Laboratory Patient Coaching Guide

Published By: John A. Catanzaro, ND

Food Hypersensitivity and Clinical Relevance

The Food Antibody Assay Panel provides information on two types of immune responses to specific foods. The immune system has an immediate response mediation known as IgE and a delayed response mediation known as IgG. The development of food allergies is complex and multifactoral. In “alternative medicine” the most common causes are inherited susceptibility to allergy, exposure to the allergenic food, frequency of consuming the allergenic food, pancreatic enzyme and hydrochloric acid deficiency and the breakdown of the healthy intestinal barrier found in a condition known as Leaky Gut Syndrome. Other common terminology used are both immediate (IgE mediated) and delayed (IgG mediated) hypersensitivity.

Specifically, there are four types of reactions that can occur as discussed in detail below and for further inquiry consult: El Rafei A, Peters SM, Harris N. Bellanti JA. Diagnostic value of IgG4 measurement in patients with food allergy. Ann Allergy 1989;62:94-99. Hofman T. IgE and IgG antibodies in children with food allergy. Rocz Akad Med Bialmyst 1995;40(3):468-473.

Type I reactions are mediated by IgE antibodies, and are characterized by the release of histamine upon exposure to an allergen. Type I reactions are responsible for “immediate” allergies, such as hay fever or anaphylaxis. These reactions can be life threatening and are considered serious reactions.

Type II immune reactions involve antibody-mediated destruction of tissue following adherence of foreign material. This reaction is often referred to as a “cytotoxic reaction,” because the reactions have direct effects on individual cells of the body.

Type III reactions are mediated by mixed antibodies, primarily IgG. Complexes composed of antigen and antibody activate a segment of the immune system known as complement and cytokines in the body. This reaction is known to cause inflammation in the body. Inflammation is the component that contributes to the undesirable symptoms of joint pain, swelling, fluid retention and other allergy related symptoms Type III reactions constitute the basis of “delayed” food allergies. Symptoms are delayed because of the time required for the formation of complexes.

Type IV refers to cell-mediated immune reactions, where killer cells known as T-Cells become cytotoxic cells when activated by antigen, capable of killing viruses, bacteria, tumor cells or other target cells. Type IV reactions play a significant role in tuberculosis, fungal and viral infections, contact dermatitis and allograft rejection. These reactions may also be involved in some severe delayed food allergies known to cause Celiac Disease. An example is a severe reaction to gliadin protein in grains. This type of reaction can cause significant damage to the gut mucosal lining and cause protein wasting common in conditions like Celiac Disease. The discussion below will give further detail on hypersensitivity reactions elimination, rotation, and reintroduction of problematic foods and identifying the role of LGS in food allergy.

Classic Food Hypersensitivity

Once a food initiates an IgE response, which is generally considered to be an immediate hypersensitivity, and a permanent food reaction most experts recommend avoiding this particular food for life. No matter how long that food is avoided, a reaction may result when it is eaten again. For example, in an individual who is hypersensitive to peanuts when ingested, an immediate life-threatening anaphylactic reaction would result, i.e., difficulty breathing, rapid heart rate, profuse sweating, etc. Strong IgE immune responses may cause immediate reactions such as asthma attacks, anaphylactic shock, or instant hives, whereas milder IgE reactions may result in acute headaches, itching of the mouth, or unclear thinking.

Since IgE reactions usually occur minutes after eating the food, you can usually trace the reaction to a certain food. Foods that are within these categories include dairy, strawberries, shellfish or peanuts. When an IgE-associated food is avoided, the IgE antibodies to that food will drop significantly within weeks. However, the antibodies often appear as soon as the food is consumed again. IgE mediated response often indicates that the problematic food is to be strictly eliminated from the diet and never reintroduced because of its severe reaction tendency. However, in some cases IgE can be positive and an individual may demonstrate a mild reaction or no reaction to the food. It is recommended that this food be eliminated for 3 months and then retested to be sure allergic symptoms associated with the food reintroduction are determined. This needs to be done cautiously and under the supervision of the clinician.

False negatives and false positives do occur in allergy testing and it is always prudent to verify a test value in question.

For further inquiry consult: El Rafei A, Peters SM, Harris N. Bellanti JA. Diagnostic value of IgG4 measurement in patients with food allergy. Ann Allergy 1989;62:94-99. Hofman T. IgE and IgG antibodies in children with food allergy. Rocz Akad Med Bialmyst 1995;40(3):468-473.

Delayed Food Hypersensitivity

A food that causes an IgG response is referred to as a delayed hypersensitivity. IgG responses may cause delayed symptoms, such as joint or muscle pain, chronic headaches or fatigue. Since IgG reactions often occur hours or days after particular foods are consumed, they can be difficult to recognize. The reactions can be subtle or severe, and may lead to chronic (long-term) symptoms and chronic degenerative conditions and chronic inflammation. When an IgG food is avoided, it may take three to nine months for the antibody level against that food to decrease significantly. However, for the antibody level to return to the previous level, the food may have to be eaten frequently for weeks to months. For that reason, these foods are often less problematic when reintroduced. When consumed infrequently in a rotation diet, they seldom have to be avoided for life.

