SOUNDBITES Paula MeeIs it an allergy or an intolerance? What's the difference and why is it so important to get the terminology right?
A food allergy occurs when the body mistakes a food - usually a protein - as harmful. The body launches an immune response by creating lots of antibodies to fight it. During the battle between these antibodies and the invading food, histamine is released.
This causes mild to severe symptoms - anything from a rash, hives, stomach pain, diarrhoea, itchy skin, swelling of the airways, shortness of breath to anaphylaxis. These symptoms are usually seen within minutes of eating the food and although rare, fatalities can occur.
Researchers have found that up to 20 per cent of people perceive they have a food allergy, but when tested only 10 per cent of children and 2 per cent of adults were diagnosed with a genuine food allergy.
What many people categorise as "allergy" is frequently a food intolerance and doesn't involve an immune response.
There's a growing concern now that as more and more people label themselves as "allergic", the factual meaning and severity of a genuine food allergy will be undermined and dismissed.
Peanuts and tree nuts are the leading cause of food-related anaphylaxis (severe body shock) in the UK, even though only 1 per cent or less of the population is allergic to them.
The good news is that 80 per cent of children outgrow their milk and egg allergies by the age of five years and up to 20 per cent of children can outgrow their peanut allergy.
Food intolerances are much more common. In some cases, as with lactose intolerance, your body is missing an enzyme necessary to properly digest milk.
People can also have intolerances to additives that colour food (tartrazine), enhance taste (MSG) and protect against the growth of bacteria (sulfites).
Salicylates are a group of chemicals found naturally in many fruits, vegetables, nuts, coffee and beer. Aspirin is also part of the salicylate family and in many people who are sensitive to aspirin, these foods can trigger symptoms too.
The problem is some of the symptoms - nausea, stomach pain, gas, cramps, bloating, vomiting, headaches and irritability - are similar to allergy symptoms.
One of the distinguishing features of an allergy is that they are triggered by even a small amount of the food and occur every time the food is eaten. People need to avoid the offending food completely whereas food intolerances are often dose related.
You may not have problems with the food unless you eat a really large portion of the food frequently.
A good case history and examination is key in determining whether you have an allergy or intolerance.
Skin prick tests, total and specific IgE blood tests and food challenges can confirm the diagnoses of food allergy, whereas food diaries, records of symptoms and elimination diets (supervised only by a qualified INDI dietitian) are useful for food intolerances.
Whether it's allergy or intolerance, you usually end up avoiding foods you previously enjoyed. Food shopping is then described by many as sheer hell. Excluding milk couldn't be that hard surely? You could just buy soya milk and yogurts instead of cow's milk. Good start - but in reality be prepared to double the time you spend in supermarkets squinting at food labels. Even after all that peering at the small print, you may not be any the wiser!
When you look at any pre-packed food - a packet of biscuits or a carton of fresh soup - the ingredients must be listed in descending order, with the biggest ingredient first. But in certain situations, manufacturers are not obliged to list all the ingredients of a food. This obviously prevents you from identifying ingredients you need to avoid.
You can't make a fully informed choice - so you either pop it back on the shelf or play Russian roulette. Take sponge fingers in the base of a frozen dessert as an example. If the sponge fingers make up less than 25 per cent of the frozen dessert, then you will see "sponge fingers" on the label, but not the individual ingredients that make up the sponge fingers.
Perhaps you could whip out your mobile and ring the manufacturer from the supermarket isle to decipher whether the sponge fingers contain the offending food or not. But remember, you'll have to confirm that its "free from" the offending food every time you buy it - just in case the formulation changes.
As a consequence of the growing number of people with food allergies and intolerances, labelling legislation is changing - but don't hold your breath. Your life is not destined to improve until November 25th, 2005. Only then will it be mandatory to provide a full comprehensive listing of the ingredients on pre-packed foods.
Some food companies have already got excellent ranges of specifically formulated "free from" foods - but it will certainly be a huge step forward when we see this labelling extend to all foods.
The milk-free shopping basket
Milk and its derivatives: the obvious and the obscure
Avoid milk (skimmed, semi-skimmed, evaporated and condensed)
Skimmed milk powder
Milk solids, non milk fats
Cream, artificial cream
Yoghurt
Cheese
Butter and some margarine
Lactose
Whey
Hydrolysed whey protein
Casein
Caseinate
Hydrolysed casein
Hidden sources of milk include products such as instant chocolate drinks, cream soups, salad cream, chocolate coated raisins and nuts, flavoured crisps, mayonnaise, cheese spreads, sausages, ham, beef burgers, other processed meats, fish fingers/cakes, many types of bread and biscuits, some brands of muesli, Special K, ice-cream, instant desserts, cream crackers, cheesecake, macaroni cheese, pizza, lasagna, fudge, toffees, chocolate and caramel.