Food intolerance symptoms can be slow to develop and hard to recognise. How can community pharmacies help customers get the right diagnosis for a food intolerance or allergy and help them to manage their newly recommended diet properly?

Food allergies are quite rare, with about 5 to 8 per cent of young children and 3 to 4 per cent of adults affected. Food intolerances, on the other hand, are more common. Allergy UK says up to one in five of people is affected by lactose intolerance, for example, and an increasing number of people are following gluten-free diets, with gluten-free foods accounting for 47 per cent of the free-from market, says market analyst Mintel. A YouGov survey published in September shows that as many as one in three households has at least one allergy or intolerance sufferer.

If your customer suspects a food allergy or intolerance, they will want your advice. ‘It’s important for your customers to get a proper diagnosis as they could be putting themselves at risk by continuing to eat foods they may be allergic to. If they have an intolerance this will affect their quality of life if not diagnosed properly,’ says Dr Adam Fox, consultant paediatric allergist at Guy’s & St Thomas’ hospital. ‘While the most common food allergies to milk and eggs are usually outgrown, other food allergies, such as nuts and many food intolerances are not.’

Allergy or intolerance?

‘The main difference between a food allergy and food intolerance is that an allergy involves the immune system and an intolerance doesn’t,’ explains Dr Fox.

A food allergy is a reaction involving the immune system when it meets a normally harmless substance, such as milk, and produces antibodies to fight off the allergen. This then releases histamine, which triggers the symptoms of an allergic reaction: tingling lips and tongue, rash, wheezing and hives. In extreme cases it can trigger an anaphylactic reaction – swelling of the tongue and face, shortness of breath and loss of consciousness. An allergic reaction to a food usually happens quickly, sometimes in minutes, but usually within one to two hours.

A food intolerance isn’t life threatening and is harder to spot, but can make sufferers very unwell. It doesn’t involve the immune system and reactions are slow – it may take a few days after eating the affected food. Food intolerance can be due to lack of enzymes needed to break foods down, such as lactose intolerance, or a reaction to chemicals in foods, such as histamine or sulphates. It may also be caused by lifestyle factors, including erratic eating patterns, insufficient fibre or a high-fat diet. Symptoms include bloating, diarrhoea, constipation, IBS, skin problems, lethargy and headaches.

Testing for food intolerance

‘There is no scientifically proven, reliable test for food intolerance. The only thing that works is an elimination diet to find out which foods a customer reacts to,’ says Maureen Jenkins at Allergy UK. ‘If a customer has a food intolerance, they won’t necessarily always have it – it is possible to be intolerant to certain foods for a while, then be able to eat them again, especially if it was brought on by illness or medication. But it’s important for customers to get proper advice and a diagnosis from a professional.’

Allergy UK advises customers to use a food and symptoms diary (sheets can be downloaded from www.allergyuk.org) for at least two weeks before they book an appointment with their GP. ‘Advise customers to follow their normal diet when they do this – they shouldn’t be changing anything yet,’ says Ms Jenkins. The food and symptoms sheets should then be analysed by a dietician, who will then advise on which foods to cut out and give suitable alternatives to ensure they can still follow a balanced diet. The exclusion of certain foods is then followed by the structured reintroduction of foods one by one, alongside continuing with the food diary sheets. This should then identify the problem foods.

How pharmacy staff can help

• Encourage sensible diagnosis, not selftesting,’ says paediatric allergist Dr Fox
• ‘Probiotics, taken alongside food elimination, could help to rebalance gut flora, keep the gut lining healthy and encourage digestive enzyme production,’ says Natalie Lamb, technical advisor at Probiotics International ‘If a customer comes in with chronic digestive symptoms, raise the possibility of food allergy or intolerance with them,’ says Dr Fox
• ‘Point your customers towards allergy services such as Allergy UK for advice. Suggest they fill in food and symptoms sheets from the website before seeing their GP and discourage them from buying self-diagnosis tests,’ says Ms Jenkins
• ‘Education is something you can help with – talk to them about foods they can and can’t eat,’ says Dr Fox
• ‘It would be helpful if pharmacy staff have an in-depth understanding of the different types formula milk. Parents really struggle with this if they have a baby with either a cow’s milk allergy or lactose intolerance,’ says Dr Fox.

Changes to labelling

A new EU Regulation on food labelling, which came into effect on 13 December, should make it easier for your customers to follow a free-from diet outside the home. The new rules mean that all food businesses, including restaurants, cafés, deli counters and sandwich bars have to inform customers if any of 14 allergens are included in the ingredients in the food they serve, either on the packaging, the menu or by word of mouth.

Category campaigns

Probiotics International has launched a winter wellness campaign to support its Bio-Kult product. It includes educational material for independent pharmacies, including posters and leaflets. A team of nutritional therapists is available for staff training.

Juvela has a range of resources for pharmacists to share with their coeliac customers. This includes a patient guide to gluten-free foods available from the pharmacy and a Juvela product guide. Pharmacists who would like a free Juvela pharmacy resource pack can email hcp@juvela.co.uk, quoting P3.

One in four adults have eaten or bought freefrom foods in the last six months, peaking among the under 35’s and 13 per cent of adults have bought gluten-free food. By 2018, Mintel says it expects the market to have grown by 47 per cent to £538 million.

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