Food Allergies or Sensitivities May Be Linked to General Allergy Symptoms |
By Dr. Steve Houser
Cleveland, OH |
Food
allergies or sensitivities may be producing, or accentuating, your
symptoms. This aspect of allergy is poorly understood in comparison
to inhalant allergy (e.g., ragweed or dust mite).
In order to diagnose and treat this aspect of your disease we will
require a great deal of cooperation and work on your part. Allow
us to briefly explain some of what we know about food allergies.
Food allergies are classified as being either fixed or cyclic.
A fixed food allergy may be very apparent; e.g., the person
whose lips swell and throat itches immediately in response to eating
peanuts. The mechanism for this type of food allergy is similar
to that of inhalant allergies, so the diagnosis is more easily reached.
Blood testing (i.e., RAST test) is typically used to verify fixed
food allergies.
Cyclic food allergies are less well understood. The immunologic
method producing these reactions are not the same as for fixed food
allergies, and are poorly explained. Clinical experience though,
has taught us to recognize and treat cyclic food allergies.
The symptoms which a patient experiences with a cyclic food allergy
are highly variable. The patient may describe headaches, sinus pressure,
rhinitis, abdominal cramping, skin eruptions, or fatigue to name
a few. To complicate the situation further, the symptoms may occur
in a delayed fashion up to 24 hours after the food is ingested.
To set about diagnosing and treating cyclic food allergy we ask
the patient to do a number of things.
First ask yourself, "are there any foods which I crave, or any food
which I avoid at all costs?" These foods may be the ones which are
causing your difficulties. Do not avoid or eat more of these foods
at this point, but let us know of your suspicions.
The next step is to keep a detailed food diary which keeps track
of what was eaten (including ingredients), when it was eaten, medications
taken, and any symptoms which developed (with time noted as well).
Please refer to the example below.
When you are writing down your entire diet, people often change
their diet to look healthier than it typically is. Please try to
maintain your normal diet; no one will judge you based on what you
are eating. We can best help you if your diet records are both accurate,
timed precisely, and truthful. We will look at your diet diary and
attempt to identify one, or several, food items which may be the
culprits. You will be asked to perform an elimination and challenge
diet at home based upon our interpretation of your diet diary.
It is best if your carefully maintain a diet diary during the period
of elimination and challenge. You must abstain from one, and only
one, of the possible culprits at a time for a period of four days.
This can be difficult to carry out if the food is very common, such
a egg or wheat, so you need to pay strict attention to your diet
during the elimination phase. Any "cheating" during the elimination
will invalidate the results. You will then eat the food on the fifth
day; this is considered the challenge. Typically, your breakfast
will include a large portion of the food in question, and your lunch
should include it as well if no immediate symptoms are apparent.
Any symptoms which develop are timed and recorded. With a true cyclic
food allergy we would expect a significant exacerbation of the symptoms
which were described in the original diet diary, although the challenge
symptoms may vary as well. If the elimination and challenge confirms
a cyclic food allergy, then you will be asked to abstain from this
food for a period of six months. After this time you can slowly
reintroduce the food on a rotary basis; it is not to be eaten more
frequently than every four days (once or twice a week).
SAMPLE
FOOD DIARY
Date: Monday
Time: 7 a.m.
Food: 2 eggs, bacon, toast with butter, orange juice
Medication: Allegra-D, Flonase, Multivitamin
Time:
10 a.m.
Food: Snickers bar, water
Symptoms: 11AM stomach cramps, diarrhea
Food: 1:20PM hamburger (lettuce, catsup, pickle), onion ring,
Coke
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