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Food Allergies, Food Sensitivities, and Food Intolerances, Oh My!!!

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Food sensitivities, food intolerances, and food allergies can become confusing terms.  What is the difference?  In this article we’ll discuss these terms.

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. Keep in mind food production can change, always check food labels to be sure products are free of your particular food allergen. For further information please see full Disclaimer.

Food Sensitivities

Food sensitivities, food intolerances, and food allergies.  What is the difference?  What is a food sensitivity?

The term “food sensitivities” is not well defined by the medical community at this time (1)

Food sensitivities are often considered systemic.  This means that food sensitivities affect several major body systems at one time.  For example, someone with a food sensitivity may have symptoms of headaches, fatigue, musculoskeletal pain, and often gastrointestinal distress.

Food sensitivities do not involve IgE antibodies as is the case with some food allergies.

Food intolerances are generally considered different from food sensitivities because food intolerances take place place in the digestive system.  

Food volume affects food sensitivities.  Food sensitivities are often considered dose dependent.  

Let’s say someone has a food sensitivity to carrots. That individual may be able to consume a couple of baby carrots without ill effect, but having something like carrot soup may result in many unwanted symptoms.

Reactions to food sensitivities may be delayed for up to 3 days, making it hard to pinpoint the offending food.  Although not life threatening, they can certainly affect your overall health and quality of life.

As mentioned, the definitions for food sensitivity are not completely clear.  However, food sensitivities are often considered as Type III and Type IV hypersensitivity reactions which occur when circulating antibodies and white blood cells release pro-inflammatory molecules.  

These pro-inflammatory molecules may cause swelling, inflammation, and pain in the body.  By reducing foods that create reaction, inflammation in the body may greatly reduce.  Once inflammation in the body decreases, the body may then be able to tolerate foods that once were problematic.  Food sensitivities are not always permanent. 

Conditions such as Irritable Bowel Syndrome, Rheumatoid Arthritis, or migraines may go hand in hand with food sensitivities.

Food Intolerances

Food sensitivities, food intolerances, and food allergies.  What is the difference?  What is a food intolerance?

Food intolerances do not involve your immune system (2), but do affect your gastrointestinal tract.  

The most well known type of food intolerance in the United States is lactose intolerance.  

Lacking an enzyme to breakdown food can create a food intolerance.  This is the case with lactose intolerance.  Someone with lactose intolerance lacks the enzyme, lactase, needed to breakdown lactose.

Food intolerances often have symptoms such as bloating and diarrhea.

Food intolerances are not life threatening, but can affect quality of life if not treated properly

Food Allergies

Food sensitivities, food intolerances, and food allergies.  What is the difference?  What is a food allergy?

Food allergies involve the immune system.  

There are three types of food allergy (3):

  1. Non-IgE Mediated Food Allergies
  2. Mixed IgE/Non-IgE Food Allergies
  3. IgE Mediated Food Allergies

Non- IgE Mediated Food Allergies

Non-IgE mediated food allergies are less understood than IgE mediated food allergies.  Terminology in literature can also be confusing and inconsistent. Non-IgE mediated food allergies can be reffered to as delayed type hypersensitivity or non IgE mediated food hypersensitivity.

Examples of conditions that involve non-IgE mediated food allergies are non-IgE cow’s milk protein allergy, food protein-induced enterocolitis (FPIES), eosinophilic esophagitis (EoE) proctocolitis, food protein induced enteropathy (FPE), Heiner Syndrome (HS), and celiac disease (4). 

Non-IgE mediated food allergy reactions usually do not occur immediately and rarely result in anaphylaxis.  However, non-IgE mediated food allergies are not the same as a food intolerance and should not be treated as intolerances.  

Strict avoidance of non-IgE food triggers is needed when diagnosed with a non-IgE food allergy.  Ingestion of a non-IgE mediated food allergy may result in need for hospitalization for various reasons including need for IV hydration.  Hospitalization could also be needed for circulation issues resulting in low blood pressure or shock for some non-IgE food allergy individuals.  

Non-IgE allergies may also result in significant damage to tissues.  An example is atrophy (degeneration of cells) of the intestine.  

Unlike some forms of IgE food allergies, treatment for non-IgE mediated food allergies does not typically involve epinephrine. 

Non-IgE food allergies should be treated seriously as they can result in improper growth and malnutrition as well as other health complications if the allergy is not treated with strict avoidance of the food trigger.

Mixed IgE and non-IgE Mediated Food Allergies

Mixed IgE and non-IgE mediated food allergy reactions involve both IgE- and non-IgE-mediated mechanisms (5).

IgE Mediated Food Allergies

The general public is more familiar with IgE mediated food allergies.

Food allergies symptoms from IgE food allergies include, but not are not limited to:

  • Hives
  • Swelling of lips, tongue, throat, face
  • Dizziness
  • Anaphylaxis
  • Itching or swelling of the lips, tongue, or throat
  • Diarrhea
  • Vomiting
  • Rash
  • Difficulty swallowing
  • Abdominal pain and cramps
  • Wheezing (difficulty breathing)
  • Nausea and vomiting
  • Runny nose
  • Nasal Congestion (stuffy nose)
  • Digestive problems
  • Coughing
  • Loss of consciousness

IgE mediated reactions usually occur immediately, but can occur within minutes or hours (2).

IgE food allergies can be life-threatening and may cause anaphylaxis. If anaphylaxis occurs, epinephrine should be administered and medical care should be given.  Be sure to discuss an emergency plan with your provider if you are diagnosed with an IgE food allergy.

What are the 9 Most Common IgE Food Allergies?

The top 9 food allergies also known as the big 9 allergens in the United States are:

  1. Milk
  2. Egg
  3. Peanut
  4. Soy
  5. Wheat
  6. Tree Nut
  7. Shellfish
  8. Fish
  9. Sesame

In the above list you will find links to other articles that describe some of these IgE food allergies.

You can be allergic to many other foods besides these top nine. 

The Top 9 Food Allergens in the U.S. Top 9 Food Allergies. 1. Fish 2. Shellfish 3. Tree Nuts 4. Peanuts 5. Milk 6. Wheat 7. Egg 8. Soy 9. Sesame

In Conclusion

The medical community needs to further define terms like food sensitivities, food intolerances, and non-IgE Mediated Food Allergy.  These terms can become confusing and have a profound effect on how community members treat individuals with one of these conditions.

There is also a concern that some members of the medical community may lack a clear understanding of these terms and therefore may not treat a situation correctly.

These definitions are a work in progress and I anticipate there will be clearer definitions put into place in the future.

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Last Updated on March 8, 2023 by Amber DeVore, RD, CSSD, CLT

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