How can you recognise and avoid incompatible foods
Anyone who has an allergy or intolerance towards a food needs to study ingredients lists and change their diet. The real challenge in many cases, however, is to find out exactly what it is that you cannot tolerate. We can tell you how to do that.
Harvard scientists have recently evaluated 2.7 million files of American patients. Their result: Around four percent of all people suffer from some kind of food allergy. For Germany, similar numbers are available, and according to the German Nutrition Society, three to four percent of adults have an allergy towards food. Significantly more common are food intolerances such as lactose intolerance which affect 15 to 20 percent of all people.
Concerned individuals must carefully study ingredient lists to stop any nasty surprises after dinner that can range from stomach rumbling, severe flatulence, rashes and dizziness to anaphylactic shock. And it is not always easy to associate a specific foodstuff with the symptoms. The consequence: people end up not finding out what is lacking in them.
In this article you will learn what happens when you have a food allergy in the body, what symptoms are indicative of an allergy, and how you can get back on track with a blood test and an elimination diet. Also: the types, symptoms and treatment of food intolerances.
What is a food allergy?
When you have an allergy, your immune system reacts strongly to an otherwise harmless substance. The substances which can trigger allergies are known as allergens. These are different proteins may occur in pollen, animal hair, the faeces of dust mites or even in food.
What happens with an allergy in the body?
An allergy always starts with a sensitisation towards an allergen. This means that the body will produce certain IgE antibodies in an excessive amount. Each of these immunoglobulins (the ""Ig"") specialises in keeping specific intruders out of the body. In doing so the immune system will combat bacteria, viruses, worms, but unfortunately also harmless allergens.
IgE antibodies bind to receptors on mast cells, which are cells of the immune system. Laboratories can detect the increased number of IgE antibodies in the blood and assign these to their corresponding allergens – and this is how an allergy test by blood sampling works. If the allergen comes into contact again, the allergen will bind to the IgE antibodies and cause the mast cell to release messenger substances such as histamine. Histamine then promotes inflammation and in so doing triggers the different symptoms of an allergy. If in addition to sensitisation symptoms occur, we speak then of an allergy[3, 4].
What types of food allergies are there?
Experts distinguish between different types of allergy. The most common forms of allergy are those of the immediate type, namely type I allergies, which also includes food allergies. The reaction occurs directly after you have consumed the allergen. A person allergic to peanuts then feels symptoms such as a furry tongue and rash between a few seconds and 20 minutes after eating. Delayed immediate reactions are also possible in which another allergic reaction can occur after four to six hours.
And this is good to know: some food allergies can resolve themselves by themselves during adulthood. For example, milk, egg, soy and wheat allergies usually affect children but then disappear in 90 percent of cases. Allergies to nuts, fish and shellfish, however, are usually retained for entire lives.
How does a food allergy develop?
Allergies are today talked of as a disease of modern civilisation. The number of allergic diseases has increased over recent decades more and more. Scientists are not quite sure why that is. A popular explanation is the hygiene hypothesis, which has put the blame for allergies on a modern lifestyle away from dirt and germs. Nevertheless, genetic factors also seem to play a role.
Are allergies inherited?
As a rule, nobody is born with an allergy. But humans can have an inherited predisposition towards developing an allergy. In other words, you can have a significantly higher risk of developing an allergy. This often applies to allergies in general, i.e.: the children of parents with hay fever are susceptible to all allergies, whether it be against pollen, animal hair or food. This also applies to other so-called topical or contact diseases, which are closely related to allergies and which often occur together with them (such as with atopic dermatitis and asthma)[2, 8, 14].
And this is good to know: as an unborn baby, the womb is our home - and this influences how our body develops. As such, the mother's diet can also influence the development of allergies. Birth by caesarean section and a high age of the mother also seem to increase the risk of developing a food allergy.
Does dirt protect us from allergies?
The hygiene hypothesis is based on the observation that allergies are particularly prevalent in cities and much less common among children raised on a farm. The theory goes that in the hygienic environments we inhabit in the Western world, our immune system seldom encounters foreign bodies such as pathogens, worms, and parasites. The defences have little meaningful to do and only rarely use their powers to defend themselves against harmless substances such as food and pollen – and this is how an allergy arises[2, 7, 9].
