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Girl cooking in a kitchen
Community, Inside scoop, Learning 3 minute read

Ask the expert: Dr. Amanda Cox on understanding food allergies and intolerances

By American Girl Feb. 15, 2019

What if you found out you couldn’t eat your favorite things anymore? That’s what happens to our 2019 Girl of the Year®, Blaire Wilson™, when she finds out she has lactose intolerance. Blaire feels excluded when her friends drink milkshakes and eat nachos in front of her—even though they don’t mean to make her feel that way.


In developing Blaire’s stories, our editors worked closely with a panel of experts to create an authentic and accurate picture of the challenges she faces. We asked advisory board member Dr. Amanda Cox, assistant professor of pediatrics in the Division of Pediatric Allergy and Immunology at Mount Sinai Health System, to share her decade of knowledge of childhood allergies.

What exactly is a food allergy?

A food allergy involves special antibodies, called “Immunoglobulin E,” that specifically recognize and bind to certain foods. These antibodies are responsible for starting a cascade of allergic symptoms during an allergic reaction. When a person eats or touches a food they are allergic to, even in tiny amounts, they may have hives, itchiness, or swelling. They may vomit, cough, or even pass out. This can quickly become a medical emergency—which is why some people carry self-injectible epinephrine, a medication that can reverse severe reactions.

Here in the United States, the most common food allergies in children are to milk, eggs, soy, wheat, peanuts, tree nuts, and sesame. This is why many schools now ask parents not to pack snacks with allergens in them. Some schools set up “allergy-free” lunch tables to keep kids with allergies safe. There is no cure for food allergies, so people who live with them must be extra-careful about what they eat.

How is food intolerance different from an allergy? Is it dangerous?

When someone has a food intolerance, it’s because of the way their body digests it, not an immune system reaction. A food intolerance is generally not dangerous. The symptoms of a food intolerance can include gassiness, belly bloating and pain, and sometimes diarrhea or vomiting after eating. The character Blaire Wilson has lactose intolerance. Her body cannot easily digest lactose, a natural sugar found in milk. Because of this, if she eats a bowl of ice cream, drinks a full glass of milk, or has a slice of cheese pizza, Blaire gets an upset stomach, but she won’t have to rush to the hospital. Lactose intolerance is very common in adults, but less common in children, so she doesn’t know anyone else who has to avoid dairy, and that might make her feel left out. Living with lactose intolerance means she has to make changes to the way she eats to prevent bloating, diarrhea, stomach cramping, or vomiting. But if Blaire were accidentally exposed to a little bit of milk, it would not cause a medical emergency.

So, it sounds like there’s a big difference between the two. What should parents know?

A true food allergy makes the body’s immune system react—this is the system that fights germs and keeps us healthy. On the other hand, a food intolerance is generally less serious, and often means digestive problems. Food intolerance can be caused by the absence of an enzyme in the digestive system, Celiac disease, sensitivity to food additives, and other issues. If you have lactose intolerance, you may still be able to eat lactose-free cheeses or ice creams without issue. It is essential to talk with your doctor if you’re worried about a food intolerance or allergy.

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