Food Sensitivities Should I Be
Concerned?
Food allergy is well recognized
in the medical community as a cause of acute asthma attacks, urticaria,
swelling or anaphylaxis, and is found as a contributing factor in many cases of
eczema or chronic nasal discharge. These types of reactions can usually be
diagnosed by a thorough medical history and skin prick or IgE-radio-
allergosorbent (RAST) testing. In the strictest immunological sense, only
10-30% of food reactions involve elevation of IgE, and in the absence of such
evidence the less specific diagnosis of Food Sensitivity or Intolerance is
preferable.
Food Sensitivity/Intolerance has
been the subject of controversy for many years. Many allergists believe
that only a few people have food allergies, and they have a short list of foods
they routinely test believing to cause only a few possible easily predictable
symptoms. The foods most commonly tested include wheat, dairy, corn, soy,
chocolate, nuts, peanuts, eggs, fish, and perhaps tomatoes.
Some sources estimate the
prevalence of Food Sensitivity/Intolerance to occur in up to 60% of the
Some of the conditions found to
have an association with food sensitivities include: fatigue, migraines,
irritable bowel syndrome, inflammatory bowel disease, gallbladder disease,
arthritis, asthma, attention deficit, eczema, fibromyalgia, psoriasis,
epilepsy, otitis media, recurrent infections, mental fog, headaches, aphthous
ulcers, nasal congestion, and a myriad of gastrointestinal complaints.
From a Naturopathic perspective,
foods which are not well digested or metabolized in a particular body can
become a source of maldigestion, intestinal toxemia, dysbiosis, and chronic
irritation to body tissues. This cascade of events will then affect or
interfere with normal function of the body, and become part of the basis for
chronic illness. This makes identification of food sensitivities a first
order concern when dealing with chronic complaints.
A food-allergic person is one who has adverse IgE-dependent reactions to specific foods. The diagnosis can be made on clinical grounds alone and distinguished from other causes of food intolerance if the symptoms: (1) are immediate in onset (within one hour); (2) recur on challenge testing; (3) include apart from gastrointestinal disturbances, such features as lip swelling, itching, redness, anaphylaxis, asthma or eczema.
Delayed food allergy or
sensitivities does not appear to involve IgE antibody, but rather IgG and less
often IgM and IgA antibodies. However, moderate levels of IgG don't give
a clear clinical picture as increased levels indicate the body has been exposed
to a reactive food even though the food clinically may not cause a
problem. However IgG is significantly involved in respiratory tract
allergies, such as rhinitis, enlargement of tonsils/adenoids, chronic cough
and asthma.
Symptoms can be delayed from one
hour to 2-3 days after consumption of the offending food(s). Because of
this delay in onset of symptoms, it is often difficult to associate the use of
food with sensitivity symptoms. This is further complicated by the
tendency of people to become addicted to the foods which they are
allergic. This so-called allergy-addiction syndrome has been observed
by many clinicians and appears consistent with Selyes general adaptation
response to stress. You eat foods that cause short term relief, which
later demonstrate to be the cause of your chronic symptoms.
There are several methods for
assessing foods to which people may adversely react. However they all
have advantages and disadvantages, and there is no simple 100% reliable
clinical test available for food sensitivity testing. Identifying the
reactants that cause common symptoms is not easy because the reactions may be
due to immune-mediated reactions, intestinal enzyme deficiencies, toxins,
infections, neurological/psychological reactions or an unknown mechanism.
A comprehensive health history
and food diary is often helpful, and hidden food intolerance may at times be
easily discovered through an elimination diet. After eating a
hypoallergenic diet for a period of time chronic symptoms disappear, then as
food is reintroduced in a systematic approach the observation of symptom return
suggest intolerance. The foods most commonly associated with Intolerance
include: dairy products, wheat, eggs corn, citrus fruits, chocolate, sugar,
yeast, peanuts, soy, coffee, tea, pork, rye, beef, tomato, barley, nuts, and
seafood.
