Food allergy or food intolerance?

Around one or two people out of every 100 in the UK have a food allergy, but food intolerance is more common.

How to tell the difference

Food allergy:

  • Symptoms come on within seconds or minutes of eating the food
  • In extreme cases it can be life threatening
  • Even a tiny trace of the food can cause a reaction
  • It is easily diagnosed with tests

Food intolerance:

  • Symptoms come on more slowly, are long-lasting, and mainly involve the digestive system
  • It's never life threatening
  • A reasonable portion of food is usually needed to cause a reaction, although some people can be sensitive to small amounts 
  • You may crave the problem food
  • It's difficult to diagnose as there are only a few reliable tests

Genuine food allergy is rare. About 2% of the population and 8% of children under the age of three are affected.

What is a food allergy?

A food allergy is a rapid and potentially serious response to a food by your immune system. It can trigger classic allergy symptoms such as a rash, wheezing and itching.

The most common food allergies among adults are to fish and shellfish and nuts, including peanuts, walnuts, hazelnuts and brazil nuts. Children often have allergies to milk and eggs as well as to peanuts, other nuts and fish. 

What is a food intolerance?

Food intolerances are more common than food allergies. The symptoms of food intolerance tend to come on more slowly, often many hours after eating the problem food. Typical symptoms include bloating and stomach cramps.

It's possible to be intolerant to several different foods. This can make it difficult to identify which foods are causing the problem.

Food intolerances can also be difficult to tell apart from other digestive disorders that produce similar symptoms, such as inflammatory bowel disease, gastrointestinal obstructions or irritable bowel syndrome (IBS).

Lactose intolerance

Lactose intolerance, sometimes known as dairy intolerance, occurs when your body can't digest lactose. Lactose is in milk and dairy products such as yoghurts and soft cheeses.

The main symptoms are diarrhoea and stomach pain. In most cases, your GP can diagnose lactose intolerance by looking at your symptoms and medical history.

Could it be another type of food intolerance or condition?

Sometimes it isn't clear which food is causing a problem. The only reliable way of identifying such a food intolerance is through an exclusion diet, where you cut out certain foods from your diet one at a time to see if there's an effect.

Coeliac disease is a common digestive condition where a person has an adverse reaction to gluten. However, coeliac disease is not an allergy or an intolerance to gluten. It is an autoimmune condition where the immune system mistakes substances found inside gluten as a threat to the body and attacks them.

Gluten is a protein found in wheat, rye and barley that damages the intestine of people with coeliac disease. Symptoms include diarrhoea, bloating and weight loss. Coeliac disease can be accurately diagnosed with a blood test and biopsy.

About 1 in 100 people in the UK have coeliac disease, but it's estimated that around half a million aren't diagnosed.

Treatments for food allergy and food intolerance

  • In all cases, always read food labels carefully, and learn where your problem food may be used as an ingredient in other foods.
  • In the case of a food allergy, you'll have to avoid the food you're allergic to. You may be able to eat the cooked versions without any problems, as can be the case with fruit or vegetable allergies.
  • With lactose intolerance, you'll have to reduce the amount of dairy food that you eat.
  • With other forms of food intolerance, you'll have to stop eating the food for a while, or possibly for life.

With the autoimmune condition coeliac disease, you must avoid gluten for life.

For more advice on your diet, ask your GP to refer you to an NHS dietitian.

Page last reviewed: 12/01/2014

Next review due: 12/01/2016

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The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Teefee61 said on 22 April 2014

Not all symptoms of food intolerances are slow; sometimes they can appear as quickly as allergies, and also lead to anaphylaxis in sensitive individuals. Unlike allergies, it is always a question of quantity that makes people react, like a bucket overflowing when it gets too full. The symptoms of intolerances are more varied than allergies, and can include migraines, foggy brain, and cramps, as well as symptoms that are similar to allergies (urticaria, swelling of the eyes/ lips).

I have multiple food intolerances, to foods with salicylic acid and those with amines. I've been tested for allergies, but my IgE levels are very low. My reactions change with time/ diet. At times, I've had very quick reactions, (touching a grape, or one mouthful of egg leading to swollen lips and hands). At other times, it may take over 48 hours before I react.

Taking a mast cell stabiliser is much better than antihistamines, but better still is to have a diet that creates the enzymes we need to digest substances that can be toxic.

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Jane1234 said on 25 February 2013

I developed a number of intolerances. I found taking probiotics very beneficial as these help maintain gut health which is linked to these problems. Please be careful about getting adequate vitamin / minerals if you are eliminating a number of foods. I found reading up on leaky gut syndrome very helpful.

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