When it comes to adverse food reactions, the terms allergy, intolerance and sensitivity are often used interchangeably (and incorrectly!). Here we demystify the language so that families and their healthcare providers can work together towards the most effective solutions for their children.

Adverse Food Reactions

Too often, the language used to describe symptoms associated with food consumption is inconsistent. The number of children affected, the intensity of their symptoms, as well as the underlying mechanisms of action, are different. Getting everyone on the same page is important – it may affect how healthcare providers talk with one another and deliver care, how patients communicate with their providers, and ultimately, the choices made in the grocery store or pharmacy.

Food Allergy

Food allergy is an immune reaction, which occurs each time there is exposure to a given food, and is absent during food avoidance. In food allergy, exposure to a trigger food most commonly brings about immediate symptoms, that is, within minutes to two hours. Some of the most common food allergy symptoms in children include: eczema or hives, difficulty breathing (asthma), sneezing, coughing, runny nose or itchy eyes, and stomach upset.

Food allergy is more common in children than in adults. While numbers vary, it’s been reported that almost 4% of US children have a food allergy. Cow milk protein allergy is one of the most common food allergies in early childhood and affects 2-3% of children under 1 year of age. Other common food allergens in childhood include egg, peanut, tree nuts, wheat, fish, shellfish, and soy.

Food allergy in children should be considered if there is anaphylaxis, symptoms that occur within minutes to hours of eating a food, or with certain disorders, such as moderate to severe eczema.

Children with a food allergy must avoid specific dietary triggers. For example, those with a confirmed cow milk protein allergy must avoid all milk proteins, regardless of source (cow, goat, sheep) – this is because of the risk of protein cross reactivity. Mothers of breastfed babies will need to remove dairy from the diet, and/or use an extensively hydrolyzed or elemental (amino acid) formula.

Food Intolerance

Food intolerance does not involve the immune system and may have a number of underlying causes. As such, it’s difficult to determine exactly how many children experience food intolerance reactions.

Food intolerance reactions may be divided into a number of ‘categories’. For example toxic food intolerance reactions may be associated with food poisoning; whereas pharmacological food intolerance reactions may result from a compound in a food, such as tyramine (found in some cheese, fermented foods and tofu).

Lactose intolerance, a disorder associated with inadequate breakdown and malabsorption of the milk sugar lactose with subsequent symptoms such as diarrhea, abdominal pain, gas, and bloating, is one of the most well known food intolerance reactions.

While the rate of lactose intolerance varies by ethnicity, lactose intolerance is uncommon across all populations before 2 to 3 years of age. For the majority of the population, the enzyme lactase does not start to decrease until 4-5 years of age.

Children with confirmed lactose intolerance must avoid lactose. Lactose-free and/or reduced lactose dairy products, or supplementation with lactase enzymes may bring digestive relief.

Food Sensitivity

Food sensitivity is an adverse food reaction, the mechanism of which is still not fully understood. Clinically, food sensitivity may encompass the delayed, mild to moderate symptoms associated with consumption of a food.

Some of the most common symptoms associated with food sensitivity in childhood may include tummy troubles such as gas, pain, colic, diarrhea, and constipation, chronic congestion, runny nose, and cough, as well as recurrent ear infections, and eczema.

Cow milk and gluten are two of the more common food sensitivities that may affect children. The exact number of children affected by cow milk sensitivity is unknown, but parental reports have suggested that up to 30% of young children may have delayed, mild to moderate symptoms associated with cow milk consumption. Whereas goat milk products must be avoided in cases of confirmed cow milk protein allergy, goat milk products may be a solution for children with cow milk sensitivity.

How Do I Know the Difference?

It may be difficult to tell the difference between food allergy, intolerance and sensitivity, especially when symptoms are moderate and because they may be similar.

When it comes to cow milk-related symptoms, lactose intolerance is uncommon in infants, and cow milk protein allergy is not as common as it may seem. The condition which may be responsible for the delayed, mild to moderate symptoms associated with cow milk consumption in early childhood may be cow milk sensitivity.

Healthcare providers will rely on a careful medical history, laboratory studies where appropriate, and possibly an oral food challenge to confirm an adverse food reaction diagnosis. For some children, a diagnosis of food sensitivity may be one of exclusion, meaning that allergy and intolerance-type reactions have first been ruled out.

Since every child is different, it’s always best to speak with your healthcare provider if you are concerned about whether your little one’s symptoms stem from allergy, intolerance or sensitivity, in order to arrive at the correct diagnosis and to make the optimal treatment plan.


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Annie Salsberg ND DrGreene.com contributor