Food Reactions; Know Which Type You Have!

Food Reactions; Know Which One(s) You Have!
On New Years Eve, my friend and I were talking about food allergies and reactions and I was surprised at how much she really did not know about the different types of reactions to food.  So I wrote about this in my January 2015 newsletter and I have transferred this to my blog.
There is a lot of misunderstanding about food reactions, in providers and patients or, from my point of view; from our customers.  Many come in here and just don’t know what they have.  I am not a doctor and you should listen to your doctor, but in our restaurant we see so many people who are just self diagnosing and that is scary. Please see a doctor. What we do here at One Dish Cuisine Cafe, Deli and Bakery is make safe food for those with Celiac Disease, Gluten Sensitivity, life threatening Food Allergies and EoE.
Below, I  will briefly explain the differences between the different food reactions and urge you to get tested when you are not sure what your issue is.  I will use my own situation to highlight the differences for you.

1) Autoimmune Response; Celiac Disease: This IgA autoimmune response can cause more than 300 signs and symptoms. Celiac Disease is the most common condition that falls into this category.  Basically, there is an autoimmune response to gluten and gliadin which can damage the intestines.  Testing for this is done by a Gastroenterologist through blood work and/or small bowel biopsy. I think you should have both.  10-20% of Celiacs test negative on blood work and positive on biopsy.  See a gastroenterologist who knows the guidelines for diagnosing Celiac Disease and get tested before going on a gluten free diet!  EoE and Celiac Disease and Dermetitis Herpeteformis (DH) are good examples of this and I have Celiac Disease and DH.

2)Food Allergy: Type I immediate IgE hypersensitivity immune response: This reaction typically occurs very quickly (minutes to hours) after eating an offending food; symptoms can be mild or severe. Food allergies can cause anaphylaxis (stopping breathing and death) but they may also experience itchy lips/tongue/throat, stuffy nose, headaches, belly ache, diarrhea, gas, bloating, skin reactions, and sudden fatigue. One mild reaction does not mean the next one will be mild! Testing is typically done through skin tests or IgE blood tests by a doctor/allergist. The majority of food allergies have a quick onset reaction.  If sour cream causes immediate diarrhea, or strawberries make your  lips swell or peanuts close your throat – you are not going to easily forget that because the symptoms occur so quickly and are severe.  IgE food panels can be run to help patients when it’s more difficult to figure out which food is causing their reaction because some may have multiple allergies. IgE testing is run through any standard laboratory and is ordered by a doctor/allergist.

I have an IgE allergy to Milk.  I was always told by doctors that I just had a severe lactose intolerance.  When I was not getting better following my GF Diet in the 90’s; my GI decided to refer me for food allergy testing.  I saw a doctor/allergist and they did skin testing for lots of allergies. When I ingest milk products, pretty quickly, the inside of my ears start to itch, my eyelids swell and I itch all over, followed by severe cramping and pains in my stomach and sometimes I start to sweat and can get irritable. If I have baked cheese or milk, the reaction is much less severe. I am lucky,  but this does not mean an anaphylactic reaction will never happen.  I know that mild reactions can sometimes become severe. I have a similar reaction to sulfites and nitrates, but more of an itching response.  With caffeine it is pretty immediate stomach pain and then sometimes I get hives.

Medications: I have also had immediate reactions to some Medications; Biaxin, Reglan, and Morphine.  For example, with Biaxin I had a less severe reaction to Milk (in the form of lactose) that is used to bind the drug together.

-In 2005 I was given Reglan to settle my stomach before going under anesthesia. I had a severe reaction and was given adrenaline/epinephrine. I am not sure what ingredient I reacted to in the Reglan because the hospital could not tell me what was in it, but they were adamant that I never, ever, ever take it! 
-In 1995 I was given Morphine while in the hospital for gall stones and kidney stones. I had a severe reaction; was given adrenalin/epinephrine to counteract the reaction and was told to never allow anyone to give me Morphine again.  I was really glad that I was in the hospital when I had those reactions and I definitely experienced the “impending sense of doom” that is often said to occur. 
-Codeine was not as severe; it made me itch all over and vomit. 
-Synthroid was prescribed for my Hashimoto’s Thyroiditis and I kept telling my doctor it was making me sick and I was told that there was nothing in it to make me sick. I did my own investigation and found out I was reacting to the lactose used in the pill and had to switch to the generic form made without the lactose. The severe stomach pain and itching ended immediately.

These are examples of immediate reactions.  The problem with medications is that you often have to call the manufacturer to figure out what is in the medication because they don’t have to label medication like they label food.

3) Non-immediate (delayed) IgG & IgA response; known as a food intolerance or food sensitivity:  This is very different from an immediate IgE food allergy response because symptoms may not show up for hours or days; which makes it very difficult to figure out exactly which foods are causing which reaction in the body.  Symptoms of IgG food intolerances/sensitivities include: sore throat, stuffy nose, congestion, headaches, belly aches, constipation, diarrhea, gas, bloating, hormone issues, foggy head, headaches, weight gain, fatigue, joint pain, depression, behavior changes, anxiety, and skin issues.  This is where IgG and IgA food sensitivity testing comes in.  Many doctors are not familiar with this type of reaction because it is not always obvious or life threatening and it is harder to diagnose and some delayed IGA reactions can be very serious; such as EoE!

I have minor delayed reactions with Oats, Corn, Quinoa, Millet and Hemp…I have a gluten like reaction to these, or what I would call a “cross reaction”.  I did strict elimination diets to figure this out. Blood tests for food sensitivities (IgG) are more likely to be run by functional medicine or non traditional doctors and they are not usually covered by insurance.

We have seen a huge increase in customers with food sensitivities or intolerances and they usually come in and claim a food allergy, it is not the same thing folks! There is some conflicting evidence on the comparison of IgG versus IgE and the testing behind it.  Note: being allergic to a food doesn’t mean you are intolerant and being intolerant does not mean you are allergic.  IgG testing is often done by alternative practitioners and is said to diagnose inflammatory responses to foods but those tests are not validated by the FDA and therefore this type of testing is often not covered by insurance.

What is the bottom line here?  Know the difference between them:

-Celiac Disease: diagnosed via blood tests and endoscopy with intestinal biopsy done by a Gastroenterologist. Dermatitis Herpetiformis: itchy skin rash that is the very specific IgA Skin Manifestation of Celiac Disease, diagnosis is done via skin biopsy by a Dermatologist.

-Gluten Sensitivity: if you are negative on the above tests for Celiac Disease but have symptoms when you ingest gluten. Diagnosed by Gastroenterologist.
-Food Allergies:  severe and possibly life threatening IgE food reactions diagnosed by a doctor/allergist who will perform IgE Testing because severe reactions mean you should be carrying an epi pen. In the case of EoE, the patient may be referred to Gastroenterologist for biopsy of the Eosiniphil in the Esophagus.
-Food Sensitivities: IgG blood work, stool samples, saliva samples, etc.; are often done by alternative medical practitioners for low level food sensitivities that are said to cause inflammation in the body. The tests are often not covered by insurance because the tests are not validated or approved by the FDA yet and they don’t in any way determine if you have Celiac Disease or Gluten Sensitivity; you need to see a Gastroenterologist for that.  There is no such thing as a “Gluten Allergy”; you would have Celiac Disease or Gluten Sensitivity or you have and IgE Allergy to wheat, rye and barley!
*To see what those with IgE food Allergies are at risk for and what severe reactions look like, please watch this video: “An Emerging Epidemic: Food Allergies in America”.
So, when you come in to see us for a meal,  we would really appreciate it if you would please use the appropriate terminology. Thanks!