intolerance & allergy
Not sure if it’s intolerance or allergy?
Allergy involves the immune system and intolerance does not. Whilst there may be an overlap in symptoms, an allergy specialist can differentiate between the two (and usually without tests). Infants or children may begin reacting to breastfeeding or when cow’s milk or other foods are introduced into their diet.
Testing may be needed depending on the type of reaction. For Adults with gut related food symptoms, allergy tests are usually of no use or will give incorrect or misleading advice which can lead to nutritional deficiencies. It is always appealing to have a ‘test’ in the hope that this will be the answer to your problems but unfortunately for adults it rarely is. Infants or children under 5 years are more likely to have allergy than an adult but most outgrow them, although nut and fish allergies can persist into adulthood.
Symptoms vary in type, severity and cause. In accordance with health guidelines, for adults I first check if disease or ‘red flags’ have been ruled out before considering intolerance.
Red flags are actual damage to the body – diseases such as coeliac or inflammatory bowel disease. These require medical intervention.
Intolerance may feel like disease but as far as we know, no damage is done. Unlike intolerance, allergy involves the body’s defence system. There are two types of allergy:
- Immediate (IgE) which causes rapid reactions normally within minutes of eating the food e.g. as seen in peanut allergy. This type of allergy can cause ‘anaphylaxis’.
- Delayed (non-IgE) reactions which can take from 1 to 48 hours to occur. Most adults with food allergy which affects their gut will have non-IgE This type of allergy does not cause ‘anaphylaxis’.
With a detailed allergy and intolerance focused history I can usually tell if it’s allergy or intolerance. The proof for intolerance or delayed allergy is removing the food from the diet and reintroduction to prove it’s a trigger. I do this in a clear and guided way whilst maintaining nutritional adequacy. There is usually no need for tests and consequently, I do not carry out tests but can request these from your GP or support a referral to an ‘Allergist Consultant’ if needed. The only reliable tests for immediate allergy are IgE Skin Prick Test (SPT) or Specific IgE blood tests. For intolerance: a hydrogen breath test (HBT) for lactulose, lactose and fructose may be helpful. I can access appropriate tests from private lab companies/GP or request from your GP/Consultant if needed. Your NHS GP may not be able to fund these tests.
There are many commercially available tests that claim they can diagnose food hypersensitivity such as IgG blood, Kinesiology, Hair analysis, Leucocytotoxic or Cytotoxic, Pulse, Electrodermal (Vega). These should be avoided as they have no scientific basis and can be harmful when multiple foods are excluded without reason and if they are not reintroduced under guidance of a dietitian.
If you have Irritable Bowel Syndrome (IBS) or gut symptoms you may be intolerant to certain foods and drink. I use a stepped approach, which needs ideally three appointments; to make the changes, identify triggers and personalise your long-term diet to be nutritionally adequate. Sometimes more appointments are required because there are extra considerations:
- First line advice and improving over-all shape of diet before any eliminations.
- Guided eliminations for lactose or FODMAPs (Fermentable Oligo-Di-Monosaccharides And Polyols). I am FODMAP trained by Kings College London and use their resources, which are regularly updated. The FODMAP diet may not need to be done entirely and is only done to identify triggers. It is not a lifestyle diet.
- Consideration of other naturally occurring food chemicals such as histamines, salicylates, sulphites and additives. Resources on the internet often over exclude and are inconsistent.
- Consideration of other causes such as bile salt malabsorption, small intestinal bacterial overgrowth (SIBO) and enzyme insufficiency.
“In June 2019, I experienced nausea, stomach pains and body itching. When preparing vegetables for dinner, my nose and mouth itched and when peeling carrots, I experienced swelling in the roof of my mouth. I researched histamine intolerance and allergies on the internet. There was a lot of information but I was confused by all the mixed messages. I excluded a whole range of foods from my diet because I was so worried about allergic reactions and aggravating my gastric problems. I lost weight as a result.
I contacted Brenda in July, just before I went on holidays abroad. She offered me an appointment at very short notice. She gave me information and advice about low histamine foods. I have been following this diet until quite recently. In October, Brenda referred me to a highly qualified and experienced allergist who carried out skin prick tests which showed that I have no allergies.
I continue to meet regularly with Brenda to review progress. My stomach problems have greatly improved and the allergy test results have given me the confidence to reintroduce a variety of foods back into my diet.
Brenda is friendly, helpful and very professional. She is very knowledgeable about allergies and food intolerances. Her advice and support has been invaluable throughout this challenging experience.”
“Our initial appointment for my son who is 11 months old was incredibly reassuring. It was so helpful to both discuss any improvements to his diet and also the next steps to take with regards his cows milk protein allergy. The stage by stage guide on re introduction was very clear so we felt confident that we understood the re introduction process and could get started with stage 1.”
JP, Tunbridge Wells
“It was a pleasure to meet you. My husband and I found the consultation with you very informative and useful. Thank you for that. We’ve started giving the girls the fortified soya and made some changes to their diet/snacks as advised.”
CH, Tunbridge Wells. Parents of Cow’s milk allergic twins – anaphylaxis.