Food Allergy and Intolerance Awareness
Food Intolerances & Allergies
Food allergies and intolerances are omnipresent in society, yet misconceptions about them remain.
According to Food Allergy Research & Education (FARE), 32 million Americans are living with potentially life-threatening food allergies.
Further, every three minutes, a food allergy reaction sends someone to the emergency room, while between the years of 2007 and 2016, there was a 377 percent increase in the diagnosis of anaphylactic food reactions.
The intention here is not to elicit fear, but rather raise awareness. Food allergies and intolerances are very much real, and if they are not affecting your patients, they are most likely impacting someone that they know.
However, as unrecognized as these conditions can be, patients can cope via lifestyle changes and have natural products as a potential solution, an option supplemented by scientific research.
Types of Allergies/Intolerances
First off, it should be noted that allergies and intolerances are indeed two entirely different cases in terms of severity level and what should and should not be avoided.
“There are marked differences between food allergy and food intolerance. Classic food allergy involves a specific immune-related response and symptoms may begin immediately or within a few hours, which may include rash, wheezing, tongue and lip swelling and chest pain,” said Kim Plaza, technical advisor, Florida-based ADM Protexin, who offers the Bio-Kult brand of probiotics. “These types of allergies require a strict avoidance of trigger foods. Food intolerance is different in that small amounts of triggering foods may be tolerated. Symptoms of food intolerance may include nausea, bloating, abdominal pain and diarrhea, possibly being noticed between 24 and 72 hours.”
Plaza broke down the most common food allergy reactions as:
• Gluten—commonly known as celiac disease. Noted to be an autoimmune condition where a genetic link is a factor. An inflammatory reaction occurs with the ingestion of gluten with damage to the gut lining. This can lead to malabsorption of nutrients and related health issues. Celiac disease affects up to 1 percent of the population.1
• Wheat—an immune (but not autoimmune) reaction with antibody activation toward the protein of wheat-containing foods. Symptoms of a reaction may include atopic dermatitis, urticaria, allergic rhinitis and GI (gastrointestinal) discomfort. It affects up to 3 percent of the American population.2
• Milk products—one of the most common food allergies in infants and young children. Symptoms include throat tightness, coughing, GI discomfort and urticaria, which may develop between one to two minutes. It affects up to 3 percent at age 1.3
• Eggs—the second most common allergy in young children, with varied prevalence amongst populations. Symptoms my include anaphylaxis, and sufferers may develop other allergies such as atopic dermatitis and/or asthma.4
• Soy—more common in young children, with around 45 percent outgrowing sensitization by age 6. May be more common in children that also suffer from a peanut allergy and is driven by antibody IgE reaction.5
• Shellfish—usually persists throughout life, unlike other allergies (such as cow’s milk and eggs). Most common reactions include mouth and throat itching, as well as lip swelling, with some experiencing skin redness and anaphylaxis. Prevalence affects up to 10 percent of the general population.6
• Peanuts and tree nuts—another allergy which commonly persists throughout life and requires strict avoidance. Self-reported allergy to peanuts was noted as 0.8 percent for children and 0.6 percent for adults in the U.S.7,8 Symptoms usually develop within a few minutes and trace amounts of peanuts may induce respiratory and GI symptoms, arrhythmias and possible anaphylaxis.8
Plaza added that “Some people may also find that they cannot consume certain fruit, vegetables, nuts and spices due to an allergy to pollen residue left on them. Over sensitivity is generally short-lived and decreases over time, however some children develop antibody allergies towards them, which persist later in life.”5 As for common intolerances, they can include dairy, fructose, gluten, salicylates, wheat and FODMAPS (fermentable oligo-di-mono-saccharides and polyols).
Indeed, as referenced above, food allergies and intolerances (or sensitivities) are regulated by the various types of immunoglobulin, which help measure the types of antibodies in the blood.
“Food allergies are mediated by antibodies called immunoglobulin E (IgE), and food sensitivities are mediated by IgG and/or IgA antibodies,” said Chad Larson, NMD, DC, clinical education advisor for Arizona-based Cyrex Laboratories, a clinical immunology laboratory specializing in functional immunology and autoimmunity. “A food intolerance is not considered an immunological reaction, but rather manifests when there is a deficiency of an enzyme that breaks down a certain food component. Lactose intolerance, for example, is caused by a deficiency of the enzyme lactase. The issue of increasing food immune reactions is becoming larger because we are exposed to more and more factors that dysregulate our immune systems. Also, lab testing is becoming more sophisticated and more readily available for individuals to get tested.”
