Almost daily I am reminded that we do not always have to rely on the latest technical interventions to significantly enhance our enjoyment of optimal health. Very often only the ‘basics’ are needed. Diet, exercise, adequate rest, optimal nutrition and attitude are all that may be required. The augmentative role of medical procedures, prescription medicines, and nutraceuticals are often essential, but they ultimately never replace the simple strategies. One such contribution is the role of food allergies and sensitivities. To be clear, this type of allergy is not related to anaphylactic type allergic reactions that can occur in some individuals. For many there are foods that, for various reasons, we do not tolerate. Exposures can often contribute to chronic inflammation, immune dysfunction, poor cellular function, and impaired cellular regeneration. The standard allergy evaluation, would frequently involve a provocation(skin prick) test. In this testing methodology a standardized low dose food antigen is injected into the skin to gauge the degree of allergic reaction as evidenced by a raised inflammatory ‘wheal’. This type of test classically measures the IgE food reactions. However, this may only represent a small percentage of the typical food reactions. Many experts in the field have argued that almost 80% of food sensitivities are mediated by a different subset of the immune system called IgG. The standard IgE reaction could be more representative of sensitivities that can lead to anaphylaxis or more typical allergic responses. A common example would be a child with a peanut allergy who develops throat swelling and shortness of breath following ingestion. This type of reaction mostly is mediated by the IgE subset of proteins in the immune system. The food allergy blood test most often measures the IgG fraction of immune reactions. I have consistently observed a correlation between foods to which people have measured sensitivity and overall improvements in health achieved through dietary modification. Oddly IgG food testing is not generally supported by most official forums of allergy experts. This includes the European Academy of Allergy and Clinical Immunology, the American Academy of Allergy, Asthma, and Immunology, or even its Canadian counterpart, the Canadian Society for Allergy and Clinical Immunology. The apparent reasoning is that it is not possible to use serum antibodies to diagnose food allergy. The qualification elucidated by the American Academy of Allergy, Asthma, and Immunology, is that to make a specific diagnosis requires a medical history and possible challenge testing. Clinically, I would agree. The implicit inclusion of challenge testing, in my observation, would not always be necessary. The favorable clinical response, in my humble opinion, can be the best diagnostic evidence. For example, wheat allergy often gets a lot of press these days as particularly villainous. While it does not affect everyone, some people do clearly have substantial sensitivity. In cases I have observed in individual patients with a myriad of symptoms, and an elevated IgG blood test to wheat(or gluten) often improve dramatically just by removing the measured offending agent from their diet. Their symptoms of improvement are often unique to the individual. Examples can include a decrease in headaches and migraines, weight loss, enhanced metabolism, enhanced functioning of the immune system, less GI disturbance, diminished irritable bowel syndrome, a decrease in inflammation and joint pain, and improved neurocognitive function. Improvements such as these are not uncommon and it is therefore not surprising that in the last several years we have seen many restaurants offering gluten free menus. Similarly and many books such as, Wheat Belly and Grain Brain, have risen to best seller status.
Followup testing in 2-6 months often shows consistent improvement. As a matter of fact, in the many years I have been ordering these tests for patients, it is rare that a given patient did not improve clinically. Their lab tests demonstrated consistent improvement as well. One challenge I observed in understanding food allergies for many individuals is the variation on a theme of the reactions and how they manifest in a given person. Food allergies can often be associated with ongoing fatigue, mental focusing difficulties, attention deficit disorder, chronic irritable bowel syndrome, chronic infections, chronic inflammation, joint pain, and even hormone imbalance. Identifying these food allergies and sensitivities can often improve these issues substantially. The interpretation can be varied as well. In my experience, some particular types of food reactions, even though they might measure low on a blood test, might have significant impact on the body. In my experience those tend to be wheat and gluten, milk, eggs, nightshade family plants, citrus, soy, and some cheeses. For example, a given individual might have a lower 1 or 2+ reaction to cow’s milk and a 3 or 4+ reaction to almonds. However they might not notice any particular adverse symptoms consuming almonds, and yet have significant responses to milk consumption. (GI bloating, irritable bowel symptoms, and sinus congestion). There can be a broad diversity of reactions each of the foods can have in a given individual. Interestingly, sometimes various foods, of different origins, can have a significant systemic effect as well. For example, I have seen individuals who react to milk on a food allergy panel. They can have adverse reactions with milk purchased at the local supermarket, but have minimal reactions with an organic milk from the local farmer’s market. The differences can be related to product processing or even potentially the adherence to the casein of molecule dissimilar molecules such as pesticides, herbicides, other farm chemicals, or even microorganisms. Such alteration of the original molecule can create unique structures that are even more immune-reactive. Therefore the results on a food allergy test do require some trial and experimentation. Strong reactions, when avoided, over time, can eventually develop varying degrees of tolerance. Paradoxically a low measured reaction can sometimes be found to be much more problematic than assumed. Common examples in my observation are some fruits and also condiments such as black pepper.
