Have you ever thought that perhaps you may have a food allergy? Perchance you thought, “I’ve eaten these foods before, sometimes every day, and I’ve never had a problem. Why should I consider being tested for food allergies?”

References to food allergies date back almost 100 years to 1905. Dr. Frances Hare, a British psychiatrist who practiced environmental medicine, linked certain ailments, such as Gout and Eczema, with food. He also found that when eliminating problematic foods, symptoms eventually resolve! Many pioneers have followed Dr. Hare’s path. In fact, food allergies continue to be an area of great interest today.

Foods are known to cause a variety of disturbances within the body. These disturbances arise due to different mechanisms. For example, you have most likely known someone who is unable to digest milk products. This is called lactose intolerance and occurs when the body has a deficiency or absence of the enzyme lactase. Other foods, like chocolate, have chemical substances that possess the ability to alters one’s mood. You have probably heard of chocoholics; you may even be one yourself. These are not food allergies. Food allergies are the only food-induced disturbance directly related to the immune system.

Let us speak briefly of the immune system, a marvelous and intricately complex component of the human body. Begin by envisioning your immune system as if it were a sentinel standing guard, protecting your body from foreign invaders. With allergies, the foreign invaders are called allergens. Allergens are so called because they induce an allergic reaction, or an exaggerated immune response. The sentinel has a variety of attack methods, including antibodies. Antibodies function to neutralize toxic materials and commence reactions that lead to removal of the allergens. The symptoms you experience are your body’s way of telling you about these reactions that are occurring.

The body has five different antibodies. The two most often associated with food allergies are called IgE and IgG. IgE is the antibody that binds to cells of the immune system, specifically mast cells and basophils, and consequently causes a release of histamine. Histamine then causes the capillary dilation and smooth muscle contraction that eventually result in your individualized symptom picture. IgE is fast acting and quickly leads to symptoms such as a runny nose, difficulty breathing, or hives. IgG, on the other hand, is slow acting. Symptoms can take up to three weeks to develop and are therefore sometimes referred to as delayed reactions. Furthermore, IgG can bind directly to the allergen. These antigen-antibody complexes subsequently deposit within tissues of the body and cause a myriad of symptoms, such as knee pain. Recent studies have even suggested that IgG can, at times, act in a similar fashion to IgE. [1][2][3]

Food allergies are of great concern because most people, and many practitioners, still do not attribute symptoms of poor or degenerating health to food. Without knowing the cause of the illness, the body continues to suffer.

The incidence of food allergies is widely disputed. Almost ten years ago, 10% of the United States population was estimated to be affected by immune-modulated food sensitivities.[i] The number of food allergens continues to flourish. With this growth, clinical indications are evolving into more complex symptoms.[ii] Unfortunately, food allergies are difficult to approximate due to the fluctuation of symptoms from person to person, dissimilar settings between cross samples, and different testing procedures leading to varied test results. For those of us plagued with a single symptom, a multitude of symptoms, or beleaguered with suffering, it matters not the prevalence, but instead the resolution.

The symptoms of any food allergy can be so diverse and so multi-dimensional that they almost boggle and confound the mind. Each individual, being individuals unto themselves, may exhibit symptoms far different from any other individual with the same food allergy. The following are lists of symptoms designed to assist you in your new awareness of the possibility that your symptoms may be a result of an allergic reaction to food. However, it is important to remember that these symptoms can also be associated with other medical maladies and only careful clinical history, exam, and laboratory testing can differentiate between the two.