To obtain a brief description of
the tests most commonly used to try to detect food sensitivities you can
contact my office, as explanation is too cumbersome for this article.
These techniques include: Radio-Allergo-Sorbent Test (RAST), PRIST,
Radio-Allergo-Sorbent Procedure (RASP), Enzyme Linked Serum Assay (ELISA),
ELISA/ACT, Food Immune Complex Assay (FICA), Cytotoxic Testing, Sublingual
Testing, Kinesiology, Neutralization Therapy, Scratch/Skin Testing, D'Adamo
Blood Type, O.G. Carroll Test, and E.A.V. testing. Each test has its
attributes and short-comings involving accuracy, cost, reproducibility, and
ease of testing method.
Experience has shown consistent
positive affordable results with the E.A.V. testing method.
Electro-Acupuncture according to Voll (EAV) Testing has tested favorably
against conventional testing methods, is non-invasive, and provides immediate
reproducible results.
EAV is a non-invasive energetic
evaluation of a patient using a galvanometer. It has been used in
EAV has shown that acupuncture
points bear a direct relationship to a specific anatomical structure or
physiological functions of the body, a system that evolved from centuries of
Oriental acupuncture and decades of European research. In 1992, French
scientist Jean Claude Darras mapped the meridians associated with the
accupoints used in a Meridian Stress Assessment, as performed in our office
using a Bio-Meridian E.A.V. machine, the only FDA registered E.A.V. machine in
the country.
Whatever clinical techniques are used in the diagnosis of
food irritants, it is always necessary at some point to demonstrate a cause and
effect relationship between food ingestion and the provocation of
symptoms. The exclusion of the intolerant food(s) is the most effective
form of diagnosis and management making an appropriate avoidance regime
essential. Regardless of which method is used, if the offending food(s)
is/are eliminated, the patient will feel better.
Allergies, Food
Elimination Diet; Hypoallergenic Infant
Formula
Bromelain; Proteolytic Enzymes; Thymus Extract
A food allergy is defined as an abnormal immune reaction caused
by the ingestion of a food or food additive. The most dramatic form of food
allergy reaction occurs within minutes, usually in response to certain foods
such as shellfish, peanuts, or strawberries. The effects are similar to those
of a bee sting allergy, involving hives, itching, swelling in the throat, and
difficulty breathing; this immediate type of allergic reaction can be
life-threatening.
Other food allergy reactions are more delayed, causing
relatively subtle symptoms over days or weeks. 1 These include
gastrointestinal problems (constipation, diarrhea, gas, cramping, and
bloating), rashes, and headaches. However, because such delayed reactions are
relatively vague and can have other causes, it has remained a controversial
subject in medicine.
Some food allergy-like reactions do not actually involve the
immune system. These are termed food sensitivities (or food intolerance). In
most cases, the cause of such sensitivities is unknown.
Delayed-type food allergies and sensitivities might play a role
in many diseases, including asthma, attention deficit disorder,
rheumatoid arthritis, vaginal yeast infections,
canker sores, colic, ear infections, eczema, irritable bowel syndrome,
migraine headaches, psoriasis, chronic sinus
infections, ulcerative colitis, Crohn's disease, and
celiac disease. 29,64 However,
not all experts agree; practitioners of natural medicine tend to be more
enthusiastic about the food allergy theory of disease than conventional
practitioners.
Conventional treatment for immediate-type food allergy reactions
includes desensitization (allergy shots), emergency epinephrine (adrenaline)
kits for self-injection, and the antihistamine diphenhydramine (Benadryl).
Delayed-type food allergies are much more difficult to identify
and treat. Although skin and blood tests are sometimes used, their reliability
is questionable. 1016,65,66 A
particular blood test called ALCAT has shown some promise, but much more study
is necessary to establish its accuracy. 17 The double-blind food
challenge is the only truly reliable way to identify delayed-type food
allergies. This method uses some means of disguising the food, usually by
mixing it with other, non-allergenic foods. Individuals are randomly given
either the food or placebo on a number of
occasions separated by 1 or more days. Neither the physician nor the
participant knows which is real food and which is not. Evaluation of the
response can then determine whether an allergic response is really present or
not. Studies suggest that perhaps only one-third of people who believe they are
allergic to a given food actually experience an allergic reaction when they are
given it in a double-blind fashion; in addition, reactions are often milder
than individuals believe. 18,19
Although it is the most accurate way of determining food
allergies, the double-blind food challenge is still mostly used in research.
The elimination diet with food challenges (described below) is the most common
technique in use.
Another conventional approach for delayed-type food allergies is
oral cromolyn (a drug sometimes used in an inhaled form for treating asthma and
other allergic illnesses). 20 A double-blind,
placebo-controlled study of 14 children with milk and other food allergies
found that cromolyn was effective in preventing allergic reactions in 11 of 13
cases, whereas placebo was effective in only 3 of 9 cases. 21 In another
study, 32 individuals were given cromolyn one half hour before meals and at
bedtime. 22 If their food
allergy symptoms were prevented, the participants were entered into a
double-blind, placebo-controlled crossover study using cromoglycate. Of the 31
people who completed the study, 24 experienced relief of gastrointestinal
symptoms when taking cromolyn as compared to 2 when taking placebo. In
addition, systemic allergic reactions were also blocked with the cromolyn.
Unfortunately, the drug also had many side effects.
There are no well-documented natural treatments for food
allergies. The most obvious approach would be to remove known allergenic foods
from the diet. Some alternative practitioners offer lab tests to identify such
allergens. However, as described above, no lab tests have been proven accurate
for this purpose.
The elimination diet is another approach for identifying
allergenic foods. This method involves starting with a highly restricted diet
consisting only of foods that are seldom allergenic, such as rice, yams, and
turkey. If dietary restriction leads to resolution or improvement of symptoms,
foods are then reintroduced one by one to see which, if any, will trigger
reactions. 23 There is some
evidence that the elimination diet may be effective for chronic or recurrent hives; 2426 it has been
tried for many other conditions as well, including irritable bowel syndrome,
2734asthma, 35chronic ear infections, 55,56reflux esophagitis, 36 and Crohn's disease. 37,38
Still another method involves simply eliminating the most common
allergens. Cow's milk protein intolerance is thought to be the most common
childhood allergy, 39 followed by
allergies to eggs, peanuts, nuts, and fish. Some evidence indicates that use of
special hypoallergenic infant formulas rather than cow's milk formula may help
prevent eczema, urticaria, and
food-induced digestive distress. 40,41,67 In
addition, eliminating cow's milk from the diets of infants and their nursing
mothers might reduce symptoms of infantile colic, 4251 although not
all studies have found benefit. 5254
In hopes of preventing food
allergies and diseases related to them, some authorities recommend that
pregnant and breastfeeding mothers as well as their children should avoid allergenic
foods. 5761 However, it
is not clear if this method actually provides any benefit. For example, one
study evaluated 165 children at high risk of developing allergic symptoms. 62 Careful
avoidance of allergenic foods in the diets of the mothers and infants did not
reduce the later development of eczema, asthma, hay fever, or food allergy
symptoms.
Digestive enzymes such as bromelain and other proteolytic enzymes have
been proposed as a treatment for food allergies, based on the reasonable idea
that digesting offending proteins will reduce allergic reactions to them.
However, there is no real evidence as yet that they are effective against food
allergies.
Thymus extract is a
supplement derived from the thymus gland of cows. Highly preliminary evidence
suggests that by normalizing immune function, thymus extracts may be helpful
for food allergies. 63 However, there
are significant safety issues with thymus extract (see the full article for
details), and this study did not prove thymus extract to be effective.
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