Doctors’ Notes


Allergy or Intolerance?

Does your child complain of belly pain, get a rash, or experience other reactions after eating or drinking certain foods or beverages? This can be exceedingly stressful, especially when it occurs in a child. In most cases, these reactions are caused by an intolerance or sensitivity to the food rather than a true food allergy. It’s important to know the difference between allergies and intolerances, because food allergies can more serious. Here, we’ll take a closer look at the clues to help you identify a reaction as either an allergic reaction or an intolerance to food.


Intolerance is caused by irritation from a food that the body can’t properly digest. Common symptoms might include, gas, cramps or bloating, heartburn or headache, or irritability or nervousness. The most common type of food intolerance is caused by lactose (a sugar commonly found in milk and other dairy foods) and the inability to digest it. For people who suffer from lactose intolerance, there is usually a tipping point — meaning it can be tolerated to a certain point, and then… it can’t.

Another common intolerance is caused by sulfites, a sulfur-based compound that may occur naturally in a food, or may be added as a preservative or enhancer in cooked or processed foods. Sulfites occur naturally in the process of making beer and wine. (Not that this should be an issue for your young one, but I thought I would mention it!) Foods such as dried fruits, soup mixes, pickled foods, trail mixes, and potato chips may contain sulfites. Apple cider, bottled lemon and lime juice, and some vegetable juices are potential sulfite suspects as well. If you believe your child has sensitivity to sulfites, be sure to read ALL food labels and look for the following ingredients: sulfur dioxide; potassium bisulfite or potassium metabisulfite; sodium bisulfite; sodium metabisulfite or sodium sulfite. Reactions to sulfites are mostly mild, but in some cases can be severe such as in causing asthma attacks. So remember to always read food labels!

The good news about food intolerances is that the majority are outgrown within the first two to three years of life.


According to the National Institute of Allergy and Infectious Disease, food allergy is defined as “an adverse reaction that results from an immune response that occurs as the result of exposure to a specific food or allergen.” Here, the body triggers an immune reaction against a specific food protein that is otherwise harmless. Food allergy can affect the whole body, not just the stomach. Symptoms could include: rash or hives, shortness of breath, chest pain, and even more seriously, a sudden drop in blood pressure or trouble breathing or swallowing. This type of reaction is life-threatening.

The eight most common food allergens account for 90% of all confirmed allergic reactions. They include: wheat, eggs, milk, soy, peanuts, tree nuts, fish, and shellfish. While parents of children who have food allergies may perceive an allergic response to several foods, research indicates that allergy to more than three foods is quite rare.

A summary of the differences between the two is defined here:

Food Intolerance

  • Gradual onset of symptoms
  • May be influenced by the quantity of food/beverage consumed
  • May be influenced by the frequency the food/beverage is consumed
  • Is not life-threating

Food Allergy

  • Sudden onset of symptoms
  • Can be triggered by a small amount of food/beverage
  • Reaction occurs every time the food/beverage is consumed
  • Can be life-threatening


Diagnosis of food allergy takes some effort, as no single test can conclusively diagnose all allergies. The first step is to identify the suspected food or food group. Next, some kind of record is needed, such as a food diary, that indicates history of a reaction. And finally, diagnostic testing through the skin prick test, radioallergosorbent testing, or an oral food challenge.

If you suspect your child has either an intolerance or an allergy to a certain food or food group, start keeping a record of foods and beverages consumed as well as any adverse reactions. Share your concerns with your Kids Plus provider, who will point you in the right direction for further testing.

For more information about food allergies, visit these resources:

Asthma and Allergy Foundation of America

Food Allergy and Anaphylaxis Network

Anne Marie Kuchera, our Kids Plus Nutrition Consultant, is a Licensed Professional Counselor and Registered Dietitian.