Is it a food allergy you have or an intolerance?

From the growing prevalence of gluten-free options and dairy alternatives, it should be no surprise, that food allergies and intolerances are on the rise. A 2025 survey by the International Food Information Council, found that over half of Americans either have, live with or know someone, affected by a food allergy, intolerance or sensitivity. Yet, as awareness grows, so does confusion. Not all reactions to food are the same and knowing what the body is dealing with matters. “There’s a broad spectrum – from true allergies to sensitivities to intolerances,” said Dr. Elizabeth Ender, allergist. “It can be tricky, to distinguish between them and knowing what’s going on with your body, will affect how you respond to it.” A true food allergy triggers a full-on immune response. These reactions can be serious, even life-threatening, with symptoms that appear quickly, like hives, swelling, wheezing, vomiting or anaphylaxis. The most common food allergens in the U.S., include milk, eggs, wheat, soy, tree nuts, peanuts, sesame, fish and shellfish. In contrast, food intolerances can happen when the body has trouble digesting certain food components, causing bloating, gas or stomach cramps. Common examples are lactose intolerance, gluten intolerance (nonceliac) and fructose intolerance. Food sensitivities are the hardest to identify. They can cause symptoms, such as headaches, fatigue, eczema flare-ups or brain fog, without known involvement of the immune system or digestive enzymes. People may react to additives, natural compounds, like salicylates (found in fruits, vegetables and spices) or FODMAPs – fermentable short-chain carbs that trigger symptoms in sensitive individuals. “Treatment depends on what kind of reaction your body is having,” said Ender. “True allergies require strict avoidance and often an EpiPen, to treat serious reactions. Intolerances and sensitivities can usually be managed by adjusting your diet, or using enzyme supplements, like Lactaid. But, unnecessarily cutting out foods can cause nutritional gaps and stress. That’s why a proper diagnosis and guidance from a health professional really matter.” Although home testing kits for food sensitivities are widely advertised, many lack scientific backing and can lead to misleading results. “The gold standard for diagnosis, is still an oral food challenge, done under medical supervision,” said Ender. If a food allergy is suspected, intolerance or sensitivity, starting a detailed food and symptom journal is one of the best things to do. Write down what is eaten, note when symptoms appear, and describe their intensity and duration. Over days or weeks, this record reveals patterns and triggers that might otherwise be missed. This information provides invaluable data for a healthcare team. This will enable them to accurately diagnose the condition and tailor a treatment plan. Managing food reactions takes effort, but the tools and support available today, are better than ever. “It can feel very scary to react to a food,” said Ender. “But, every year, we have more knowledge and more options, to help prevent and treat food allergies, and we’re here to help you figure out what is going on.”