Is it Food Allergy or Food Intolerance?

Sue Hubbard, M.D.

An allergic reaction to a food, such as strawberries, might include hives, itching, swelling of the tongue or difficulty breathing

An allergic reaction to a food, such as strawberries, might include hives, itching, swelling of the tongue or difficulty breathing

I just received an email question via our free iPhone app. A mother with a 9-year-old daughter asked, "Could my daughter could be allergic to strawberries, as she gets a stomachache and sometimes vomits after she eats them? She hasn't had problems eating strawberries before." This is interesting because I've been reading and reviewing several articles on food allergies and their diagnosis.

One piece ran in JAMA and another in the Consultant for Pediatricians. Both articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies.

Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it's an "adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance." Statistics show that somewhere between 1 percent and 2 percent of the population may have food allergies. It's also unclear if food allergies are on the rise, as data on this is conflicting.

All this being said, it sounds more like this child has developed an intolerance to strawberries, rather than an allergic response. It would be important to get more history, such as what else she's eaten with the strawberries when the reaction occurs, if the symptoms are always the same, and if the child has any other problems associated with the ingestion. Specifically, does she complain of hives, itching, swelling of the tongue or lips, difficulty breathing? Does she have problems with any other foods?

I also wonder if this child has the same symptoms if she picks fresh strawberries, or if the fruit is frozen. In other words, like so many things in medicine, a good history is probably the most important part of this "strawberry story."

If the child continues to have problems and the same symptoms, this sounds more like intolerance than a true allergic reaction, and she should simply avoid strawberries.

Her mother might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries. A food intolerance would not trigger an increase in IgE antibodies, as it's not an allergic reaction. If confusion persists, she could be referred to a pediatric allergist for further evaluation and even an oral food challenge.

There continue to be a great many studies surrounding the etiology of food allergies, and I'll keep you posted as new information is presented.

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