So you’ve been to the doctor and been told you have an allergy or coeliac disease. Or maybe you’ve just realised you’re feeling crappy all the time, no matter what you do. Maybe you have no idea what an inappropriate immune response is (is my immune system getting drunk and shouting obscenities at my loved ones?). Or maybe you’ve noticed your kid is irritable at certain times, and traced it back to every time they eat ice cream.
Maybe (probably) you’re a little (or a lot) more irregular than you’d like.
You might be keeping a food diary to try to track down what the problem is and you’ve had advice from everyone and their grandma (and their grandma’s neighbour) about what to eat.
Whatever the reason, you’ve arrived at a diagnosis - I have an allergy. I have an intolerance. I have a sensitivity. I am a coeliac. What the hell are these and what does that mean?
It means that your life will change a little bit (or possibly a lot, at first). It means that going grocery shopping can take over 2 hours, that going out to eat will be a minefield of judge-y waitstaff who sigh and look less than enthused that another special dietary requirements person has made their day more difficult, or dealing with well-meaning relatives who ask again and again and again, “so, what CAN you eat?” followed by them baking you “treats” or buying you products that might make you sick, because they don’t quite get it.
This is for you, so that you understand the severity of your issues, understand what’s happening in your body and work out where you sit within this confusing spectrum
Firstly, we’re going to talk a little bit about your immune system, as you have probably seen lots of terms relating to the immune system which are confusing.
Immune System: Your immune system is your body’s defence against invaders.
Your immune system checks everything that’s coming in, and decides if it is harmful or not. If it IS, it sets off reactions in your body to help fight the harmful invader. The organs involved in the immune system are: the thymus (a gland behind your breastbone/sternum, between your lungs), the spleen (under your ribcage, to the left, above your stomach), the lymph nodes (all over!) and lymph tissue (some of which is found in your gut!), plus a bunch of cells and proteins who all have a specific job to do.
Immunoglobulins (shortened to Ig, because it’s annoying to type), also called ANTIBODIES
- these wonderful proteins can attach to foreign substances, like bacteria, and help destroy them. There are 5 types of immunoglobulins: IgE, IgA, IgG, IgM, IgD.
IgE - This is the antibody mainly responsible for the ol’ “inappropriate immune response” you may have heard about. This doesn’t mean that your immune system stands on a hilltop in a thunderstorm wearing wet copper armour shouting, “All gods are bastards!”* - although it sometimes feels as though that’s what’s happening in your body.
In a non-allergic person, IgE is generally pretty chill, and the jury is still out on what it exactly does, but it is thought to help when people are infected with various parasites and ticks, among other things.
In an allergic person, IgE is produced to defend against something that is harmless to a non-allergic person - cow’s milk, shellfish, peanuts, tree nuts, soy, wheat, for example.
For the allergy to be discovered, exposure has to occur first. So, as the food is being digested, your immune system senses an invader, and overreacts to try to protect you. Cells all over the place are suddenly producing IgE in large amounts - much larger than normal. The IgE antibodies are then released into your body, and immediately run to the nearest mast or basophil cell, where they cling like a terrified toddler, attaching themselves to the cells and not letting go.
Often, the first time you ingest the food, there is no immune response; instead, the IgE, antibodies hugging the basophil/mast cells are simply sensitised, lying in wait, ready for the next time they come into contact with that particular food.
Sometimes, the immune response takes place then and there, where the IgE yell at the cells to release their chemicals. The cells do what they’re told, and chemicals are released, causing swelling or inflammation wherever they are. Then, it is pretty much the wildebeest stampede scene in The Lion King.
A huge cascade of reactions occur within your body which continue to irritate and harm tissues. These reactions range from mild to severe, typically occurring in the nose, throat, lungs, skin or gastrointestinal tract.
These specific IgE are now bound to your mast and basophil cells, and are feeling very happy with themselves that they have protected you from an invader. :)
Either way, if an allergic reaction occurs the first time you eat the food or not, if/when you do eat the food again, the allergic response will be swift.
IgA - Not to be confused with the grocery chain. These antibodies are found in serum and secretions such as saliva, tears, and sweat, as well as in the gastrointestinal, respiratory, and genitourinary tracts. They help protect our mucous membranes (the lining of our organs).
IgG - Found in all body fluids - They are the smallest but most common antibodies (75 - 80%) in the body. IgG antibodies are very important in fighting bacterial and viral infections. They are also the only antibody that can cross the placenta to help the fetus. An IgG blood test canNOT tell if you have an allergy.
IgM - These are found in blood and lymph fluid, and are the first type of antibody produced in response to an infection.
IgD - no-one knows what they do, yet.
Now that that’s out of the way, we can get down to business.
An inappropriate immune response (hurhurhur) to a usually harmless substance. An allergy involves your immune system. Intolerances and Sensitivities do not. The most common food allergies are milk, eggs, peanuts, tree nuts, shellfish, fish, wheat and soy, but there are lots of other foods that can cause allergies as well.