For further inquiry consult: El Rafei A, Peters SM, Harris N. Bellanti JA. Diagnostic value of IgG4 measurement in patients with food allergy. Ann Allergy 1989;62:94-99. Hofman T. IgE and IgG antibodies in children with food allergy. Rocz Akad Med Bialmyst 1995;40(3):468-473.

Elimination, Rotation and Reintroduction Of Problematic Foods

The most important component of any allergy program is the reduction of exposure to the offending agent. When exposure is maintained to certain offending foods, antibodies will continue to be produced, and the immune system will respond to such challenge. As mentioned previously, IgE-mediated allergies tend to be “fixed,” thus required avoidance is usually life-long. In contrast, the IgG-mediated allergies may be reversed over time. Reactive foods are ideally eliminated from the diet for a minimum of 12 weeks, particularly those that evoke the most severe symptoms or the highest scores on the allergy test.

There are certain foods that categorized as being in a “family” of foods. Ideally, exposure to foods within the same food family of a reactive food should be reduced or avoided as well. For example, a sensitivity to clam may indicate a greater likelihood that sensitivities to oyster, scallop and squid (other members of the mollusk family) might be present. Hidden foods, e.g., eggs contained in mayonnaise, must also be considered, and care must also be taken that suspected foods are not inadvertently consumed while hidden in other foods. Eliminating the antigenic food provides the immune system a rest, and the levels of antibodies gradually decline, immune complexes are cleared, and symptoms improve. Lesser reactive foods are often tolerated in the beginning, if eaten no more often than every four days or so; however, this tolerance varies between individuals, and in the more symptomatic patient even foods with low reactivities may have to be temporarily removed from the diet in order to clear the symptoms.

Reactions to foods are categorized on three response levels, namely low, moderate and high antigenic activity. Based upon the severity of these reactions, foods either need to be eliminated permanently or rotated out of the diet and reintroduced.

Low Antigenic Activity (Insignificant) Low reactive foods are considered to be mild and often are not problematic. However, in cases of significant delayed allergic reactions certain low antigenic foods may have to be avoided to improve the clinical outcomes. This all depends upon the type of symptoms experienced and how often this “low” food is consumed.

Moderate Antigenic Activity (Moderate) Moderate foods are considered problematic and significant and must be eliminated from the diet for 12 weeks and then reintroduced gradually. Care must be taken that hidden foods are also eliminated as they can continue to cause reactive symptoms. Reintroduction is usually one food at a time over a course of several days, and if symptoms of reaction reappear, this food needs to be eliminated from the diet for a longer period of time before it is reintroduced.

High Antigenic Activity (Significant) High antigenic foods are considered highly problematic and need to be strictly avoided for 12 weeks before being reintroduced into the diet. These foods usually cause significant reactions, and care must be exercised in the reintroduction process.

Additional Considerations

Genetic Predisposition

Genetic factors in food allergy are currently under serious study by researchers and medical experts. There is no doubt that genetic predisposition is an important determinant. However, acquisition of sensitization to food proteins and subsequent allergic disease is known to be influenced by a variety of environmental factors and the timing, duration and extent of exposure. Moreover, the nature of the allergen itself may have an important impact on the severity and persistence of clinical disease. 1 2

The Leaky Gut Connection

The Gastrointestinal Tract

The gastrointestinal tract is the first check-in point for all processing of foods and anything ingested. Technically, the GI tract is outside the body. It is basically a long tube with one opening at the mouth and another at the anus. The GI system has a vast amount of immune tissue that assists in the protection against foreign antigens that are introduced by external environment. Just as the skin protects the body from the external environment, so does the GI tract, with respect to everything that is ingested.

The main functions of the GI tract are:

•Absorbs the products of digestion so they can be converted into energy and proteins.
•Carries nutrients like vitamins and minerals across the intestinal lining into the bloodstream.
•Contains a major part of the chemical detoxification system of the body.
•Acid barrier against pathogens
•Immune defense against pathogens

What is Leaky Gut

Leaky Gut Syndrome (LGS) is the name given to a condition which reduces the ability of the intestinal wall to keep out large and undesirable molecules. These large molecules are considered “antigens” or “foreign substances,” causing the spaces between the cells of the intestinal wall become enlarged for various reasons. Inflammation of the gut mucosa can also facilitate this activity. Inflammation can be caused by a bowel ecology that is imbalanced and has greater number of potentially threatening disease-causing organisms known as pathogens. As illustrated in the diagrams below, when the gut flora is altered, inflammation and Leaky Gut can result. LGS is seldom tested for, or diagnosed by, doctors in general practice, but there is a vast amount of implicating altered permeability of the intestinal wall in a large number of illnesses such as autism and others described below.

What happens when you have a Leaky Gut?

A leaky gut results in many problems and symptoms that affect the whole body:

Gastrointestinal Symptoms - The most obvious problems resulting from a leaky gut are digestive symptoms like bloating, flatulence and abdominal discomfort.

