Food Allergies, Food Interolerances', Food Sensitivities...oh my!

Who's confused by all the talk of food allergies, food intolerances' and sensitivities, raise your hand? Oooo oooo me, me me!!! And I'm a Dietitian!  So I can't imagine what and how everyone else feels.  I think my confusion comes in because for those of us growing up in the 80s and prior, maybe even the 90s, it was rare to hear about peanut free zones (probably unheard of), dairy free products, sunflower butter, soy butter, and the list goes on and on.  

I have always been intrigued by the increasing prevalence of food allergies. And I think this is because there is no answer, only theories (I have heard of the cleanliness theory, I have heard of an overuse of antibiotics, and of course GMOs and our food supply).  I guess it's too soon to understand the why's. But listen to these stats: In a 2008 report put out by the CDC, it was reported that the prevalence of food allergies from 1997 to 2007 had increased by 18% in children.  Then in 2013 a new report was put out that stated that food allergies in children increased 50% from 1997 to 2011. 

My interest to food allergies has now taken a turn to look at not only allergies but intolerances and sensitivities because our family has been affected and I swear I've heard all different terminology when it comes to my son Leo.  He was diagnosed at 5 weeks old as having something called FPIES--Food Protein Interolarance Enterolcolities Syndrome. And it was told to me by his pediatrician that it was basically a delayed food reaction to milk. No this isn't an intolerance and yes this is an allergy--it's just localized to his gut.  He was diagnosed due to his reflux problems and bloody stools (he was nursing and I LOVE cheese so it was passing through to him).  My head started spinning because up to this point I had never heard of a delayed food reaction, couldn't believe he could be diagnosed at 5 weeks old and was just over all skeptical because it wasn't like he was having any other reactions and certainly not life threatening reactions. But I did as I was told and I changed my diet to exclude all milk and milk products (bummer, no goldfish crackers or pizza).  And after all this Leo remained the same.  To be honest, he wasn't even all that bad off to begin with! He was a happy kid that just so happened to spit up a lot and had some gas early on and the only reason why they tested his diapers was because I was on high alert to anything weird that could be going on with stools as I knew there was a correlation with gas, fussiness, diaper rash and reflux (all of which he had). 

Life went on, I did my research and got some other opinions and started educating myself on this term FPIES.  After our move to Raleigh, NC, we got into a Duke Pediatric Specialist for Food Allergies and they let me know that Leo did not show signs as to what typical FPIES kids exhibit (profuse vomiting) and she believed he has a milk protein intolerance.  YIKES another term I'm not familiar with!!!!! But isn't an intolerance associated with lactose intolerance?  Ah yes, it does, but those with lactose intolerance issues can tolerate sodium caseinate (a milk protein but not a source of lactose) and Leo, was still having issues (loose stools alternating with diarrhea) with all milk including sodium caseinate.  Hmmm....interesting. And the protocol was to just keep avoiding all milk and try yogurt again at 18 months to see what happens.  

So the saga continues... About a month ago I went back to Duke for a follow up because I noticed Leo wasn't tolerating citrus foods (i.e. peaches, mango).  Major major diaper rash was happening and it looked like a contact burn. What the heck???? It was explained at this appointment that some kids have sensitivities that irritate their stomach and it was recommended I see a GI specialist just to make sure he does not have any absorption issues.  Ok, and another interesting term popped up-a sensitivity. What exactly is a sensitivity anyways? Are doctors using this as a broad term that can mean just about anything?  Can anyone come in complaining of stomach problems and a doctors says--oh just a sensitivity.  Who knows.  And by no means am I saying anything bad about Leo's allergy specialist. I love this doctor and and department. Best care we've received and very very informative.  This doctor has been a blessing to us. This is just me thinking out loud about the topic at hand.

We are now waiting to get into the GI Specialist.  We've gone from having a delayed food protein allergy to really a milk protein intolerance that he should outgrow around 2 to a mention of citrus sensitivity.  My question is this just Leo? Like...this is just how he is and his system is and I'm reading into it too much?  Has society programmed us to be overprotective and constantly take our children to the doctors for every little thing?  I'm not sure. In this whole journey I have tried to keep myself in check and not jump at every little thing.  But then again, you know your kids. And you know when something is off.  But I somewhat digress...the point of this blog post is to ponder how we went from barely hearing about food allergies to coming to an age with terms like FPIES, Intolerances and sensitivities. And how do we make sense of all these terms? Are they subsets of food allergies?  Are doctors and society over using terms like "sensitivities" to provide an explanation if a particular food disagrees with you?  

So really, I have no idea what to make of this topic.  I'm sure some of you reading this were hoping for some kind of profound statement or eye opening blog post that could help you out.  I was taught you either have a food allergy or you don't.  You either have symptoms or you don't and react to that protein across the board.  Gluten free is the best example here. I had only heard of gluten free in relation to Celiacs disease. A condition where you absolutely avoid wheat!  But you've seen how this has turned out. I have heard of people avoiding wheat in terms of diets for weight loss, fad diets (paleo) and avoiding gluten for a whole slew of other reasons. So if this is the trend with gluten, are we seeing this trend with other foods too?  Is dairy the next thing to go? OR is it that people really do know their bodies and are seeking professional help because they know something is off and now the medical profession is catching up and realizing there's much more out there (a gray area) and we are still putting the pieces together? Hmmmm, things to think about and am so curious as to where the research in the food allergy world takes us.  I wonder what our world will be like when it comes to our food supply, food and children and schools in 5, 10 and 20 years. I'm sure it will be very very different than it is today!



Food Allergy- The definition of a food allergy is when a reaction occurs when the bodys immune system mistakingly attacks harmless food proteins. IgE antibodies detect the food and alert the cell to pour out histamines that result in allergic reactions.  Reactions includes hives, swelling of the throat or tongue or nausea.

Food Intolerance- Caused by an enzyme deficiency; it does not involve the immune system. Lactose intolerance is an example. They lack an enzyme that is needed to digest milk sugar. When the person eats milk products symptoms are gas, bloating and abdominal pain.

Food Sensitivity- An understudied area generally means people have an unpleasant reaction to certain foods; perhaps acid reflux, nausea, abdominal cramps, but not immune system reactions.