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Food intolerance or allergy, which is it?
Prairie Doc
Jennifer May M.D.
Jennifer May, M.D.

Food intolerance and food allergy are common these days. When I was a kid, no one asked about nut allergies or gluten sensitivities when inviting you to a birthday party. You could bring homemade snacks to school. Peanuts were served to everyone on airplanes. Today, we are constantly reminded to be aware and take precautions to help prevent exposure for those who are intolerant or allergic.  

Understanding the difference between allergy and intolerance is important. Allergies can result in life threatening reactions, whereas food intolerances are not life threatening but can be very problematic. Food allergies and intolerance have many overlapping symptoms making diagnosis difficult.  

Food intolerance is very common and is estimated to affect 20 percent of the world’s population. Food intolerance occurs when the body has a chemical reaction to eating a particular food or drink. Most food intolerance reactions involve the digestive system, skin, and respiratory system. Many of us have mild intolerance, say to diary, but other common triggers are gluten, caffeine, and eggs. 

Food allergies can be more serious and result from an inappropriate immune system response. Nuts, for example, are harmless yet the immune system can identify them as toxic. Even a small exposure can lead to a life-threatening reaction known as anaphylaxis.  

Thankfully, we have new approaches to manage food allergy. Today, we better understand how exposure to a broad variety of food in infancy can reduce risk of developing allergy as we age. Another option available is immune therapy for peanut allergy. 

On the other hand, managing food intolerance requires an understanding of what food or ingredient triggers symptoms, then we focus on avoidance. We do not have immune therapy for food intolerance.   

Both food intolerances and allergies are becoming more prevalent. For example, between 2007 and 2016 there was a 377 percent increase in treatment of diagnosed anaphylactic reactions to food. Why are more people having challenges with food? It is not clear. Maybe it is our environment, our diet, or both. No specific cause has been identified. 

Our world has changed and our treatments for food allergies and food intolerance have changed as well. It seems we will continue to have special dietary requests for a long time to come, so getting the right diagnosis is our most important first step.  

Richard P. Holm, MD, passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc. For free and easy access to the entire Prairie Doc library, visit and follow Prairie Doc®on Facebook. Jennifer May, M.D. practices rheumatology in Rapid City, S.D.