And this is good to know: whether we develop an allergy over the course of our lives is decided during the first months of life, and perhaps even in the womb. It therefore depends on the environment in which babies live at the beginning of their lives – and later holidays on the farm will not be able to prevent any allergies.
What role do the intestines play in the development of allergies?
The microbiome (archaically known as the intestinal flora) describes the composition of the billions of bacteria that inhabit our gut. This microbiome plays a key role in helping our immune system develop from earliest childhood onwards. Researchers suggest that our modern way of life affects intestinal bacteria, which in turn can have an impact on the development of allergies.
A study from Estonia showed that Estonian children, who still grow up relatively frequently on farms and spend a lot of time outdoors, have a much better bacterial colonisation of their intestines than children from Sweden, who are less likely to grow up on farms.
Does breast milk protect us from allergies?
For the immune system to develop healthily, it is ideal for mothers to breastfeed their infants for at least four months. Until just a few years ago, strict nutritional guidelines were recommended. To reduce the risk of allergies, breastfeeding women had to avoid eggs, nuts, dairy products and wheat products. Experts also advised against touching baby porridge with their gluten-containing grains. And fish was just as much taboo, as sometimes were celery or carrots.
New studies have turned these recommendations on their head. They showed that children are more likely to tolerate foods if they have been in contact with them while still in the womb or breastfeeding. Of course, this only applies if the child has not already developed an allergy!
And this is good to know: Since if your baby has a food allergy, you, as its mother, should also avoid that food during breastfeeding.
How to prevent an allergy
The appearance of an allergy is a complex process that scientists still do not fully understand. There are no binding recommendations for preventing allergies.
Medical guidelines, however, provide recommendations that make an allergy a little less likely. They are aimed at ""families at risk"", i.e. at families in whom allergic diseases, atopic dermatitis or asthma also occur. Recommendations also include:
- That the mother and child should not refrain from allergens in the diet, since even the consumption of fish by the mother can exert a protective effect.
- From pregnancy, mothers should also avoid tobacco smoke.
- Pregnant, breastfeeding and children should not come into contact with mould.
- You should not keep a cat as a pet - unless the child is at a high risk of developing a cat allergy. In this case an early contact can actually have a positive effect.
- You should be exposed to as little vehicle exhaust as possible
Foods that trigger allergies
170 foods are allergens, but most reactions are triggered by just a few foods. The most common allergens are cows milk, eggs, peanuts, nuts, soy, wheat, fish and shellfish[6, 18].
Cow's milk allergy
Cow's milk allergy is the most common food allergy. It usually develops in childhood before it disappears again during school age. Cow's milk allergy sufferers respond to all dairy products, including cheese, yoghurt, butter and cream, and 92 percent are also allergic to goat's milk. People with cow's milk reactions should also avoid goat and sheep's milk products.
Important: An allergy to cow's milk is a completely different disease than lactose intolerance.
Chicken egg allergy
Chicken egg allergy is the second most common food allergy in childhood after cow's milk allergy. It too often resolves itself in adulthood.
And this is good to know: Some foods have a reduced potential to cause allergies when they are cooked. For example, many people with allergies can much better tolerate strongly heated milk or eggs used for baking. Peanuts, on the other hand, have an even higher allergic potential when roasted[22-24].
In nut allergy, doctors distinguish between allergies to peanuts - which are actually legumes - and other nuts that they refer to as tree nuts. All nut allergies tend to trigger relatively frequent violent reactions that even extend to anaphylactic shock[26,27].
Fish and shellfish allergy
A fish allergy is often only seen in adulthood. Affected people usually cannot tolerate any sort of fish. Most fish allergic individuals, however, can easily eat shellfish and vice versa.
Shellfish allergy also usually develops during adulthood. Shellfish include all crustaceans, including crabs and lobsters, molluscs (snails), including oysters, scallops and squid, as well as insects such as cockroaches and locusts. Since house dust mites are crustaceans, shellfish allergy sufferers also often respond to house dust.
