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    What’s the Difference Between Food Allergy, Intolerance, or Sensitivity?

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.   eNewsletter: Get our eNewsletter

      True food allergies are the body's most serious reaction to food. Food allergies happen when the immune system reacts to certain foods.

    What’s the Difference Between Food Allergy, Intolerance, or Sensitivity?
    Caption: Skin tests for food allergies. Image: CC BY 2.0--NIAID

    Celiac.com 03/24/2020 - Many of us have experienced unpleasant symptoms after a meal or snack. The effects might range from mild itching of the mouth, to nausea, or other symptoms, including sneezing, wheezing, skin rash, joint pain, bloating, diarrhea, and more. 

    So is the problem a food allergy, an intolerance, or a sensitivity, and what is the difference?

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    It's not uncommon for people with food sensitivities or intolerances, or even celiac disease, to think they have food allergies. In fact, "food allergy" is a fairly common term that can mean any of these conditions, depending on who is doing the talking.

    In reality, though, food allergies are more rare and usually more serious than food intolerances or sensitivities. True allergic reactions to foods can range from merely inconvenient to life-threatening.

    Differences Between Food Allergies, Food Intolerances, and Food Sensitivities

    Food Intolerances

    Food intolerance basically means that the body is unable to process or digest certain foods. Food intolerances are very common, and are usually less serious than food sensitivities or food allergies.

    Lactose intolerance is one of the most common food intolerances. Lactose intolerance happens when people guts don't produce enough of the enzyme lactase to break down the lactose. Lactose intolerance can be inherited, or it can simply happen as some people age and produce less lactase. Research data shows that only about one in three people worldwide can digest lactose past the age of seven or eight.

    Interestingly, most celiacs with lactose intolerance recover on a gluten-free diet. Once the damaged villi and microvilli to grow back, and the gut heals, the sensitivity to lactose often disappears. This can take time.  In most people, full gut healing takes between six months and a year, but it can take up to two years or more.

    Also, most people who are lactose intolerant can consume goat and sheep cheeses, such as feta or pecorino Romano, without any problems. Some can consume goat or sheep's milk products with no issues. Many people with lactose intolerance can also consume raw, unpasteurized dairy from cows without symptoms. 

    Links to Goat, Sheep, and Raw Cow Milk Products 

    Lactose intolerance is not a serious medical condition, but symptoms can be quite uncomfortable. Simply avoiding milk and dairy products is the easiest way to avoid symptoms, but over-the-counter lactase enzyme supplements can be helpful for those who wish to consume dairy.

    Food Sensitivities

    Food sensitivities are common, and are usually include more serious or debilitating symptoms than food intolerances. Food sensitivities happen when people experience symptoms after eating certain foods. Symptoms are not life-threatening, but can be serious. Symptoms of food sensitivities include joint pain, stomach pain, fatigue, rashes, and brain fog. Gluten is probably the best-known trigger of food sensitivities. When people with celiac disease or certain other medical conditions eat wheat, they provide an immune reaction in the gut that can cause long-term health consequences if left untreated. 

    Researchers currently believe that food sensitivities are the result of an immune reaction that generates a wide rage of symptoms. Food sensitivities can strike at any time, and they can also vanish, sometimes with no apparent explanation.

    People avoiding certain foods due to sensitivities may want to try small amounts of the food from time to time to see if the situation has changed. 

    Elimination Diet Helps Spot Food Sensitivities

    The best way to spot food sensitivities is through careful observation and elimination. Removing potential food allergens from the diet for two to four weeks, reintroducing them one at a time, and watching for symptoms is the best way to figure out which food or foods is causing the reaction.

    Once you've narrowed it down, avoiding the foods that trigger sensitivities can improve both symptoms and quality of life.

    Food Allergies

    True food allergies are the body's most serious reaction to food. Food allergies happen when the immune system reacts to certain foods. For example, people with peanut or shellfish allergies can suffer from symptoms including serious difficulty breathing and low blood pressure following exposure to peanuts or seafood. These symptoms can sometimes be fatal. Many people with food allergies carry an epinephrine shot device, such as an Epic-Pen, as a precaution against such episodes. These pens can save lives.

    Sometimes people have food allergies from very early in life, but they can strike at any time during life, even in old age.

    If any food causes you to have true allergic reactions, such as significant rashes, dizziness, swelling of the face, or difficulty breathing, it is wise to consider a visit to the doctor for allergy testing and treatment.

    Celiac Disease

    Celiac disease is an autoimmune condition that affects about 1% of the Western population. Celiac disease results from a complex inflammatory reaction triggered by gluten consumption in genetically predisposed people.

    Celiac disease is not a food allergy. Eating gluten a few times does not cause an immediate life-threatening problem. However, when people with celiac disease eat gluten, they often suffer nausea, vomiting, and other symptoms in the short term. Over time, if left untreated, gluten consumption can cause diarrhea, weight loss, and malnutrition, and can lead to many other associated conditions, including certain deadly types of cancer.

    Avoiding gluten is the only effective treatment for celiac disease. Gluten is found in a variety of grains, including wheat, rye, barley, and in wheat types like kamut, spelt, semolina, bulgur, farro, emmer, einkorn, and farina. Many processed foods also contain gluten in the form of wheat flour. Also, cross-contamination from gluten-containing food is a constant threat, especially when eating out.


    So, food allergies come with strong physical symptoms, such as itching, face swelling, and difficulty breathing. Food allergies can be serious, and even life-threatening, while food intolerances and sensitivities are usually just unpleasant and inconvenient, but some can have long term health consequences.

    Once you’ve identified the food or foods that trigger your allergy, sensitivity, or intolerance, a nutritionist or a physician can help devise a diet that is safe and nutritious. In the case of allergies, they can also provide you with tools, such as an epinephrine injection, and a plan of attack should a life-threatening reaction occur.

    Though food intolerances and sensitivities are not unusual, they can be challenging to figure out. Even with an active elimination diet, finding out which foods trigger reactions can be challenging, and time consuming. Ultimately though, tracking down the cause of food intolerances and sensitivities is rewarding, and usually leads to better health and well-being.

    Resources for Food Allergy, Intolerance, and Sensitivity

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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