Earlier this week, we reported on a recent food allergy study that, perhaps not surprisingly, stirred up a long of strong feelings among readers. The research suggested that roughly 10 percent of adult Americans are allergic to foods like shellfish, tree nuts, and dairy. But it also found that nearly as many people described themselves as having an allergy, but then reported symptoms that weren’t consistent with a true food allergy.
Sounds innocuous enough, right? Here are some of the responses we got:
“As someone who deals with an actual, literal food allergy (Tree nuts put me into anaphylaxis pretty fucking quickly), I appreciate an article illustrating the difference.”
“For some reason having food allergies is now a desirable trait. Just one more checkbox for being different and unique.”
“In Other News, people want to feel special and so make up all sorts of baffling conditions, thereby ruining the business for people who are ACTUALLY allergic.”
“[S]ometimes it’s been just plain easier to tell someone who’s crafted six plates of egg-based hors d’oeuvres/custards/meringue-topped-goodies that I have an allergy. I’m not happy about doing this, but it’s simpler and easier for people to understand than explaining how I’d rather not spend four hours with a sweaty stomach ache just to have the pleasure of their deviled eggs.”
“Yeah, I know that I don’t have an ‘allergy’ but milk, certain cheeses and cucumbers will result in hours of painful cramps, vomiting and other unpleasantness. So much easier to just say I have an allergy than a sensitivity to which people just think I am picky.”
Readers, both via email and in the comments section, expressed worry about what they viewed as the study’s hidden implications. If there are people who say they have a food allergy but don’t have symptoms consistent with one, doesn’t that mean they’re essentially fooling themselves? A minority of readers took it further, suggesting that some people are lying about their problems to fit into the latest health trend. That’s a common canard tossed out at people who say their diets need to be gluten-free, for instance.
Our original article made sure to point out people who misidentify an allergy weren’t faking their problems, but might be experiencing something else, like a food intolerance. But given the intense emotional reactions from readers—both from those who feel their food sensitivity is not taken seriously, and from those who feel people with food issues are being overly precious—it’s worth examining why we shouldn’t be dismissive of people who don’t have classic food allergies but are hypersensitive in some way.
For one thing, the study authors themselves weren’t trying to minimize anyone’s food issues.
“We are not at all saying people are wrong. One in 10 U.S. adults have a food allergy and that is a very significant number. Half of these allergies are developing in adulthood which is also very alarming,” lead author Ruchi Gupta, a professor of pediatrics at the Northwestern University Feinberg School of Medicine in Chicago, told Gizmodo. “Another 9 percent had very valid food related conditions which could have been a food allergy but the symptoms overlapped with other food related conditions.”
The survey, for instance, asked people with a food reaction to list the symptoms of their most serious reaction. And Gupta’s team classified those who had at least one of several well-documented symptoms of a food allergy, such as hives or a swelling of the mouth or throat, as having a true allergy. But asking people to remember their past is always a tricky matter. So maybe some people not classified as having a food allergy in the study actually did have consistent symptoms but didn’t mention them.
Moreover, scientists are discovering and studying all sorts of ways the body can react badly to food that don’t necessarily look like a classic food allergy.
People with a rare eosinophilic disorder, for example, produce more eosinophils, a type of white blood cell, than they actually need. This overproduction can then cause attacks of inflammation. There are different types of the disorder, depending on where the overactive eosinophils are produced. But people with eosinophilic gastrointestinal diseases, meaning their eosinophils can cause havoc all along the digestive system, often have food-related triggers. The most common form of this type, eosinophilic esophagitis, or EoE, might affect one in 4,000 children.
And while many reactions to a trigger food can be immediate and involve the antibody immunoglobulin E, like a typical allergy, not all will. Some people can have delayed, chronic reactions—like heartburn, chronic stomachache, and a damaged esophagus—that involve other antibodies not associated with food allergy, like immunoglobulin G, a spokesperson for the American Partnership for Eosinophilic Disorders told Gizmodo via email.
There are other complicated immune disorders out there, like mast cell disease. As with eosinophilic disorder, people with mast cell disease can experience a mix of sudden and delayed reactions to food triggers. Estimates of how many people have mast cell disease are difficult to make, but some forms may affect around one in every 10,000 people. People with celiac disease have a delayed immune reaction to gluten. There’s also Hashimoto’s disease, an autoimmune condition that gradually damages the thyroid and affects 1 to 2 percent of people in the U.S. Sufferers of Hashimoto’s are especially sensitive to iodine, which is used to produce thyroid hormone, so they have to carefully monitor their diet and avoid too much of it. And of course, there are other conditions, like lactose intolerance, that don’t involve the immune system at all.
The long and short of all this is that our bodies are weird, and we’ve only barely scratched the surface of understanding the many ways it can go wrong. Given that, it’s understandable why some people with lactose intolerance, for example, might just want to call their problem an allergy, a simple term everyone understands. In other cases, as some readers pointed out, people may choose to call their complex food sensitivity an allergy in order to avoid judgment or nosy questions.
“We still have family members who will ask, ‘Well, I can still give them this food, right?’ Because they don’t see the impact of a trigger,” GM Contreras, founder of a support group for families dealing with EoE and father to a child with EoE, told Gizmodo. “Some kids just get hives. Some get stomachaches. Some die. You just never know when and how the impact will come.”
Of all food movements, the gluten-free trend seems to garner the most eye-rolling. Research has gone back and forth on the question of whether people can get sick from eating gluten but not actually have a wheat allergy or celiac disease. But while we’re not completely sure how gluten could be sickening these people (or even that gluten itself is the true dietary culprit), there have been studies showing that some people with a reported gluten sensitivity really do show signs of internal damage and experience relief after cutting wheat and other high-gluten foods out of their diet.
But whether you choose to call a sensitivity an allergy when you’re declining a dish at a dinner party, or you suspect you have an issue but don’t know how to categorize it, it’s definitely worth identifying why exactly you can’t tolerate a certain food. While finding a doctor willing to help you better understand your particular food-related problem is not necessarily an easy or affordable task, it’s better than self-diagnosing. That, Gupta said, is what she hopes people can take away from her research.
“We wanted to emphasize the importance of getting a physician diagnosis so if it is another food-related condition versus a food allergy, they know how to manage it, as some are treatable and some, like food allergies, can be life threatening,” she said.
Whether or not you are officially diagnosed with an allergy, intolerance, or anything else, if avoiding a certain food makes you feel more comfortable, less sick, or just all-around better, then there’s no shame in that.