Introduction
However, their mechanisms, severity and management are very different. Correctly distinguishing between the two is essential to avoid unnecessary food exclusions or, conversely, to prevent potentially serious reactions.
Symptoms
- Hives, itching, redness
- Swelling of the lips, face or throat
- Respiratory symptoms
- Possible digestive symptoms
- Anaphylactic reaction in severe forms
- Bloating, abdominal pain
- Diarrhoea, wind, nausea
- Feeling of heaviness after eating
- Tiredness or general discomfort
Causes
- Immune system reaction
- IgE-mediated or non-IgE-mediated mechanism
- Very small amounts of a food are enough to trigger a reaction
- Enzyme deficiency (e.g. lactose)
- Individual digestive sensitivity
- Dose-dependent effect (amount eaten)
Diagnosis
- Detailed medical history
- Skin prick tests
- Specific IgE testing
- Oral food challenges in a safe setting
- Analysis of digestive symptoms
- Breath tests (e.g. lactose breath test)
- Temporary elimination diets and reintroduction
Treatments
- Strict avoidance of the culprit food
- Antihistamines if needed
- Adrenaline auto-injector if there is a risk of severe reaction
- Therapeutic education
- Personalised dietary adjustments
- Reducing amounts that are poorly tolerated
- Replacement enzymes (e.g. lactase)
- No risk to life
- Food allergies
- Food intolerances
Management
Formally distinguish allergy from intolerance
Avoid unjustified restrictive diets
Ensure patient safety
Refer for appropriate nutritional care if needed