The Food Allergy Maze

My exclusively breastfed son was diagnosed with 12 food allergies in infancy, so my experiences with true food allergies were filled with heightened awareness and ongoing worry. Learning from a half dozen allergists all over the US, I work personally and clinically with food allergies, sensitivities, and intolerances. These terms are often used interchangeably, but they are not the same thing. It is important to understand the definitions, treatment approaches, and potential outcomes for each of these conditions.

A food allergy is an immunoglobulin E (IgE)-mediated response to the protein in a food that may contribute to anaphylaxis and death. A food allergy is a type of autoimmune disorder. IgE skin and/or blood testing is required for diagnosis. Eliminating specific foods may be required, and the allergist will prescribe the best course of action.

A food sensitivity is a suspected reaction to a food that is not caused by the IgE response. There are immunoglobulin G (IgG) tests available, but these results are often inaccurate (AAAAI, 2020). In this case, the careful, temporary removal (3-4 weeks) and reintroduction of a single food may be recommended. Keep in mind that there are numerous contributors to food sensitivities, and the underlying cause may include gut dysbiosis.

A food intolerance is the inability to digest or metabolize a certain food. Think in terms of lactose intolerance where it is "normal" for the majority of the world's adult population to lack the lactase enzyme needed to digest the lactose in milk. In populations where dairy was introduced long ago, these individuals may actively produce lactase into adulthood.

In Southern California, clients come to me with (IgG) food sensitivity testing results and claim to have multiple food “allergies.” While this may be true, it is often derived from unreliable food sensitivity testing that measures both reactivity and tolerance to various foods (AAAAI, 2020). Orthorexia is also an increasingly common condition where individuals are obsessed with "healthy eating" and have food fears that conceal an underlying eating disorder. Receiving a proper diagnosis is the first step to experience symptom improvements.

Be cautious about implementing a partial or full elimination diet until you understand the exact diagnosis and implications of various protocols. If you suspect a poor relationship with food or an eating disorder, an elimination diet will likely worsen symptoms. The recommendation to exclude foods based on hunches or inaccurate food sensitivity IgG testing can result in INCREASED allergic responses to foods because the underlying causes (difficulty digesting foods, gut dysbiosis, etc.) have not been addressed while the autoimmune response can be heightened (Järvinen et al., 2013; Licari, 2019).

The science regarding food allergy onset and how it can be "outgrown" has changed over the last few years. There are newer approaches, such as oral immunotherapy (OIT), to help individuals overcome food allergies (AAAAI, 2020). OIT should always be administered with the oversight of an allergist. A nutrition practitioner should never recommend the inclusion of a food allergen when the specialist has advised against it.

I purposely chose to practice extended breastfeeding until my son was almost four to help him outgrow his food allergies through a mild form of OIT via breastmilk. He was recently re-tested (now age 11) and currently reflects only one possible food allergy to a nut he's never had in its whole form. There can be cross-reactivity between plants and protein similarities among foods. In addition, genetically modified organisms (GMO) can contain altered protein structure that can result in unknown allergies. See my article, What Are GMOs, Really?, to learn more about GMOs.

For food allergies, sensitivities, and intolerances, it is not the food alone causing the reaction. It is the inability of the individual to react positively to the food. Addressing the underlying causes, the biological terrain, is critical. Even in cases of food allergies, practitioners can help individuals to improve gut health and to expand their diets, but only when approved by the allergist.

References

American Academy of Allergy, Asthma & Immunology (AAAAI). (2020, Feb. 4). The current state of oral immunotherapy. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/the-current-state-of-oral-immunotherapy

American Academy of Allergy, Asthma & Immunology (AAAAI). (2020, Sept. 28). The myth of IgG food panel testing. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/igg-food-test

Järvinen, K. M., Konstantinou, G. N., Pilapil, M., Arrieta, M. C., Noone, S., Sampson, H. A., Meddings, J., & Nowak-Węgrzyn, A. (2013). Intestinal permeability in children with food allergy on specific elimination diets. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 24(6), 589–595. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774110/

Licari, A., Manti, S., Marseglia, A., Brambilla, I., Votto, M., Castagnoli, R., Leonardi, S., & Marseglia, G. L. (2019). Food allergies: Current and future treatments. Medicina (Kaunas, Lithuania), 55(5), 120. https://doi.org/10.3390/medicina55050120