Elizabeth Livengood, ND, owner and doctor at Livengood Natural Health and co-founder and chief marketing officer at Restorative Methods (both in Arizona), was in agreement with some of Plaza’s insight, and among several points, spoke on the possibility of false negatives occurring in some instances.
“The classic food allergy is mediated by IgE immunoglobulins and [can] cause a relatively quick reaction (< 8 hours), with a relatively small exposure to the offending food,” she explained. “Intolerances and sensitivities are more difficult to identify because symptoms can take 24-72 hours to manifest and are less specific than the typical anaphylactic reactions. IgG antibodies show that a person has had a reaction to a food within the last 21 days (which is why we get false negatives if a person has already been on an avoidance diet for three weeks or more). IgA antibodies are more specific to the gut lining, so this shows us where the reaction took place. However, the addition of C3 complement reactivity shows a current inflammatory reaction rather than just a previous exposure. This is helpful because the complement cascade is what causes inflammation and tissue damage with prolonged exposure to the antigen.”
Another interesting detail surrounding food intolerance is that some patients could experience symptoms quite similar to other conditions.
“ … Food intolerance symptoms are more nuanced, as individuals may experience symptoms similar to other conditions such as congestion, bloating, constipation, skin rashes (eczema), headaches,” said Erika Gray, PharmD, co-founder and CMO of ToolBox Genomics, a testing lab in California that offers genetic testing for food intolerances among other health issues. “The explosion of food allergies/sensitivities have been attributed to the increase in cesarean births, rampant antibiotic use (both as a prescription and in the food supply) and the standard American diet (SAD). Each of the above instances is linked with decreased microbial diversity and abundance which help increase food intolerance.” Natural Remedies
Simply put, a potential solution could be to avoid the foods that IgG allergy tests recommend.
“The most effective treatment for IgG-related food allergies is an elimination diet based on serum IgG-based food allergy tests,” said William Shaw, PhD, laboratory director, The Great Plains Laboratory, Inc. (Kentucky). “Supplementation with DPP IV enzymes may be very helpful in the case of deficiency of this enzyme.”
DPP IV (dipeptidyl peptidase IV) enzymes as noted by Dr. Shaw, “can lead to inability to digest major milk and wheat proteins, leading to food-related illnesses like eosinophilic esophagitis, which can constrict the esophagus, making eating difficult.”
Traditional Chinese medicine (TCM) and probiotics could also be viable options.
“As serious illness can be a risk with food allergies, there are limited treatment options other than strict dietary avoidance,” said Plaza. “Some studies have found preliminary results with TCM, where a blend of herbs is taken over time. Large scale studies are however needed to confirm these initial results.9 Probiotics are a good option with traditional treatment, as they are generally safe to take and may go some way to reintroduce beneficial bacteria to the microbiome and possibly restore any imbalances that may be apparent. The use of probiotics has been used in combination with oral immunotherapy (OIT) in children with a peanut allergy, as well as using probiotics in cow’s milk allergy. They found a higher tolerance to these food groups as a result of taking probiotics.10,11 Caution must always be taken however when discussing therapy in food allergy, and visiting your consultant before trying new therapies is recommended.”
Practitioners could consider other supplements as well, such as vitamin D3, prebiotics, quercetin and zinc. Alternative approaches could even go hand-in-hand. “Vitamin D3, probiotics, prebiotics, quercetin and zinc are all supplements that have been studied to help decrease symptoms of food allergies/intolerances. Homeopathy and acupuncture have also been shown to help lessen food intolerance symptoms,” Dr. Gray explained. “Both of these modalities work well with traditional treatment and may even take the place of conventional treatment depending on the severity of symptoms. Anyone with shortness of breath or anaphylaxis should not use natural remedies exclusively when they are experiencing an active allergic reaction, or only use natural remedies to manage symptoms.”
Being able to interpret the various details of lab results could provide help additional information as well.