Wheat allergy most commonly develops in childhood and usually resolves itself before adulthood. 20 percent of wheat allergic individuals show cross-reactions with other cereals such as spelt or rye. But you should not extend your suspicions to all cereals, as this would restrict your diet too much. If in doubt, it is better to do an allergy test. It's best to make sure of what you can tolerate using a provocation test.
Important: A wheat allergy is not coeliac disease! As a wheat allergic individual you can still eat gluten-containing foods as long as they do not contain wheat.
Spices are found in all sorts of processed foods, cosmetics and dental products. However, they do not have to be marked on the packaging. This makes it difficult for allergy sufferers to avoid certain spices. However, spice allergies are relatively rare. The most common are allergies to cinnamon and garlic, but more rarely there may be reactions to black pepper and vanilla.
It is not the entire foodstuff that triggers an allergic reaction, but much rather certain proteins within them that act as allergens. Sometimes different types of these proteins are so similar that the body can not tell them apart. In such a case, a cross-reaction may occur: The body is sensitised towards one allergen, but also reacts to the other. This happens between foods - and those allergic to peaches often also react to apples. However, it can also happen that a pollen allergy leads to a cross-reaction with fruits, vegetables and nuts. And even latex often triggers cross-allergies - against kiwis, bananas and avocados.
Foods and their potential cross allergies:
Cross reaction to
Risk of cross-allergies
Watermelons, bananas, avocados
Apples, plums, cherries, pears
Apples, peaches, honey melons
Brazil nuts, cashews, hazelnuts
Kiwis, bananas, avocados
Food allergy - symptoms
A variety of symptoms may indicate the presence of an allergy or intolerance. Some are mild and barely noticeable, while some cannot be overlooked and others are even very severe, such as allergic shock. Food allergies do not always just affect the mouth and the gastrointestinal tract, since they can also impact on the skin and the respiratory tract[2, 5].
What are the symptoms of food allergies?
In allergic reactions, the following symptoms frequently occur:
- Redness and wheals on the skin (nettle fever)
- Diarrhoea, vomiting and abdominal pain
- Burning in the oral cavity, swelling of the mucous membranes and tongue
- Breathlessness extending to allergic asthma
- A fall in blood pressure
In the extreme case: allergic shock
The most severe form of allergic reaction is allergic shock, which is also referred to as anaphylactic shock. The causes of this are usually insecticides, medicines and, especially in children, food. But foods such as nuts, soya, shellfish, milk and eggs can also cause anaphylaxis.
In anaphylactic shock, large amounts of histamine are released, resulting in severe dilation of the blood vessels. The blood pressure falls rapidly, while dizziness, fainting and even death can occur in the worst case.
If you are aware of the risk of shock, you should respond quickly if more severe allergic symptoms occur and call the emergency services immediately. While waiting for the ambulance arrives, the victim should be placed in the shock position, i.e. lying down with the legs up. At-risk patients also often carry an emergency kit containing an adrenaline pen. This emergency medicine will ensure that the shock abates[3, 4].
And this is good to know: Depending on the severity of an allergy, even the smallest amounts of an allergen sometimes suffice to trigger an anaphylactic shock - such as the remains of a nut on the partner's lips or traces of soy in certain foods[3, 4].
Just because you have an allergy, you will not automatically respond to the slightest sign of the allergen. A reaction threshold exists, meaning that you need exposure to a certain amount of the allergen before symptoms occur. As an example, peanut allergy sufferers often have a very low reaction threshold, with a small crumb of a peanut being enough to cause a furry tongue and swollen neck.
Stress, sports and infections can also lower your reaction threshold. This will make it more likely that you suffer an allergic reaction.
During or immediately after exercise, the risk of an allergic reaction is increased. This phenomenon even has a name: namely exercise-induced anaphylaxis (EIA). If you eat a food that you are allergic to right before exercise, you may experience hives and itching, or feel drowsy. You should avoid any of your food allergens at least four to five hours before each workout.
Studies have shown that stress can make the symptoms of allergy worse and more likely to occur. If you suffer from an allergy and are often stressed out, it makes sense to deliberately seek to be relaxed. Relaxation techniques such as yoga, autogenic training and progressive muscular relaxation can all help.
