Know the facts; Understanding food allergies and intolerances

Living with food allergies or food intolerances isn’t easy for adults, so you can imagine the double trouble for kids. Diligently reading food labels and finding foods that are safe or tolerated when eating away from home can be challenging. If your child suffers from a potentially life-threatening food allergy, it can be down right scary!

Food allergy and food intolerance are not the same thing.

Food allergy is when the body’s immune system reacts to a specific protein in a food as if it were a harmful substance that it needs to get rid of. The immune response causes antibodies and other chemicals to be released in the body that cause the symptoms related to a food allergy. Symptoms could include hives, swelling, itching, flushing, tingling, anxiety, difficulty breathing and in severe cases can be fatal. Health Canada estimates that approximately five per cent to six per cent of young children and three per cent to four per cent of adults suffer from food allergies and suggests that although we don’t have reliable statistics that food allergy is becoming more common, most experts believe that indeed it is. The most common food allergens are peanuts, tree nuts, shellfish, fish, milk, eggs, wheat, soy and sesame.

Food intolerances do not involve the body’s immune system and are usually caused when you can’t digest or absorb a certain food or component of that food. Food intolerances most often involve the gastrointestinal tract. Lactose intolerance, which is an inability to digest the lactose in milk, is a common food intolerance that can cause cramping, bloating, gas and diarrhea.
Food intolerances usually require a normal-sized portion of the food to be ingested to cause a reaction, while food allergies can be triggered by very small amounts of the allergen.

Chemical sensitivities are adverse reactions to naturally occurring or added chemical substances in food such as, caffeine, sulphites, or monosodium glutamate (MSG).

Celiac disease is an autoimmune disease affecting the gastrointestinal tract. When foods containing the substance gluten are eaten, the body’s reaction causes significant damage to the lining of the small intestine. This reduces the intestine’s ability to absorb essential nutrients in food (protein, fat, carbohydrates, vitamins and minerals). Gluten is a protein found in all forms of wheat, barley and rye and even the tiniest amounts will damage the intestine. It is estimated that approximately one per cent of the population has celiac disease, and because it is genetically linked, you are at greater risk of developing celiac disease if a family member has it.

The symptoms of celiac disease can be quite variable and are often confused with the symptoms for other common conditions such as irritable bowel or lactose intolerance. Some people with celiac disease will experience very few symptoms, but most will experience some combination of anemia, diarrhea, weight loss, fatigue, cramps, bloating, irritability, bone or joint pain and skin problems. Failure to thrive can be common among infants or children with celiac disease. Some of the long-term complications from untreated celiac disease, such as osteoporosis, are a result of the malnutrition that develops when the gut is damaged and cannot absorb the nutrients from food. With strict adherence to a gluten-free diet, this type of complication can be reduced; however people with celiac disease do have a higher prevalence than the general population of other conditions, such as type 1 diabetes, Down syndrome, arthritis, liver disease, infertility, thyroid problems and depression.

The “gold standard” for diagnosing celiac disease has always been a biopsy of the small intestine; however there are blood tests that can be done as well. Both the blood test and the biopsy require the person to be including gluten in their diet. The blood test for celiac disease however is not 100 per cent accurate. While not a definitive diagnosis, recovering from symptoms while following a gluten-free diet is a good indication that celiac disease or some other form of a gluten allergy is present.

Currently there is no cure for food allergy, so carefully avoiding the food when cooking; asking questions about the foods you are consuming away from home; and reading food labels are important steps to managing allergies and intolerances. People with severe food allergies should speak with their doctor about carrying an EpiPen and seek emergency medical attention if exposed to the allergen. Children who have food allergies should be taught to ask questions about the foods they are eating and read labels.

Food labelling Ingredient lists on packaged foods are an important tool for someone with food allergy or intolerance. Ingredient lists are required on most packaged foods, with ingredients appearing in decreasing order of proportion so that the amount in the largest quantity by weight appears first on the list and the amount present in the smallest quantity appears last. In early 2011, amendments to the Food Allergen Labelling Regulations from Health Canada were published, which required clearer language and additional labelling for hidden allergens such as gluten and sulphites that were not previously listed. Industry had until August 4, 2012 to implement these new labelling regulations. If you are uncertain about a food, call the manufacturer for more information. Be careful with bulk foods as they have the potential for cross-contamination with other foods.

Food allergies and intolerances are challenging to manage and often require learning to shop and prepare foods differently. If you or your child has a food allergy or intolerance that requires avoiding many foods, or an entire food group, it is important to be sure you are not eliminating key nutrients without a substitute. For example, if you eliminate all milk products due to an allergy or intolerance, it is essential to make sure there is an alternate source of adequate amounts of calcium and vitamin D in the diet. Speak with a registered dietitian for guidance and to help you find appropriate substitutes for the foods you eliminate.

Want more information about different food allergies and intolerances?

Allergy/Asthma Information Association: www.aaia.ca
Anaphylaxis Canada: www.anaphylaxis.ca
Canadian Celiac Association: www.celiac.ca Health Canada: www.hc-sc.gc.ca

Kelly Barry is a registered dietitian who has a passion for food and all things related. She has spent many years helping individuals and families along the road to healthier eating and understands the challenges parents face when choosing to make healthy foods a priority.

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