Ask the Allergist: What’s the Difference Between Food Allergy and Food Sensitivity?

Q: What specific symptoms should you look for that differentiate between a food allergy and food sensitivity?

Jay Lieberman, MD: In the classic food allergy model, symptoms develop immediately after eating a food allergen. They typically occur in minutes — and in rare cases, up to an hour.

Food allergy symptoms almost always have a skin component:

• hives
• swelling
• itching

Food allergy symptoms can also involve the stomach:

• nausea
• abdominal pain
• vomiting

Food allergy symptoms could also involve the respiratory system:

• Coughing or wheezing
• Trouble breathing

These are some of the signs to watch for when it comes to a food allergy that can lead to anaphylaxis, a severe allergic reaction that involves multiple body organs.

For food sensitivity and intolerance, symptoms typically involve the stomach:

• abdominal pain
• cramping
• bloating
• diarrhea

Related food sensitivity symptoms may include headache and chronic fatigue.

Q: Is a trial-and-error diet appropriate for identifying a food allergy? Food sensitivity?

Dr. Lieberman: For a food allergy, especially one that can lead to anaphylaxis, we do NOT recommend trial and error.

If you’re concerned about a potential food allergy, see a board-certified allergist. An allergy test, conducted by an allergist, is the best way to diagnose a food allergy.

If your concern is food intolerance or sensitivity, especially when symptoms involve headache and chronic fatigue, then a trial-and-error diet is appropriate.

Your allergist can help you decide what might be the best foods to remove from your diet.

Q: When should you turn to an allergist for diagnosis and treatment for food allergy or food intolerance?

Dr. Lieberman: There’s never a wrong time to see an allergist if you have a concern about food allergy or food intolerance. Many patients I see come in with the concern of food allergy. After talking with them, I come to understand they are experiencing food sensitivity or lactose intolerance.

Allergists can help guide you on appropriate testing. Anytime you have a question or concern, it’s reasonable to see an allergist.

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Jay Lieberman, MD, FACAAI, is a board-certified allergist and immunologist in Memphis, Tennessee. He is an Associate Professor at The University of Tennessee Health Science Center at Le Bonheur Children’s Hospital. Dr. Lieberman serves as Associate Editor for Annals of Allergy, Asthma & Immunology and as vice-chair for the ACAAI Food Allergy Committee.

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Have a medical question? Email editor@allergyasthmanetwork.org or write to Ask the Allergist, Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.