Large food particles can pass into the bloodstream - As discussed earlier the immune system assumes these particles are dangerous foreign material, and the body creates antibodies against them. This leads to the situation where large numbers of different foods set off an immune reaction every time they are eaten. These antibodies may also attack the body’s own cells that are structurally similar to the large food molecules. This leads to autoimmune disease.

Nutritional deficiencies - Although you might expect that having a leaky gut would mean you can absorb more nutrients, this is not the case. This is because the “carrier proteins” are damaged when the gut becomes inflamed and more permeable. This means that the nutrients cannot get across the intestinal wall, and nutritional deficiencies result. Leaky Gut is not a favorable condition.

Increased absorption of toxins - This places a great strain on the liver, and as detoxification enzymes become depleted, more and more toxins are able to circulate to all parts of the body in the bloodstream. In severe cases leaky gut can lead to liver inflammation and toxic hepatitis. These toxins circulating in the blood can result in multiple symptoms, from fatigue to skin rashes, as well as inflammation of various tissues and organs.

The gut’s immune function is impaired - When the gut wall is inflamed, the antibodies (IgA) that protect the gut are adversely affected. This reduces its ability to fight off potentially pathogenic bacteria, parasites and yeast such as candida. The development of reduced mucosal immunity begins in infancy and can continue throughout life. (For further inquiry consult: Rautava S, Isolauri E The development of gut immune responses and gut microbiota: effects of probiotics in prevention and treatment of allergic disease. Curr Issues Intest Microbiol (England), Mar 2002, 3(1) p15-22)

Gut microorganisms can enter the body - When the intestinal lining is inflamed, the bacteria that usually reside within the intestine are able to “translocate”. This means that they can pass across the gut wall and into the bloodstream, from where they can cause infection anywhere in the body, causing havoc for the immune system. (For further inquiry consult: Microbial Ecology and Dysbiosis In Human Medicine. Alt Med Review 1997; 3 (2) p202-209)

Other Illnesses Linked To Leaky Gut Syndrome - All of this can lead to any number of seemingly unrelated symptoms affecting every organ system in the body. The best available evidence demonstrates that there may be a connection between certain illnesses and food reactivity. Some of these may include Arthritis, Celiac disease, Ulcerative colitis and Crohn’s disease. 3 4 5 6

Treatment Considerations

Approaching the treatment for food allergy can be complex. The most obvious is to begin with reduction of antigenic burden. Elimination of the causative agents is recommended. However, this is not easy as there are some agents that cannot be completely eliminated. Here is where supportive nutrients, botanical medicines, homeopathy and other alternative options can be considered. The aim of therapy should be addressing inflammatory mediation and histamine mediated activity. This can be achieved by alternative and traditional treatment combined.

The best available evidence in alternative treatment for food allergy demonstrates the probable connection of reduced hydrochloric acid and pancreatic enzyme output. Focusing in upon the digestive tract and the possibility of Leaky Gut are parameters that bring about restoration of the gut integrity and microflora balance.

Immunotherapy and Enzyme Potentiated Desensitization are both popular methods for the treatment of food sensitivity. Keep in mind that food allergy/sensitivity treatment is a lengthy process and should be communicated to the patient clearly. The treatment plan may evolve and change based upon the progress or the lack thereof of the patient.

Summary

As you can see from the information provided, food allergy / sensitivity can facilitate significant changes in the body, and it is essential that causative factors be identified and eliminated, when possible. Reducing the antigenic load is essential in overall health and recovery. Identifying the foods that are problematic is the first step in facilitating wellness, and other factors mentioned above should not be ignored. All systems of the body are interdependent, and the health of the whole person should be the focus. Focusing on a systems approach facilitates the healing process and enhances wellness, assuring better outcomes.


References

1 Kimber I, Dearman RJ Factors affecting the development of food allergy. Proc Nutr Soc (England), Nov 2002, 61(4) p435-9
2 Gaby AR. The role of hidden food allergy/intolerance in chronic disease. Alt Med Review 1998;3(2):90-100.
3 Van Den Bogaerde J, Cahill J, Emmanuel AV, et al. Gut mucosal response to food antigens in Crohn’s disease.
Aliment Pharmacol Ther (England), Nov 2002, 16(11) p1903-15
4 D’Arienzo A, Manguso F, Astarita C, et al. Allergy and mucosal eosinophil infiltrate in ulcerative colitis.
Scand J Gastroenterol (Norway), Jun 2000, 35(6) p624-31
5 D’Arienzo A, Manguso F, Scarpa R, et al. Ulcerative colitis, seronegative spondyloarthropathies and allergic diseases: the search for a link. Scand J Gastroenterol (Norway), Oct 2002, 37(10) p1156-63
6 Saito T Progress in the study of allergy and collagen disease in the last 100 years: Rheumatoid arthritis]
Nippon Naika Gakkai Zasshi (Japan), Sep 10 2002, 91(9) p2663-70

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