Monday, November 19, 2007

Word Games: Allergy Or Intolerance?

Let's do an informal poll (you can "vote" in the comments section). Do you use the word "allergy" when you really mean "intolerance?"

I guess we'd best define our terms. According to FAAN, a food intolerance "is an adverse food-induced reaction that does not involve the immune system. Lactose intolerance is one example of a food intolerance. A person with lactose intolerance lacks an enzyme that is needed to digest milk sugar. When the person eats milk products, symptoms such as gas, bloating, and abdominal pain may occur."

A food allergy "occurs when the immune system reacts to a certain food. The most common form of an immune system reaction occurs when the body creates immunoglobulin E (IgE) antibodies to the food. When these IgE antibodies react with the food, histamine and other chemicals (called "mediators") cause hives, asthma, or other symptoms of an allergic reaction." I am aware that there are other immune system responses, such as Eosinphilic Enteropathy, and of course conditions such as these should be considered allergy, too. IgE responses are the most common in those with food allergies, to my understanding.

I am intimately acquainted with both food allergies and food intolerances. Regular readers of my blog know that my little boy has a severe allergy to peanuts. His immune system has confused the usually harmless (and delicious!) peanut protein with Evil Body Invaders that must be destroyed immediately. That's allergy.

Now you may not know this about me (and you may not wish to!), but I have a food intolerance. Onions hate me. Which is really upsetting, because being rejected by a food is not the most self-esteem-building moment of a person's life, trust me. Oh, I loved onions: in salads, on pizza, hamburgers, wherever a little extra onion-y flavor is called for. But in my early 20s, I came to realize that this love was violently unrequited and dreadful things would happen to me upon consuming more than a bite or two. I have accepted this and moved on, and am extremely thankful that my love for garlic is mutual and everlasting.

Now way back before I really knew about food allergies, waaaaayy before I even had any kids, I would sometimes refer to my onion intolerance as an "allergy." At restaurants, usually. I learned pretty early on that if I said "Leave the onions off." then I had about a 50% chance of receiving a dish with no onions. If I said "Leave the onions off, I'm allergic." then my odds improved to about a 20% chance of an onion-laden plate. By changing the perception of the severity of an adverse reaction, I saved myself a whole lot of discomfort.

I have a lot (A WHOLE LOT) of sympathy for someone who uses the A-word in order to protect themselves from the adverse effects of their food intolerance. But I now think that it's best to call a spade a spade. An intolerance is awful, but not life-threatening. An allergy, well, you know, death and all that. And as part of my self-identified mission to Educate The World About Food Allergies, I am taking a stand on this Allergy versus Intolerance issue.

I think that overuse of the term "food allergy" may have the unintended consequences of contributing to many misperceptions about food allergies. Consider this statement from a recent Newsweek article:

"Not every rash or stomachache after lunch is an allergy . . . Allergists say a fair number of kids are being told to avoid foods they aren't allergic to. "Studies have shown that up to 25 percent of parents think their children may have a food allergy," says Dr. David Fleischer, of National Jewish Medical and Research Center in Denver, "but they've only been confirmed in about 8 percent."

I think this demonstrates why it's so important for everyone to use the correct medical terminology. People who do not have to live with food allergies day in and day out read a statement such as the one above and, because they don't live it and aren't informed about it, become skeptical. This contributes to the PB&J Wars at schools and daycares, along with the bad feelings, suspicion, accusations, and sometimes even harrassment that makes everybody crazy.

Now calling an intolerance an intolerance is not going to make the PB&J Wars disappear overnight and certainly will not eliminate the trials that come with putting food allergic kids in schools and other populated settings. But I think it will help. It will help to explain to parents of kids without allergies where some of the confusion comes from and help them see that we are not simply overanxious, overbearing parents who panic over every little thing. It will help them know that this Food Allergy Thing is a Very Big Thing, worth a little worrying about and certainly worth a little discussion about how to make a safe environment for small children who can't yet be fully responsible for keeping themselves safe.

It's a start anyway.


Anonymous said...