Infections can also potentiate allergies. Elevated temperatures lead to increased blood circulation, which in turn can cause more allergen to enter the bloodstream. With infections in the gastrointestinal tract, allergies are aggravated by the fact that a larger quantity of undigested proteins crosses the mucous membrane. As a result, such proteins affect the sensitised immune system and are more likely to trigger an allergic reaction.
Alcohol is also discussed as an allergy-enhancing factor among scientists. In some case studies, allergy symptoms were exacerbated under the influence of alcohol, and in alcoholics the number of IgE antibodies is increased. Conclusive scientific evidence for this association, however, does not yet exist.
Food allergy test
Do you suspect that you cannot tolerate certain foods, because after eating symptoms such as rash, a furry tongue or gastrointestinal discomfort occur? Then it may be worthwhile to test for a food allergy. There are four common tests that can detect allergies:
- prick test
- blood test for IgE antibodies
- elimination diet
- oral provocation test
The prick and blood tests provide evidence of merely a sensitisation towards certain allergens. Elimination diets and provocation tests serve to find out whether an allergy is behind the sensitisation.
In a prick test, a doctor scratches you under the skin with allergens dissolved in liquid, and usually on the forearm or the back. If wheals develop at any point, this indicates that there is a sensitisation towards the allergen introduced at that point.
The prick test provides rapid results and is not painful - but can in its aftermath lead to severe itching.
IgE Blood Test
Laboratories can survey the blood for specific IgE antibodies. The benefit of such a blood test is that you can use a single blood sample to test for many different food allergies. If specific antibodies are found particularly frequently in your blood, you will be considered as sensitised towards the associated allergen.
But that does not necessarily mean that you have an allergy! This would also requires symptoms when you take the food in question. In some cases this might not be difficult to spot. But in others, the reactions may be delayed or unclear. In such cases an elimination diet or a provocation test will help.
It can happen that, according to an IgE blood test, you are diagnosed as being sensitised towards a food, but you nevertheless experience no symptoms when you eat it. In that case, you do not need to completely eliminate it from your diet. Your body has probably built an immune tolerance - but it can still lose if you do not eat that food for a long time. It is therefore recommended to eat the food only every four days. This will ensure that your gut does not become overwhelmed. Another possibility is that a cross-reaction with inhaled allergens is the actual cause of the measured reaction.
cerascreen® Food Reaction Test
You do not have to have an IgE blood test performed by a doctor. Self-tests such as the cerascreen® Food Reaction Test allow you to take a blood sample yourself with a little prick in your finger in the comfort of your home. You can then send your sample to a specialist laboratory that will examine your blood for specific IgE antibodies. The foods tested cover 95 percent of the typical causes of food allergy in Europe.
In an elimination diet, you omit the foods that you suspect of being an allergy trigger from your diet. Such a diet is often the first measure a doctor prescribes if a prick test or blood test reveals a sensitisation.
You should not take the elimination diet for longer than two to four weeks if you want to rid yourself of food allergies, and you should only omit one food at a time. During this time, the first effects should already be recognisable if you are allergic to a food - and often even very rapid changes are noticeable.
The provocation test can finally confirm a food allergy. This test must always be performed by a doctor as there is a definite risk of suffering an anaphylactic shock. The doctor will give you the food to test for, and see if suffer any reactions. If there are no symptoms, you do not have an allergy.
Food allergy - therapy
Food allergies can not be treated in the normal sense. Once you have them, you have to live with them, unless they resolve themselves. However, based on a reliable diagnosis, you can avoid the triggers, relieve worse discomfort with medications, and arm yourself with an emergency kit to treat an anaphylactic shock.
Avoid triggers and eat a balanced diet
This is clear: If you have a food allergy, you should stop taking that food - even in small quantities. If an allergy is accompanied by severe discomfort or even the risk of anaphylactic shock, you should carefully study the ingredients on the packaging of the food you consume. Heavily processed foods in particular often contain ingredients that you would not necessarily expect.
