Food Intolerances, Sensitivities, and Allergies: What’s the Difference?

Introduction

 Hi everyone. Welcome back to the Immune Edit. I’m Dr. Doug Jones. Today is a great topic because it is something I talk about every day and it’s so easily confused, but the differences between. Food intolerances, sensitivities, and allergies. And what are those differences and how can we really tell the difference?

Don’t Toss Everything Into the “Allergy” Bucket

So what I’ve observed over the last decade and a half is if somebody has some kind of reaction to a food, they always want to throw any kind of adverse reaction or anything into the food allergy bucket. And I’m here to like make an edit on that today, because that’s not. Great. Um, first of all, we need to understand the differences between these things.

Why Getting the Terms Right Matters

If you’re putting everything, whether it’s a sensitivity, intolerance or allergy into just one bucket, that’s almost like saying people who have had a, a stroke or seizures or dementia all have seizure disorder, for instance, throwing it all in the same bucket. We can’t do that. They’re very distinct.

They’re different, and just like that with food allergy intolerance or sensitivity, we really need to understand what some of these differences are because there are, the risk of each of these is different. And so if somebody has a potentially true life-threatening food allergy. It needs to be taken very seriously because of the risk that they have.

Not that I’m downplaying the other things, it is just the risk is different.

Food Intolerances

Food intolerances are often due to a digestive enzyme that may be lacking within the body or something within the, the digestive tract where we’re not able to digest the food properly. As a consequence, you can get some gas, bloating, often diarrhea. It’s predominantly GI related.

Food Sensitivities

Sensitivities, on the other hand, can have very similar symptoms of gas polluting diarrhea. This is one where you may not be lacking like a digestive enzyme. You may just have a sensitivity to a food where it’s creating some inflammation within the body, and that can also cause gas, bloating, diarrhea.

You can have some constipation with it, but also with sensitivities, you may have some other symptoms. Brain fog, fatigue, joint pain, those kinds of things. So it may not just be GI related, it would be GI plus.

Food Allergy (Immune-Mediated)

Food allergy is one where it’s triggered by the immune system though, and that’s the one where it can lead to a potentially life life-threatening situation.

There are a couple of different types. Of food allergy. There’s one that we call in broad categories, IgE mediated food allergy or non IgE mediated food allergy. Both can be potentially life threatening in different ways.

IgE-Mediated Food Allergy

So IgE is a protein or an antibody that our body makes and it’s very specific to. The foods that somebody’s allergic to. And so it, it’s almost like a lock in key mechanism where it’s that lock and it’s waiting for the key, meaning the food that, that somebody’s allergic to that exposure to unlock the door and create the allergic reaction.

It can be mild, moderate, or severe, but the truth is we can never predict what type of reaction may occur. In my mind, if you have a potentially life-threatening food allergy, it’s severe, because we always want to be prepared for the most dangerous scenarios—anaphylaxis.

With anaphylaxis, multiple systems can be involved:

• Skin (hives, rash)
• Lungs (tightening, wheezing)
• Throat (swelling, airway closure)
• Blood pressure (dangerously low levels)

A myth is that reactions always get worse with each exposure. Not necessarily. Severe reactions can happen even after one or two exposures.

Non-IgE-Mediated Food Allergy (FPIES Example)

One example of this is FPIES (Food Protein-Induced Enterocolitis Syndrome).

This condition can be life-threatening due to severe vomiting and diarrhea leading to dehydration and volume loss. While the presentation is different, the need for caution is the same.

Nuance Within Food Allergies

Food allergies vary by food type. Some may be outgrown; others are lifelong. Cross-reactivity with pollens, latex, or nickel can complicate diagnosis.

Examples:

• Oral Allergy Syndrome (pollen-related cross-reactions)
• Latex-food cross-reactivity
• Nickel in foods causing rashes or GI upset
• Alpha-gal syndrome (red meat allergy triggered by tick bites)
• Eosinophilic esophagitis (EOE), involving both immune pathways

Testing Pitfalls

Some try to boil all of this down into one or two tests, but that’s not accurate. In an upcoming episode of The Immune Edit, we’ll discuss testing, pitfalls, and what’s valid vs. not.

Histamine Intolerance & MCAS

Other reactions include histamine intolerance or mast cell activation syndrome (MCAS). These are real, but often over-diagnosed and oversimplified. Many wellness influencers may exploit them with unvalidated tests and questionable supplements.

Quick Summary & Risk Differences

• Intolerances: Usually due to enzyme deficiencies (ex: lactose intolerance). Mainly GI symptoms.
• Sensitivities: GI symptoms plus systemic ones (joint pain, brain fog, fatigue).
• Allergies: Immune-mediated, can involve multiple systems, potentially life-threatening.

How to Get Help

I want people to really make the edit of not putting every single adverse reaction that you have to food in an allergy bucket if it doesn’t deserve to be there.

So if you have questions on this, happy to, you know, have some questions in the comments. Leave the questions, message, make an appointment, or meet with your local allergist to sort through what you or your child really have.

That’s it for today and hope you have a great day.

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