My 5 year-od daughter is allergic (as in "has an anaphylactic reaction") to milk and eggs. Our biggest obstacle is getting other people to understand that her allergy is not a food preference or intolerance but a life-threatening condition. Once care-givers, friends, and extended family "get" the danger, then all the safety precautions are a lot easier to handle. Because the word "allergy" seems to imply different things to different people, I have occasionally resorted to more dramatic (but truthful) explanations - saying things like, "if she drinks milk, you have about 8 minutes to call an ambulance". So I agree - when too much ice cream makes your tummy upset, please try to use the right terms, and save "allergy" for those kids and parents who really need it to keep everyone safe and healthy.

Onion free in the UK said...

I do have a strong onion intolerance. And that is how I will describe it. As a person who is allergic to wasp stings I know how serious an allergy can be. But many people assume as insultingly the anonymous poster does that food intolerance is akin to “too much ice cream makes your tummy upset”. Firstly it implies its self inflicted because the person was too greedy then that it is only a tummy upset.

Writhing in agony in a fetal position with blinding headaches, tightening chest muscles making it difficult to breathe, dizziness, cramping, diarrhea and nausea are not akin to someone indulging in too much rich food. Suffering those symptoms for a few days is very painful and while not life threatening does mean I am unable to do normal things while I am sufferering.
This attitude of “anonymous” is part of the reason people will describe it as an allergy. It does need to be taken seriously. She is part of the problem she complains about.

This mother is simply assuming only her daughter is worthy of consideration. Maybe she resents other people daring to have problems. I hope her child can avoid the allergens that could kill her. But I hope her self obsessed mother develops the a severe onion intolerance(not a dislike) then she might not be so dismissive. She might learn something about that which she is sneering at.

Anonymous said...

Call it what you want...but onions and orange juice are not a mere inconveninece to me. I have absolutely no food allergies. By that, I mean, whatever I eat is not going to put me in anaphylaxis and kill me. Drinking orange juice or eating onions, however, does a h*ll of a lot more than "upset" my "tummy." A genuine food intolerance can cause diarrhea, profuse sweating, intestinal cramping, excruciating gas pains, searing reflux and even vomiting. I'm assured by medical professionals I have neither an allergy, nor an enzyme deficiency, just a severe intolerance. Honestly, do I have to describe the possible symptoms in great detail at every restaurant, or can I just say, "please, no onions, I'm allergic" without the condemnation of someone who has to say, "Oh, YEAH? Mine is worse than YOURS!" Trust me, I really need to say it to keep myself safe and healthy.

eliSabeth said...

you're a funny lady. I truly enjoyed reading this post. I was googling, trying to figure out what it is in onions and orange juice that tries to kill me. and, while your post didn't offer the information that I was looking for, it did make me laugh and smile. :)

thank you for being you, and for sharing yourself with the world.

I am intolerant to orange juice (though I feel it's actually the other way around, as I do so love it!) and onions, as well as allergic. they make my tongue and throat swell up, which, yeah, sounds pretty devastating, but it's nothing compared to the intolerance that happens when they get to my tummy. :p

it's good to know I'm not the only one who suffers from this cruel injustice that life has chosen to bestow upon me, though. ;)

Anonymous said...

Guess what? I am ALLERGIC to onions. I really can't tolerate them either.
Any proximity to onions, cooked or raw, and I can't breathe. I have been to an allergist who gave me an epi-pen (four of them, actually) and told me to USE THEM then go immediately to the hospital. (I carry a book or crochet work with me quite often, in case I have to be at the hospital for four hours or so.)
I also carry allergy cards with me, so I can inform the wait staff and cooks at restaurants that I will die if they put onion in my food - in any form! I can't eat gravies, sauces, etc. I also can't eat anything that has touched onion. If someone touches onion for my husband's salad then makes my salad without washing their hands, I will have a reaction. (I also can't kiss my husband - or do anything else with him - if he has ingested onion.
I have often had to leave my husband sitting in a restaurant alone because someone at the next table ordered something with fragrant onions. Yes, even the smell can cause anaphylaxis!
I did not have this allergy until I became pregnant about 25 years ago. It started slowly, with just not feeling well after eating and gradually got worse and worse.
I am finding more and more people who are allergic to onion, although most seem to have gastric problems - not anaphylaxis.