Allergy or Sensitivity? The Answer Could Save Your Life
Name It Right: Sensitivity or True Allergy
A sensitivity, as opposed to an allergy, happens gradually and isn’t life-threatening.
For instance, if your stomach aches and you cramp up after eating a pint of ice cream, but feel fine when you eat cheese on your sandwich, then you may have lactose sensitivity. More , called intolerances, occur when the body lacks a particular enzyme for digestion (such as in celiac disease). But intolerances are not life-threatening.
In contrast, a true allergy can trigger anaphylaxis, a potentially life-threatening reaction by your immune system that causes the body to go into shock.
The most common cases of true allergic reactions I see in my Lexington emergency department involve tree nuts, insect stings, or medications. Again, people are often confused about whether they have a sensitivityto a medication or a true allergy.
For instance, one commonly reported medication allergy is an allergy to penicillin. In reality, however, doctors are finding that more people have sensitivities to medications like penicillin than true allergies. Someone who is truly allergic to penicillin generally reacts immediately or within a few hours after a dose, with symptoms that range from mild wheezing to anaphylaxis.
For others, symptoms such as rashes or gastrointestinal complaints (heartburn, indigestion, bloating, etc.) may appear quickly or several days after they begin penicillin. These people could probably benefit from penicillin and may be able to tolerate most of these relatively mild adverse reactions.
But they often assume, and inform their doctor, that these symptoms mean they are allergic to penicillin. Unfortunately, as more people report such medication sensitivities incorrectly, doctors are forced to prescribe stronger — and often more expensive — alternatives.
Confusion About Allergies Can Kill
One day, an attorney came into my emergency room. He looked severely sick and was wheezing. He reported taking ibuprofen prior to arrival because he was sore from helping his son move into a dorm at the University of Kentucky. Soon after he told me his story, his condition worsened and it was clear he was experiencing anaphylaxis.
Although my patient later revealed that his doctor told him that he had a true allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), taking ibuprofen hadn’t caused him problems in the past and he didn’t think it would be a risk. Turned out that was a life-threatening decision on his part.
True allergies start with an antibody called immunoglobulin E, or IgE, that is released into your body when triggered by something it doesn’t like — in my patient's case, ibuprofen. IgE binds to allergens and triggers an allergic response to any substance it sees as foreign. Often, the reaction isn’t severe the first time, as was probably the case for my patient. But the next time this man took ibuprofen, these stored IgE molecules mounted a strong response that led to his visit to our ER.
Do You Need Allergy Testing?
If you have a history of allergies or if your nonallergic adverse reactions don’t improve, you may benefit from allergy testing. To identify true allergies, sensitivities, or intolerances, your physician may perform blood or skin-prick testing.
For suspected food allergies, there are also doctor-supervised food challenges in which you're given small doses of suspect foods to measure your reaction, or food elimination diets in which you keep a food diary for weeks, and strategically stop eating suspect foods. The results, combined with an analysis of your history, can help determine what you’re allergic to, and lead to effective treatment plan.
If you experience a reaction that includes hives, itching, fever, swelling, wheezing, or shortness of breath within one hour of taking a medication or eating, call 911.
Always listen to your physician and comply with the directions for medications you are prescribed. Your physician will help ensure that your meds are safe and appropriate.
Jeremy J. Corbett, M.D.,is the chief health officer of Nurtur Health — a behavior-change company with wellness and health coaching programs that focus on overcoming life barriers to improve health outcomes. In addition to his expertise in Nurtur’s specialties, such as preventive care, shared decision-making, chronic health conditions, and telemedicine, Dr. Corbett is a practicing emergency room physician in Lexington, Kentucky, where he lives with his wife and three children.
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