An allergic response usually occurs within the first 2 hours of ingesting the food. In some very rare cases, where the allergy is not mediated by the IgE protein, the reaction may be delayed by 4-6 hours. This is most typical of kids who develop eczema as a food allergy symptom. Another type of delayed reaction is seen in a syndrome known as FPIES (food protein-induced enterocolitis syndrome), which usually occurs in babies and is a severe gastrointestinal reaction.
Symptoms of a food allergy are:
Vomiting and/or stomach cramps
Shortness of breath
Shock or circulatory collapse
Tight, hoarse throat; trouble swallowing
Swelling of the tongue, affecting the ability to talk or breathe
Pale or blue colouring of skin
Dizziness or feeling faint
Anaphylaxis - a life threatening response where your immune system, in a misguided attempt to stop you from ingesting any more of the allergen, can send your body into shock and stop you from breathing.
If you have an allergy, please avoid the foods you are allergic to.
Please do not feel bad or feel that you are an inconvenience when going out to dinner or going to a friend’s for lunch.
Please tell people about your allergy. There is no point in making yourself sick just to be less of a hassle for other people. SIDE NOTE: I personally once ate chicken and mushroom risotto just so that my friend’s parents wouldn’t be inconvenienced. I am allergic to mushrooms. It was not a fun night.
Food intolerance means you do not have the particular chemical (called an enzyme) needed to digest a certain food.
For example, being lactose intolerant: Lactose is the sugar in milk and milk products. Lactase is a naturally occurring enzyme in our bodies which helps break lactose down. In a lactose intolerant person, there is not enough lactase to go around, so undigested lactose sits in your gut, being gradually broken down by bacteria, causing bloating, stomach cramps, diarrhea, etc.
An intolerance does not involve the immune system and an allergic, inflammatory response. The main symptoms of most intolerances are gastrointestinal in nature - bloating, cramps, diarrhea, constipation, gas, etc. This does not mean it is not as serious as an allergy. While it may not be life threatening, it is quality-of-life threatening, and can result in a lot of pain and misery, particularly when undiagnosed (especially being an undiagnosed lactose intolerant person on a tour of a cheese factory).
Some people lump intolerances and sensitivities together, but the latest research indicates a separate mechanism is at work. A sensitivity does not involve the immune system, and yet symptoms are not limited to the gut, unlike an intolerance.
Symptoms of a food sensitivity vary hugely between individuals, and can affect the entire body, causing things like headaches, mood swings, “brain fog”, gastrointestinal issues, etc.
If you can tolerate small amounts of the particular food you know/suspect is causing you problems, or tolerate it if it’s prepared a certain way, you likely have a sensitivity and not an allergy or intolerance.
Coeliac disease is somewhere between an allergy and an intolerance on the spectrum. It is an autoimmune disease, involving the immune system, but it is also the lack of ability to digest gluten, a protein found in wheat, barley and rye. When a person with coeliac disease eats gluten, their immune system begins attacking their body (far out immune system can you just calm down for 2 seconds?). This damages the person’s villi - the tiny, nutrient-loving, finger-like projections that hang out in the small intestine, where most digestion and absorption take place. Poor little villi :( Because of this damage, it is very difficult for absorption to take place, meaning people with undiagnosed/untreated coeliac disease cannot absorb nutrients they need, and can become seriously unwell.
Diagnosis of coeliac disease is usually done via biopsy (where they take a few tiny pieces of your gut lining and look at it under a microscope), sometimes after a blood test which shows a genetic predisposition to the disease. Coeliac disease is different to non-coeliac gluten sensitivity, which is a sensitivity to the gluten protein, without the damage to the intestinal lining. Symptoms can be similar, however, which is why many people with gluten sensitivity think they have coeliac disease at first.
WIth coeliac disease, it’s important to remember it comes with a higher risk of developing bowel cancer, so regular bowel screenings are a must. Sorry guys, but you are probably going to become very familiar with BOWEL PREP.
BUT! IT’S NOT ALL BAD NEWS! After coeliac disease has been diagnosed and the person is avoiding gluten, the gut can begin to repair itself.
During this time, many coeliacs have to avoid other foods, such as dairy, to avoid nasty symptoms. This is because the damage to the intestines is so severe that it cannot absorb nutrients from large proteins (such as dairy) that take a while to break down. So, if you are a newly diagnosed coeliac, please take care of yourself as your gut recovers - which it can, with the proper diet! (No milkshakes for a while you gaiz, soz babez!)
Why does all this matter?
So that you can look after yourself. So that you can explain what exactly you suffer from and describe your needs accurately. Please do not ever feel that you are an inconvenience. Just like us here at Noshable, along with millions of people around the world, you’re a person who needs to eat different things - that’s all. (And maybe a person with an immune system that occasionally takes off all its clothes and goes dancing in the street - but that just keeps life interesting.)
*…stands on a hilltop in a thunderstorm wearing wet copper armour shouting, “All gods are bastards!” - Quote from Terry Pratchett, The Colour of Magic
Coeliac Disease: An Inappropriate Immune Response
Difference between wheat allergy, coeliac disease, gluten sensitivity:
Difference between food allergy and intolerance:
Allergic reactions overview:
How allergic reactions work: