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Food Allergies and Intolerances: What's What?

          What is a food allergy and how do they manifest?  An allergic reaction is caused by the interaction between an antigen (a food) and your immune system.  Reactions can range from very mild (runny nose, headache, sleepiness) to more severe (joint pain, fatigue, diarrhea) to very severe or anaphylaxis (throat closure).  When a reaction happens immediately after eating a food it is very easily detected.  We all know someone who has this reaction to peanuts, eggs, or dairy.  This immediate reaction is known as an IgE reaction and can be detected with a blood test.  Many people who have this type of reaction will carry an “epi-pen” in case they have contact with the offending food. But the more common food allergies are much harder to detect and are often “hidden” because the reactions are less severe and may occur for up to 72 hours after eating the food.  These are delayed reactions and are called IgG allergies. These are often foods that are eaten daily and are most often foods that are craved or are “addicted” to.  Whenever I hear someone say “I can’t live without…” red flags immediately go up in my head that this is likely a problematic food.

           Hidden food allergies can often be the cause of such chronic complaints as joint and muscle pain, irritable bowel syndrome (IBS), fatigue, depression, headache, eczema, and ADHD symptoms.  While blood tests can identify actual immune-mediated IgE or IgG reactions, many people experience intolerance reactions to food that do not show up on blood tests.  It should be noted that effective September 21, 2012, New York State will no longer allow IgG food testing.  These intolerances can be the most frustrating for people. They think they may be sensitive to a certain food, have food sensitivity testing, and the results are negative.  People are then confused.  They think they are sensitive but all testing is negative.  There is a reason for this.  Food intolerances are often delayed reactions; therefore, blood or skin tests for food allergens may only partially clarify whether there is a reaction to an offending food or sometimes not at all.  In the end though, the goal is to identify the problem food; it’s less important if the reaction is an IgG immune reaction or an intolerance reaction. 

           Perhaps the most reliable method for identifying problem foods is to follow an elimination diet followed by reintroduction of the food. What is an elimination diet?  It is a diet that avoids the most common allergic foods while still allowing a wide variety of foods unlikely to cause a reaction.  The most likely foods that cause reactions are: dairy, gluten (wheat, rye, barley, kamut, spelt), corn, eggs, soy, oranges, peanuts, shellfish, refined sugars, alcohol, and caffeinated beverages. Also eliminated is any food a person craves or eats more than three times per week.  The nightshade family (eggplant, potato, tomato, and peppers) can also be eliminated for those with arthritic symptoms.  These foods are eliminated for 28 days.

           Once started on an elimination diet, there may be an initial period of “withdrawal” during which symptoms may actually worsen (especially with caffeinated beverages). During allergic reactions, the body may actually produce narcotic-like substances which cause more craving to the food.  For the first three days a person may think continuously about the food.  They may have cravings, headaches, bloating, fatigue, or aches and pains.  After three days, these symptoms reside and there is a gradual improvement in symptoms. 
A record of symptoms should be kept for the 28 days.  Then each food is reintroduced individually at three day intervals.  Upon reintroduction, an offending food should elicit a return of symptoms, often worse than before. Careful record keeping is important when reintroducing or “challenging” foods after the 28 day elimination diet.  Waiting three days before adding a new food allows for a delayed reaction.

           Although it can be tedious and time consuming, an elimination diet is the best tool there is for detecting hidden food intolerances (sensitivities).  After two to three months of eliminating the offense foods many symptoms such as headache, bloating, fatigue, etc. may have disappeared.


Barb Goshorn, BS MSACN works in private practice as a nutritionist in Webster.  She sees many clients for food related sensitivities.  She uses applied kinesiology to help determine food intolerances and sensitivities.

References:
Gaby, AR. The role of hidden food allergy/intolerances in chronic disease. Altern Med Rev. 1998;3(2):90-100.
Nsouli TM, et al. Role of food allergy in serious otitis media. Ann Allergy. 1994;73(3):215-219.
Zar S, Kumer D. Role of food hypersensitivity in irritable bowel syndrome. Minerva Med. 2002;93(5):403-412.
Olendzka-Rzepecka E, Kaczmarski M, Lebensztejn D. Therapeutic effectiveness of treatment of an elimination diet in children with atopic dermatitis of different ages. Rocz Akad Med Bialymst. 1995;40(3):602-606.
Anderson, JA. Food allergy and intolerance. ASDC J Dent Child. 1985;52(2):134-137.
Sicherer Sh. Food allergy: when and how to perform oral food challenges. Ped Allergy Immunol. 1999;10(4):226-234.

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