An EU regulation requires food manufacturers to clearly label the 14 most common triggers of allergies and intolerances on their products: Gluten-containing cereals, crustaceans, eggs, fish, peanuts, soybeans, dairy products, nuts, celery, mustard, sesame seeds, sulphur dioxide and sulphites, lupins, molluscs. The term ""May contain traces"" is not regulated, with manufacturers using it voluntarily.
If you only have reactions to one or two foods, it is often easy to eliminate them from the menu and replace them. However, if you or your family has a lot of food allergies, this can quickly get quite complicated. Experts recommend dietary advice in such cases. You will then learn how to avoid allergens while still maintaining a balanced diet.
Antihistamines, which are also known as anti-allergic tablets, weaken or even block the action of the messenger histamine. In this way, they can combat allergic reactions throughout the body. They are used for hay fever, but can also relieve minor ailments of a food allergy such as rashes, palatal itching or nausea. The most common active ingredients are cetirizine and loratadine, and these are available as drops or tablets over the counter in many pharmacies.
With anaphylactic shock, however, the effect of antihistamines is usually not sufficient. That is why people with severe allergies to more dangerous allergens such as nuts and shellfish often carry an emergency kit with them. The emergency kit includes an adrenaline pen which is injected into the thigh, glucocorticoids and, for asthma sufferers, an inhalation spray.
A food allergy, as it is defined, is always a reaction of the immune system in which specific antibodies play a role, usually the IgE antibodies. This must be differentiated from food intolerance that causes non-immunological reactions to food. Instead of incompatibility, the term intolerance is often used.
Intolerances include coeliac disease (gluten sensitivity), intolerances to lactose, fructose, sorbitol and histamine, and IgG4-mediated intolerances. According to experts, 15 to 20 percent of the world's population are affected by intolerances, and women more so than men[38,40]. The causes of intolerance are not always obvious, with possible factors including genetic predisposition and environmental influences.
Many people believe that they may have an intolerance to a food - but in reality this only affects a fraction of them. In a UK survey, 20 percent of people believed that their household suffered food intolerances. Investigations showed, however, that of these 20 percent only two percent were affected by real intolerances.
What symptoms are associated with intolerances?
Intolerances are usually delayed, unlike allergies. If you eat something that you can not tolerate, it can take hours for symptoms to materialise. This often makes it difficult to detect an intolerance and to find out what food is responsible for it.
The symptoms of intolerance are usually expressed in the gastrointestinal tract. Unpleasant flatulence is typical, but it can also lead to nausea, constipation, diarrhoea and vomiting. Other possible symptoms include:
- Headaches and migraine
- Whistling breath sounds and a runny nose
Frequent food intolerances
Scientists today already more or less understand a number of intolerances. We tend to know roughly what's going on in the gut and why sufferers can no longer tolerate certain foods. Well-researched intolerances include those to lactose, fructose, sorbitol, histamine and coeliac disease.
Probably the most common intolerance is intolerance to the sugar present in milk, lactose. Lactose occurs in milk and many dairy products. In Germany, lactose intolerance affects up to 15 percent of the population. In other regions, especially in Asia, it is even more common. In affected individuals, the specific enzyme that breaks down lactose occurs at low levels in the intestine. The body can not process the lactose properly so that flatulence and abdominal pain results.
Fructose and sorbitol intolerance
Those who have fructose intolerance can not tolerate the fructose present within fruit. This gives fruit its sweetness, but it also occurs in some vegetables. A transport protein transports the fructose from the intestine into the blood. In fructose intolerance, this transport protein does not function properly, causing problems in fructose utilisation - and symptoms of flatulence, abdominal pain, fatigue and mood swings result. Sorbitol intolerance runs similarly - where the intestine can not properly process the sugar substitute sorbitol.
Gluten intolerance (coeliac disease)
In coeliac disease, the protein gluten triggers an immune reaction that leads to inflammation in the intestinal mucosa and subsequent gastrointestinal discomfort, and long-term to nutrient deficiency and consequential symptoms such osteoporosis and anaemia. Gluten is found in many cereals, for example in wheat, spelt and rye, as well as in many finished products - much to the chagrin of those affected who then have to nourish themselves in a completely gluten-free manner.
