If your child is complaining of feeling exhausted, has stomach cramps, a constant runny nose, mood swings, or generally isn't their usual bright self, it could be an allergy, intolerance or sensitivity. Cayman Parent sat down with Dr Cyril Alex, a gastroenterologist at Health City, Dr Glatz, an Ear, Nose and Throat doctor with a specialty in otolaryngic allergies, and two Registered Dietitians, Kristen Lomas at Seven Mile Medical Clinic, and Chad Collins at Cayman Nutrition, to try and understand what route parents can take if they suspect there is an issue.
Parents are increasingly exploring how food affects their children's health, especially when they think something isn't quite right. Many hope that an allergy or food intolerance test will reveal the answer they've been seeking, and after the test identifies the offending food, it can be removed and your child will be back to normal. However, it's often not as easy as that. Here are the reasons why and what you can do about it.
Food & Environmental Allergies
Food and environmental allergies involve the immune system reacting to a substance, whether that be something in the air, like pollen, or something that's consumed, like nuts or shellfish. If an allergy is present, the immune system reacts almost immediately (usually within two minutes to two hours), and the body will produce antibodies called immunoglobulin E (IgE).
An allergic reaction can be triggered with very small amounts of the offending substance, and the reaction is consistent if they are exposed again. Reactions include hives, swelling of the lips or face, vomiting, wheezing and in severe cases, anaphylaxis.
Common triggers are things like milk, eggs, peanuts, tree nuts, shellfish, wheat, soy or airborne allergens like pollen, mould, pet dander and dust mites.
Testing for Allergies
To test for these allergies, you have a few options: 1) a skin prick test; 2) a FRIES test (Food Protein-Induced Enterocolitis Syndrome); 3) a blood test to measure specific IgE antibodies; and 4) a supervised Oral Food Challenge test (OFC).
The 'gold standard' of all of these tests is the latter. This is because, while a blood test (specifically the IgE test) or skin prick tests can show a sensitivity, they often produce false positives, and the results are almost never repeatable. The OFC test is the only method to confirm whether a sensitised person will react to the food, making it the most accurate diagnostic tool.
Food Intolerances & Sensitivities
Intolerances and sensitivities do not involve the immune system, although when you get a bad headache they often feel like they do. A food sensitivity frequently originates from an inability to digest a certain food, often because you don't produce the enzyme needed to break down the food.
Symptoms may take hours or even days to appear, making it very hard to identify which food is causing the problem. Symptoms can include bloating, gas, diarrhoea, stomach pain, headaches, skin problems and fatigue.
Common food intolerances include:
- Lactose (due to the lack of the lactase enzyme)
- Gluten (not to be confused with coeliac disease)
- Histamine (due to an impaired ability to break down histamine in the gut)
- Alcohol or caffeine
- Tyramine (found in aged cheese, smoked foods and vinegar)
- Food additives (such as sulfites and MSG).
Testing for Intolerances & Sensitivities
Testing for lactose intolerance is very straightforward, as it's just a simple breath test. But the gold standard for all other intolerances or sensitivities is trial and error using the elimination diet.
Did you know?
A food intolerance is different to a food allergy, which causes symptoms such as itchy skin, wheezing, or swelling of the lips, face and eyes.
Every doctor and registered dietitian that we spoke to agreed that testing for food sensitivities is next to impossible. Although there are immunoglobulin G (IgG) food panel tests on the market (such as the ALCAT and MRT tests), the tests produce a high rate of false positives, since IgG antibodies are found in all healthy adults and children.
Leading organisations, such as the American Academy of Allergy, Asthma and Immunology and the NHS in England, advise that IgG tests, and all other general intolerance tests, have no scientific basis, and are not to be confused with IgE allergy tests used by gastroenterologists. Though results may not be immediate, the elimination diet is the best testing method for intolerances.
All you have to do is avoid the food that you suspect is a problem for five days, then have a day of eating the offending food. Record how you feel, and then don't eat that food for another five days. Keep a food and symptom diary to track your findings.
Other Very Useful Tests
Although the following tests are not specific for identifying food allergies, they can be very helpful in evaluating general metabolic health. As a parent, they can help uncover why you or your child might be having specific symptoms.
Standard Labs: Your GP or paediatrician can run standard labs such as testing for vitamins B and D, iron, a complete blood count (CBC), metabolic panel (BMP), lipid profile and a thyroid function test.
A SpectraCell Micronutrient Test: This is a specialised blood test that is designed to measure nutrient deficiencies. It examines the nutrient levels of 31 vitamins, minerals and amino acids inside your white blood cells. If your child has chronically low levels, your doctor or dietitian may recommend taking daily supplements.
An Organic Acids Test (OAT): This is most commonly used to explore the causes of chronic fatigue, digestive issues and suspected nutrient deficiencies. One of the standout features of the OAT is its assessment of mitochondrial markers, which are closely linked to the Krebs cycle – the body’s core energy production process. These markers help evaluate how efficiently your body converts proteins, fats and carbohydrates into usable energy.
A Genetic Methylation Test (GMT): This test analyses DNA for inherited variants which can affect how your body works. It measures your methylation of B6, B9 (folate), B12 (cobalamin), methionine, betaine, choline, zinc and magnesium. If you are not absorbing these properly from your food, then it can lead to low energy and poor detoxification. Methylation is involved in basic energy production, fat metabolism, immune responses, vascular health and cell membrane repair. It is needed to create DNA and RNA and regulate gene expression. It also works to neutralise toxins and hormones.
Advice for Parents
While food allergies and intolerances can play a significant role in your child’s health, testing is rarely a simple “quick fix”. Understanding the difference between true allergies, intolerances, sensitivities, and underlying nutritional or metabolic issues is key to finding the right support.
Work closely with qualified healthcare professionals and keep detailed symptom records. With patience, careful observation and evidence-based guidance, you can make informed decisions that support your child’s long-term wellbeing.
