It is not unusual to develop symptoms after eating. Foods can be contaminated by germs or toxins produced by a germ. The conditions that will be discussed here refers to when foods affect the individual through the immunological system. It is not unusual to find a person that is labeled as a “picky eater” when in reality what is happening is that one or more foods in this person’s usual diet trigger symptoms.
This reactivity to food(s) that is/are consumed could be called Food Allergy, but the term “Food Allergies” carries a lot of controversy. From the clinical point of view, a reaction to a food can occur immediately upon consumption. Sometimes the reaction is so immediate that symptoms develop as soon as the food touches the lips. Other times, symptoms developed later on, in a “delayed fashion”. In this case the symptoms can develop hours to days after the food has been consumed.
Immediate Food Reactivity
In this case, the symptoms develop so quickly that the patient usually knows which food is responsible for the problem. In general, this type of reactivity is mediated through an antibody called Immunoglobulin E (IgE). Food reactivities mediated by IgE are known as “Food Allergy”.
A blood test known as a “RAST” test is usually able to demonstrate antibodies against the culprit food(s). The treatment in this case consists of
- Patient is advised to avoid eating the food(s) that trigger the symptom(s)
- If the symptoms that develop are severe (example: asthma or throat tightness with difficulty breathing) the patient is then advised to carry an Autoinjector of Adrenaline at all times to self-treat in case of accidental consumption.
Delayed Food Reactivity
In this case the symptoms are present more or less frequently or even permanently. Usually, the intensity of the symptoms is not so severe as with the immediate food reactivity. In general, the patient does not associate a food as being responsible for the symptoms. In these cases, IgE is not present so most doctors do not call this an “allergy” rather a sensitivity or intolerance. So, when reading about food allergies and one sees “Food allergy and Intolerance”, or “Food Allergy and Food Sensitivity”, it means that reactivity to food mediated by IgE and reactivity to food where there is no IgE will be addressed.
Click here to learn about the 4 types of immunological reactions.
The management of this type of food reactivity is extremely complex.
Because the symptoms do not develop immediately after the intake of the food, the patient will have difficulty suspecting which is/are the food(s) involved. To make things more complicated, it is possible that the symptoms develop when food “A” and food “B” are consumed at the same time but not if only “A” or “B” are consumed. Also, symptoms can be persistently present while the offending food is eaten only 2-3 times per week.
Special lab tests, usually not covered by most insurance carriers, can demonstrate presence of another type of antibody (Immunoglobulin G or IgG) or analyze the number of immunological cells when a sample of blood is exposed to the food being tested. These tests are of difficult interpretation. It requires experience managing this problem before a conclusion can be drawn from food tests results. This also applies to usual skin tests for the diagnosis of food allergy. In reference to skin tests, it should be underlined that testing foods that trigger a severe reaction in the skin could be dangerous. And in reference to all food tests, blood or skin, there is a very confusing issue that it is rather a frequent occurrence: finding a positive result to a food that the patient appears to consume without any problems, and sometimes there is a negative result to a food where there is clear reactivity.
Symptoms related to food consumption
When consuming a reactive food, any type of symptom can be triggered. It is understandable that after eating a food to which the patient reacts, symptoms like abdominal pain, bloating, gas or diarrhea could develop. It is also understandable that the patient may develop itching or swelling (mild or severe) of the lip, tongue and even throat. It is more difficult to understand that the offending food can trigger symptoms pertaining to the nose and eyes (usually known as “nasal allergies”) or trigger an asthma attack, any type of skin rash (the better known: eczema and urticaria or hives), headaches or even swelling of the hands or feet. A patient with clear inhalant allergies (symptoms related to breathing pollen for example) can have an exacerbation of symptoms when eating certain foods. This may render the treatment against pollen not fully successful.
Management of food reactivity
1) Diet: When a specific food is known to trigger a problem, the patient is advised to eliminate this food. When the problem is mediated by IgE, the reactivity usually is for life so the patient will be advised not to reintroduce the food. When the problem is not mediated by IgE, the patient will acquire tolerance when the food is eliminated. After a variable period of time, the food will be able to be reintroduced. Upon reintroduction there will be no symptoms (tolerance) but continued consumption of the food will again lead to symptoms (intolerance).
This is a complex and confusing problem. Management requires a health professional aware of these issues and a cooperative and compliant patient. There are foods that will need to be eliminated for life and others, that after a period of elimination can be reintroduced as long as there is an interval of 4-5 days between consumptions of this problem food. This concept is called food rotation, and diets based on this concept are called Rotatory Diets
There are treatments to treat IgE food allergy, considered as experimental by the medical community like Oral Immunotherapy and Sublingual Immunotherapy (SLIT). For SLIT, after testing, dilutions of the involved food(s) are made. The patient administers the drops under the tongue, very much in a similar way as SLIT is used for desensitization of inhalant allergens.
There is another treatment useful for the management of food allergies and intolerances that is called LDA. This is a treatment based on clinical observations by a British doctor in the late 1960’s. (drshrader.com) It is very safe and highly effective for many circumstances. Again, this is not a treatment that is recognized by the medical establishment. It is not approved by the FDA and therefore not reimbursed by any insurance carrier. The original descriptions include successful treatment of food allergy (mediated by IgE).
Management of food reactivity at Associates in ENT & Allergy
The objective at Associates in ENT & Allergy is that the patient regains health. In order to do so, different aspects of lifestyle and health need to be addressed.
Diet: Elimination diets and food rotation are advised as indicated.
Autoinjector of Adrenaline: This device will be prescribed when indicated.
- SLIT for foods
- LDA: LDA is prescribed when patients have clear reactivity to foods, or when it is suspected that the diet interferes with patient’s health. An example of this is when the patient is not responding to inhalant Allergy Immunotherapy as expected or when the patient has pathologies that frequently are related fully or partially to patient’s diet, for example eczema or urticaria.
Detoxification support: Vitamins and supplements that increase immunity and improve liver function are advised
Hormonal support: When the thyroid gland does not work efficiently it is common for the patient to develop allergies or worsen preexistent allergies. At Associates in ENT & Allergy, thyroid function is supported when patient is symptomatic. Natural supplements and natural thyroid replacement therapies are used.
LDA role in the management of food reactivities
It is very rare to find a patient that will have food reactivity without also reactivity to environmental allergens. Treatment with LDA as a minimum will include a shot for the environmental allergens and a shot for the foods. There are two different food-LDA formulations. The difference is in the strength of the formulations.
The first one is highly effective for patients with eczema, which is a frequent finding, mainly in children with food reactivity. The other food-dose is highly effective for patients with asthma. Patient that have eczema and asthma at the same time are very common. Managing these cases is more challenging and if using the wrong dose, the symptoms can exacerbate. In these cases, medical interventions with drugs like prednisone and increased inhaler dose may need to be considered until the acute symptoms abate and the effect of the LDA treatment manifests itself.
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