Digestive System: abdominal cramping, abdominal pain, bad breath, belching, bloating after meals, flatulence, gagging, itching on the roof of the mouth, vomiting

Nervous System: anxiety, confusion, depression, hyperactivity, inability to concentrate, aggressive behavior, irritability, restlessness

Musculoskeletal System: joint inflammation, joint pain, muscle pain, weakness

Genitourinary System: bed wetting, urinary frequency, urinary urgency, vaginal itching, vaginal discharge, premenstrual syndrome

Respiratory System: asthma, chest congestion, chronic cough, sore throat, runny nose, postnasal drip, chronic sinus inflammation

Cardiovascular System: chest pain, irregular heart beat, high blood pressure, increased heart rate

Integumentary System: acne, brittle nails and hair, dandruff, hives, eczema, dry skin, paleness of skin, dark circles under eyes

Miscellaneous: abnormal cravings, chronic fatigue, dizziness, headaches, difficulty sleeping, nausea, water retention, nightmares, rapid weight fluctuation, obesity, teeth grinding

As you can clearly see, nearly all symptoms can be related to a food allergy. These lists are even abbreviated and do not include every conceivable possibility. So, if your symptoms do not appear here, by no means does this indicate that your symptoms are not due to food allergies.

Now you may begin wondering how you would know if your symptoms are actually the result of food allergies. As I stated previously, clinical exam and history taking, as well as laboratory testing, are all very important. Your practitioner’s role is integral for understanding, prioritizing diagnoses, ruling-out possible underlying causes, interpreting test results, and filtering information. Your practitioner can then help direct treatment that will prevent further outbreaks.

You will be happy to know that most food allergies can be evaluated by drawing a small sample of your blood. This is a near painless test, involving just a needle prick. The blood is than processed and sent to a lab for evaluation.

ELISA is a common lab analysis used when evaluating food allergies due to one or both of the antibodies IgE and IgG. ELISA stands for enzyme-linked immunoabsorbent assay. This is an impressive sounding test, but actually simple and quite definitive. ELISA is referred to as a quantitative test, meaning that the number of IgE and IgG antibodies in your blood can in fact be counted. After the blood is drawn, the tube is set aside to clot and then spun with a centrifuge. The clear portion (or serum) containing the antibodies is removed from the tube and sent to the lab. At the lab, the serum is added to numerous vials, each containing a single food to be tested. After a period of incubation, an enzyme is added to each vial. This enzyme identifies any antibodies that have reacted with the food. Enzymes that have not identified the antibody-food reactions will be washed away. Last, a color agent is added to each vial. This color agent will bind with any enzyme that is left in the vial. The degree of color in each vial, measured with an optical density reader, determines the degree of antibody activity. The darker the vial, the more antibodies. The more antibodies, the stronger the possibility of that food causing an allergic reaction in your body.

Once you have been tested and the offending foods discovered, your practitioner will assist you with the next stages, elimination and challenge of allergenic foods. The elimination phase is the actual elimination of all foods to which you have reacted. The challenge phase occurs after elimination. It is the period of time when you reintroduce foods back into your diet.

Elimination is at the least, difficult. Careful decision-making with an open-mind is rudimentary to success. You will undoubtedly require patience of yourself. The process can be tedious and time-consuming. Lifestyle and dietary changes will be necessary. It is not simply eliminating a specific food, or foods, but learning to read labels and choosing your dining out meals with deliberate care. When cooking, you many need to learn to prepare your meals differently or even devise new menus and recipes. Moreover, working with family members who do not want to participate could become wearisome. Importantly, no matter what the difficulty, the end result will ultimately be worth the process. Soon, the tasks will become second nature and you will look forward to the end in sight. In fact, in a few months, your entire life will be changed. You will be a new person: healthier, stronger, happier. The struggle, the investigation, the diet, the blood draw, and the waiting time will all have been worth the effort.

The best method of elimination utilized by most practitioners is the quick and immediate elimination of all foods in question. Some refer to this as going, “cold turkey”. Beginning the changes in your diet at a slow pace will only prolong the whole process. Discipline is the most aspect in this early stage of altering one’s habits. One must be accustomed to reading labels. Problematic foods are oftentimes hidden within the multitude of ingredients of processed foods. An obvious example of this is milk. Milk is the key ingredient in ice cream. Therefore, logical reason says that if one is allergic to milk, then ice cream should also be avoided! Always be mindful that allergenic foods are hidden everywhere. Carrying snacks or nibbles with you always may also behoove you, just in case, and for those times when you simply cannot determine if a food item is safe.

