoms in some patients.

How Long Do Food Allergy and Food Intolerance Last?

Food allergies and intolerances often last for life. In some cases, the symptoms subside on their own.

The symptoms of food allergies and intolerances can last from a few minutes to several days. In most cases, they disappear within several hours. Their duration depends on the symptom’s severity, the amount of trigger food consumed, and the patient’s activity before the meal (alcohol intake, physical activity, etc.).

Conclusion

Food allergies and intolerances are widespread medical concerns. Allergies are potentially fatal, so patients should work with their medical providers to adequately manage the condition. Intolerances are milder, but also need addressing to ensure proper nutrition and symptom management.

Contact our medical professionals at Vibrant Vitality Clinic and book a food sensitivities testing.

Jenna Hilton
Jenna Hilton has been a practicing PA since 2009, specializing in Family, Internal Medicine and Medical Aesthetics. She attended Arizona State University where she received her Bachelor's Degree and graduated magna cum laude. She received her Master of Science degree in Physician Assistant Studies from A.T. Still University.

Jenna has been injecting neurotoxin and dermal filler since 2013. She received certification as a Master Injector in 2017 through Empire Medical in Los Angeles, California. She is currently working on a Fellowship Program in Anti-Aging and Regenerative Medicine through the American Academy of Anti-Aging Medicine. Her special interests include use of PLLA, Ablative/Non ablative skin resurfacing, PDO threads, hormone therapy and nutritional therapies to improve cellular regeneration and medically supervised weight loss.

Jenna Hilton believes in a multi-factorial approach, considering internal factors that accelerate aging and disease development. She always enjoys teaching. She co-founded Vibrant EDU courses at Vibrant Skin Bar and regularly performs one-on-one training with fellow injectors. She teaches Aesthetic and Advanced Injectable Courses at National Laser Institute. She has been named Preceptor of the Year and is an Adjunct Faculty Member at Midwestern University. She was born in Iowa, and lives with her husband and three children in Phoenix, AZ.

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