Which statement best distinguishes a food intolerance from a food allergy?

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The key idea is the involvement of the immune system and how the reaction happens. A food intolerance happens through non-immune mechanisms—such as enzyme deficiencies or metabolic issues—so it isn’t IgE-mediated. Because the reaction isn’t immune-driven, it usually takes a larger amount of the offending food to provoke symptoms and these effects are typically not life-threatening. For example, lactose intolerance results from a lack of lactase, leading to bloating, gas, and diarrhea after dairy, and the symptoms tend to appear once a threshold amount is eaten.

In contrast, food allergies involve the immune system and can be triggered by very small amounts, with the potential for rapid and severe reactions. That’s why epinephrine is used for allergic reactions, not for intolerances. The other statements aren’t as accurate: one reverses the role of the immune system, and another claims intolerances are always mild, which isn’t a defining feature.