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[6 min read] Managing food allergies & intolerances in primary care

Did you know that two per cent of Australian adults live with food allergies? Allergies and intolerances have been on the rise for several decades and has become a significant public health issue (1).

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Some food allergies can be severe, causing life threatening reactions known as anaphylaxis. Primary care physicians and dietitians play a key role in the clinical diagnosis, education, and treatment of patients who present with allergies and related issues (2).

What are allergies?

A food allergy involves the immune system and happens when the body reacts to a protein in specific foods, which are usually harmless. Reactions are usually immediate and can occur after being exposed to very small amounts of the food.

Symptoms of an allergic reaction manifest in many ways, with more severe reactions including difficulty breathing, vomiting, hives and swelling and/or anaphylactic shock, sometimes resulting in death (3). Food allergies may also manifest as chronic eczema where the relationship with food is not always obvious.

The most common allergies include eggs, peanuts, soy, milk, wheat, fish, and shellfish (4).

What are intolerances?

Food intolerances are sometimes confused with or mislabelled as food allergies. While a food allergy induces an immune response, a food intolerance involves the digestive system and often less serious than a food allergy (5).

Many people with food intolerance can tolerate a small amount of the offending food and their symptoms are often limited to digestive issues such as bloating, constipation or diarrhoea but can include headaches, difficulty breathing, skin sensitivity, sweating and heart palpitations which are symptoms like that of an allergy (3).

An example of food intolerance is lactose intolerance, when the body does not produce enough of the enzyme lactase to properly digest lactose found in dairy products. Though food intolerances may cause great discomfort, they are not considered fatal.

Medical nutrition therapy and management

Currently the management of food allergy involves complete avoidance of the food proteins identified. Primary care physicians can offer conventional prick tests for allergies, while Accredited Practising Dietitians can advise patients on sources of food allergens, possible sources of contamination, and suitable substitute foods so that nutritional adequacy is not compromised (6).

Patients can also be referred to an allergy specialist if suffering from anaphylaxis or multiple food allergies, or if an oral challenge is to be performed.

food allergies and intolerances

– Lynette Law, Accredited Practising Dietitian

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  1. Mazzocchi A, Venter C, Maslin K, Agostoni C. The Role of Nutritional Aspects in Food Allergy: Prevention and Management. Nutrients. 2017;9(8):850.
  2. Garzon DL, Kempker T, Piel P. Primary care management of food allergy and food intolerance. Nurse Pract. 2011;36(12):34-40.
  3. Onyimba F, Crowe SE, Johnson S, Leung J. Food Allergies and Intolerances: A Clinical Approach to the Diagnosis and Management of Adverse Reactions to Food. Clinical Gastroenterology and Hepatology. 2021;19(11):2230-40.e1.
  4. Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, et al. Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy. 2008;63(3):354-9.
  5. Gargano D, Appanna R, Santonicola A, De Bartolomeis F, Stellato C, Cianferoni A, et al. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients. 2021;13(5):1638.
  6. Food allergy and intolerance. Australian Journal for General Practitioners. 2012;38:705-7.

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