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The last thing a person wants after enjoying a meal is to break out in rashes or rush to the toilet feeling queasy. This could happen if the person suffers from either food allergy or food intolerance. In Singapore, a small but significant number of individuals do suffer from food allergies and food intolerance. Therefore, if you have experience the same symptoms after having something, it is sometimes wise to be more aware of the food you eat.

Food allergy

A food allergy is any adverse reaction to a food or food component that involves the body s immune system. Reactions to food allergies can be mild like skin rashes, or severe, like anaphylactic shock that can even cause death. The top eight common food allergens identified are eggs, milk, soy, peanuts, tree nuts, crustaceans (for example crabs and prawns), fish, and grains such as wheat, oat and barley.

Food intolerance

Food intolerance does not involve the immune system and are usually not life threatening. Some of these reactions are caused by an inability to digest a particular food. Common food intolerance are for lactose and gluten. Some sensitive individuals also react to food additives and components.

If you have a food allergy, you will suffer a reaction even if you consume a small portion of the food you are allergic to. If your reaction is more of intolerance, you may be able to tolerate small amounts of the offending food without a reaction.

Coping with food sensitivities

If you or a close family member suffers from a food reaction, you will know how distressing it can be especially when the trigger is not identified. An accurate diagnosis is very helpful in avoiding the discomfort and risks. It will also help the sufferer to eat a more balanced diet and enjoy a variety of other food without fear.

For a proper diagnosis of your food reaction, you must see a qualified medical doctor as it requires skill to pinpoint the cause of a food reaction and make a clear distinction between food allergy and food intolerance.

The specialist will conduct a comprehensive history (including the review of a detailed food diary), physical examination, and order several tests such as skin tests, blood tests such as the measurement of blood counts and total IgE, pulmonary function tests and others, as needed. After the tests, the specialist will offer the diagnosis and treatment plan, answer any questions and arrange follow-up.

Some of the simple but effective strategies to cope with food reactions are as follows:

1. Avoid allergens

   Since true allergies involve the immune system and can trigger severe reactions, it is best to avoid any food or ingredient that causes allergy. With accurate diagnosis and a strict exclusion diet, individuals with food allergies can cope pretty well with life. To prevent unnecessary food exclusion, careful food challenges can be conducted under the supervision of a qualified medical practitioner, to confirm food allergies.

   As food allergies last a lifetime, it is important to replace the potential food allergen with a nutritionally equivalent substitute. This is particularly important in the diet of individuals who are allergic to many food.

2. Lactose intolerance

   Lactose is a sugar found in milk, and all healthy babies produce an enzyme known as lactase to help digest lactose. For the majority of Asian people, our bodies naturally stop producing lactase as we grow up, a condition known as lactase non-persistence. People with lactase non-persistence can still drink milk without suffering symptoms of intolerance.

   Individuals with lactose intolerance will suffer from flatulence, stomach cramps, bloating, discomfort and diarrhoea.

   Here are some simple ways to help those who want to drink milk:

   • Continue to consume milk and dairy products beyond the age of 2 years. This will help the friendly bacteria in the large intestine to adapt and breakdown milk sugars, relieving you of stomach pain and diarrhoea when you consume a small amount of lactose.
   • Have milk and other dairy products with other food (e.g. milk with cereal).
   • Select fermented dairy products (e.g. yoghurt or cheese) as the lactose content of these products is lower than that in milk.
   • Have milk in small quantities. Drinking half a cup (125 ml) or less at a time will help to reduce symptoms of lactose intolerance as you may have enough of the enzyme in your gut to help you break down the milk sugar in this small portion.

   If you do avoid milk and milk products, then be careful to include other calcium-rich food such as fish with edible bones, soybean curd, green leafy vegetables and other calcium-fortified food.

3. Wheat intolerance

   Some people react to wheat or to just the protein in wheat called gluten. If you are sensitive to or intolerant of wheat, then avoid the grain. But this is easier said than done as wheat is incorporated into a variety of everyday food such as bread, biscuits, cakes, pastries and a variety of noodles including, yellow noodle. To prevent a reaction, try to identify which of the food that you eat regularly contain wheat and avoid these.

   Gluten intolerance is even more difficult to manage as gluten is found in a variety of grains wheat, oats, rye and barley. Eliminating all these food may make meal planning difficult. Switching to rice-based products is helpful. Some supermarkets in Singapore do carry a range of gluten-free products that may make the diet less monotonous.

4. Other food insensitivities

   Every individual is different. Some react to food additives and others to natural components in food such as caffeine. The best way to tract the offending food down is to keep a detailed food and symptom diary. Careful observation can provide some clues. Try an elimination diet to check for symptom relief. Confirm the suspicion by challenging yourself with a standard portion. Resurgence of the symptoms will help you confirm the food you cannot tolerate.

Selecting food

1. Buying food - Read food labels

   The best way to identify offending ingredients in food is to read the ingredient list. You may need to carry a magnifying glass to read the fine print. But, because of the intense discomfort you suffer after eating the offending food, you need to study the list carefully to check out if the packaged food included the trigger. If it does, avoid the food.

2. Eating out Give clear and specific instructions

   Eating out is one of the pleasures of life. But, eating out when you have a food allergy or food intolerance makes it a risky affair. If you still do want to eat out, give clear and specific instruction on what you cannot eat. Confirm that you can finally eat the dish placed before you by double-checking that the dish does not include offending ingredients. Always carry your injectible anti-allergy shot. Always inform your accompanying dinner partner or family member about how to use it correctly.