The Festive Season is nearly here again. When we think of Christmas we think mince pies, Christmas pudding, brandy cream, trifle, cheese boards and many other tasty treats. But for lots of us some of these foods can leave us feeling anywhere from quite uncomfortable to requiring hospitalisation.
This can be due to one of a few different possible underlying causes that can have very similar symptoms that range from mild to severe. It is therefore not surprising that we confuse allergies with intolerances and even coeliac disease.
What is the difference between a food allergy, an intolerance and Coeliac disease?
What is the difference between a food allergy or intolerance, and Coeliac disease?
A food allergy is an immune response
Common food allergies include peanuts, shellfish, and eggs.
A food intolerance is a digestive issue
Lactose intolerance is where the body lacks an enzyme called lactase, which is needed to digest lactose in dairy. This is different to a milk allergy which involves an immune response to milk proteins, potentially causing hives, anaphylaxis or other severe reactions.
An Autoimmune Disease is the body attacking itself
Coeliac disease can result in long-term damage to the small intestine resulting in bowel cancer in rare cases, unlike an allergy or intolerance, which typically causes temporary reactions.
Genetic Factors
Does someone in your family have allergies, lactose intolerance or coeliac disease?
If so, you might have it too. That’s because allergies, primary lactose intolerance and coeliac disease can be hereditary. If you have allergies, that doesn’t mean your child will definitely have them. There is a 50-50 chance. If your spouse is also allergic, your children’s chances go up to 75%. There are however other factors that come into play, like your environment, air pollution, respiratory infections – even diet and emotions.
Coeliac disease has a strong genetic component and is linked to specific genes, particularly HLA-DQ2 and HLA-DQ8. People with these genes are more likely to develop coeliac disease, though not everyone with these genes will develop the condition.
Primary lactose intolerance is genetically determined, often developing with age as the production of lactase decreases, particularly in populations where dairy has not been a traditional part of the diet (e.g., East Asian, African populations).
Onset and Reversibility
Allergies are typically present from early life and may persist throughout life, though some can be outgrown (e.g., egg or milk allergies). While allergies are more common in children, they can appear at any age. Sometimes allergies disappear, only to return years later. Exposure to allergens when the body’s defences are weak, such as after an illness or during pregnancy — can play a role in developing allergies.
Intolerances like lactose intolerance can appear later in life and are often not reversible.
Autoimmune diseases like coeliac disease are lifelong conditions but can be managed by avoiding the trigger (gluten).
Symptoms of Intolerance vs Autoimmune Disease
Intolerance symptoms are generally confined to the gastrointestinal system, like bloating or diarrhoea (e.g., lactose intolerance).
Autoimmune diseases like coeliac disease cause more systemic damage, including nutrient malabsorption, anaemia, and long-term health complications.
Treatment Approaches
Allergies are managed by complete avoidance of the allergen, taking anti-histamines and sometimes emergency medication like epinephrine.
Intolerances are managed by reducing or eliminating the problematic food (e.g., lactose-free products).
Autoimmune diseases like coeliac disease require strict lifelong avoidance of gluten to prevent ongoing immune damage.
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