Histamine intolerance is also referred to as pseudoallergy. With a food allergy it shares the feature that the messenger histamine leads to symptoms such as redness, flatulence, dizziness and a runny nose. But while immune cells release too much histamine during an allergy, histamine intolerance is due to a lack of a specific enzyme in the gut and blood that breaks down histamine in food. Histamine-rich foods such as red wine, mature cheeses and dried sausage can then trigger its symptoms.
Symptoms of intolerance can also originate in the psyche. For example, your brain may associate traumatic memories with a certain kind of food. Sometimes the body will then react with discomfort when you consume the food again.
In addition to the IgE antibodies, the immune system has other spanners in its tool-kit, including IgG4 antibodies, or immunoglobulin G4. Our body also produces different IgG4 antibodies in response to all kinds of foods that we consume.
Test IgG4 values
According to theories, the production of certain IgG4 antibodies increases all the more when we cannot tolerate a certain food, leading to various defence and inflammatory reactions. There is then an IgG4-mediated intolerance. These reactions and the associated symptoms only occur after a delay, and sometimes only hours or days after the food was eaten. The number of IgG4 antibodies can be determined using a blood test, and also using the cerascreen® Food Reaction Test. The result might then be a sign of an intolerance.
Some researchers and professional societies have criticised that the IgG4 concentration only provides information on the extent to which certain foods were eaten and that it is not clinically relevant. It instead points towards an immune tolerance rather than an intolerance. Thus far, there has been no large-scale study investigating the link between IgG4 levels and food reactions[38, 39, 44].
Intolerance to histamine, lactose, fructose and sorbitol as well as coeliac disease can not be detected using an IgG4 intolerance test. In each case, other blood or respired gas tests are required.
How do I handle my IgG4 test results?
An increased number of IgG4 antibodies does not mean that you cannot tolerate a food. However, you can still deliberately omit the foods identified in the test from your diet and check whether your symptoms start improving. If the test shows a clear reaction to a food, remove it from your diet for two weeks. If your symptoms improve then this is an indication that an intolerance might be present. You can then forgo taking the food for the next six months. Only then try to reintroduce it back into your diet slowly.
An alternative would be a rotation diet. With this diet, you can omit several potential intolerance triggers. To do this, eat the foods you responded to in the IgG4 test only every four days. This will allow your intestines to recover in the meantime. Such a rotation can already lead to a significant decrease in complaints.
Food reactions: At a glance
What is a food allergy?
In a food allergy, our defences try to combat otherwise harmless proteins called allergens that are found in foods. The mast cells of our immune system release histamine, and this causes inflammation that can bring about discomfort in the whole body.
What are the symptoms of a food allergy?
A food allergy can manifest itself through gastrointestinal discomfort, palatal itching and a furry tongue. However, reddening, itching and rashes on the skin as well as respiratory complaints and even asthma are also common. In rare cases, a fall in blood pressure and an anaphylactic shock might occur.
Which foods can trigger an allergy?
Theoretically, many foods can trigger allergies. In practice, however, just a few foods are responsible for more than 90 percent of all allergies. These include cow's milk, eggs, peanuts, nuts, soy, wheat, fish and shellfish.
How can I recognise a food allergy?
If a food allergy is suspected, one of the things you can do is take a blood test. The test determines the numbers of certain IgE antibodies in your blood. If an IgE level is elevated, a sensitisation towards the antibody-related food exists. Then you can avoid the food temporarily to see if your symptoms are alleviated.
What is a food intolerance?
In case of an intolerance, also called an incompatibility, symptoms do not arise through immune reactions as they do in an allergy. Often, the gut has problems processing certain ingredients of foods, such as gluten, histamine, lactose, or fructose.
What are the symptoms of food intolerance?
In contrast to a food allergy, intolerance symptoms are often not immediate. Sometimes symptoms only appear after hours or days. Typical symptoms include gastrointestinal complaints, and particularly flatulence, headaches and migraines, runny nose, rashes and fatigue.
What is an IgG4-mediated food intolerance?
The IgG4 antibodies of the immune system can, according to some theories, provide an indication of intolerance towards a food. Using the IgG4 values measured in a blood sample, you can embark on elimination and rotation diets that might help prevent more intolerance and reduce discomfort.
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