The time frame for elimination differs with each individual. Times range from three weeks to six months, or until symptoms have regressed or ceased. No matter how long the time frame, be sure to replace any nutrients you would usually get through your eliminated foods with our sources. Be ever vigilant. Remember this is your well-being and you are at the helm.

The challenge phase is next. Choosing foods for the challenge, or reintroduction, phase, should be done carefully and methodically. Gradually these foods will be reintroduced into your diet one-by-one. First bring back foods of greater nutritional value, and believed to be unlikely candidates for allergy. Only after introducing those foods should more allergenic foods be tested. This is important because with each new allergic uprising a period of time is lost while your system returns to normalcy. Moreover, challenging foods should be done in their most simplistic whole forms. For example, if you are challenging cow’s milk, drink a cup of cow’s milk; do not have hot chocolate. If challenging corn, eat corn on the cob without butter, salt, or pepper; do not have chips and salsa. Reactions can be delayed, as mentioned earlier, due to the differing reaction times of IgE and IgG, so waiting a few days between foods is recommended. No foods should be reintroduced while in the throes of the reaction, otherwise the reaction to that food will be masked. Instead, wait until you symptoms subside, and then reintroduce the next food. When symptoms do arise after ingesting a certain food, do not continue to eat that food through the remaining challenges. Again, this will mask your results! One important thought, if you have a known adverse reaction to a specific food, such as shrimp causing hives or anaphylaxis, do not challenge the food, unless supervised within a clinical or hospital setting!

The process of challenge is fun and exciting. As an added bonus, you will learn more about food, your body, and your health. Now, rewards are actually within reach.

Once you have identified your food allergies through the process of testing, elimination, and challenge, the next step for you and your practitioner is to choose a treatment protocol that best suits your symptom picture and is directed at alleviating the underlying cause of your allergies. Your specific treatment may involve diet changes, supplementation, and even allergy shots. Although, injection therapy is rarely prescribed for food allergies.

The search for the underlying cause can be a lengthy process and sometimes bewildering. Often, a direct association with the onset of allergies is not identified or remembered. This is when a thorough investigation may be required by you and your practitioner. You will need to be on high alert, listening carefully to your body and its symptoms. Much akin to an espionage novel, you may find yourself investigating and thinking of where you were, what you were doing, and under what conditions you ate a particular food item. Optimizing digestive and immune functions are oftentimes the perfect places to start treatment. With treatment, you may be able to once again eat the foods for which you were found to be allergic. Searching for the underlying cause of your allergies is the key to long-term health.

As you have undoubtedly come to realize, food allergies are not well known, not well investigated, and are therefore, oftentimes overlooked as a possible causative factor to illness. Fortunately, laboratory testing is available and lends to easier identification. Feeling as well and as strong as one can be is the best reward. Ultimately, you will be the victor and you can take total satisfaction and delight that you have accomplished a great deed. Your health and well-being will be in your hands.

Christa Hinchcliffe, ND

[1]Takahashi T, Kitani S, Nagase M, Mochizuki M, Nishimura R, Morita Y, Sasaki N.  IgG=mediated histamine release from canine mastocytoma-derived cells.  Int Arch Allergy Immunol.  2001 Jul;125 (3):228-35.

[2]Okayama Y, Kirshenbaum AS, Metcalfe DD.  Expression of a functional high=affinity IgG receptor, Fc gamma RI, on human mast cells:  Up-regulation by IFN-gamma.  J Immunol.  2000 Apr 15;164(8):4332-9.

[3]Awazuhara H, Kawai H, Maruchi N.  Major allergens in soybean and clinical significance of IgG4 antibodies investigated by IgE- and IgG4-immunoblotting with sera from soybean-sensitive patients.  Clin Exp Allergy.  1997 Mar;27(3):325-32.

[i]Opper FH, Burakoff R.  Food allergy and intolerance.  Gastroenterologist.  1993;1(3)211-220.

[ii]Rance R, Kanny G, Dutau G, Moneret Vautrin DA.  Food allergens in children.  Arch Pediatr.  1999;6(Supp11):61S-66S.