“Understanding lab results can drive effective treatment plans,” Dr. Livengood pointed out. “Identifying inflammation through active C3 complexes, eosinophils, mast cell markers (such as prostaglandin D2 or tryptase), ESR (erythrocyte sedimentation rate) or homocysteine can show if a person is currently inflamed. If so, we would offer anti-inflammatories and histamine inhibitors such as quercetin, bromelain, bioflavonoids, nettles micronized or lipophilic curcumin, milk thistle, and vitamin C. An antihistamine diet in addition to their specific food avoidances is recommended. Ulmus, althea, aloe, zinc carnosine and DGL (deglycyrrhizinated licorice) are beneficial for general gut healing. Probiotics are essential to replace inflammatory flora with healthy microbiota.”
For those looking for specific supplements, Florida-based Enzyme Science provides Intolerance Complex, which according to Julia Craven, vice president of education, “offers a unique formula for targeted digestion of gluten, dairy and phenols as well as a complete digestive formula to address protein, carbohydrates and fats of all kinds. While Intolerance Complex can be very digestively supportive for those with intolerances, it is important to remember that allergies are not treated by the enzymes in this product and will only help hydrolyze accidentally ingested allergens such as in the instance of cross contamination.”
Market Status
Food intolerances are legitimate concerns—however, the problem lies in the fact that patients may not recognize their symptoms as all being connected.
“Recognition of food intolerances as a common challenge is growing,” Craven said. “As leaders in natural digestive health, we’ve invested significantly in understanding the needs of consumers who experience food intolerances. Quite often, these individuals may experience gas, bloating or other symptoms of digestive discomfort, but not recognize it as a food intolerance. This is starting to change, and many practitioners are finding that they can differentiate their business and increase patient volume by promoting themselves as experts in food intolerances.”
But as the awareness increases, the market expands accordingly.
“The market is expanding primarily due to increased public knowledge about food sensitivities and intolerances as a distinct category from allergies,” said Dr. Livengood. “An example of this is ‘non-celiac gluten sensitivity,’ which is a relatively new diagnosis that is now widely recognized by both medical and lay people. Food sensitivities affect approximately 100 million people worldwide.”
What many may not realize is that in the case of food allergies, their popularity has risen over the years.
“Food allergies have risen in prevalence over the last few decades, primarily affecting industrialized countries,” said Plaza. “They are more predominant in younger people, with 8 percent of children under 18 years of age self-reporting allergies in the U.S.12 Food intolerances are also increasingly reported by individuals, which has led to rapid expansion in ‘free-from’ food and beverages. However, many of these are highly processed and contain numerous additives and emulsifiers, some of which may have negative effects on the microbiome.”
Research
As alluded to previously, ToolBox Genomics specializes in genetic testing for food sensitivities among other topics, and research suggests allergies can be in one’s genetic makeup. “ToolBox Genomics is interested in the role of genetics in the development of food allergies/intolerances,” Dr. Gray said. “Research suggests that individuals with a genetic profile that is associated with various food allergies will often go on to develop the very allergies identified in their genetic pre-dispositions. Additionally, genetic profiles can help identify individuals who may have a more vigilant immune system and may have a more significant reaction to certain foods compared to others.”
The Great Plains Laboratory has also made strides in the realm of IgG food allergy tests. “The Great Plains Laboratory has done research over the past five years to develop the first IgG food allergy test not based on ELISA technologies. The test is performed by a new immunofluorescence technology that allows 190 foods to be tested either on very small amounts of serum or dry blood spots,” Dr. Shaw explained. “This allows the testing of most foods eaten throughout the world, including foods on Western, Asian or Mediterranean diets.
“In addition,” he continued, “The Great Plains Laboratory has developed the only commercial test in the world for DPPIV deficiency. This deficiency is a major factor in eosinophilic esophagitis, chronic obstructive pulmonary disease, psychiatric diseases such as depression, bipolar depression, alcoholism, Alzheimer’s disease, rheumatoid arthritis, lupus erythematosus, eating disorders, certain types of cancer and fibromyalgia pain. The Great Plains Laboratory also offers complete serum IgE food allergy testing.”
Although more research is needed, ADM Protexin is closely following research which points to the benefits of using probiotics during pregnancy and beyond as helping combat both food allergies and intolerances.
“Studies are showing positive results for taking probiotics in pregnancy, breastfeeding and in infants as a preventative measure in food allergy and intolerances,” said Plaza. “However, there are further studies which show positive benefits of taking probiotics to restore intestinal microbe equilibrium and modulate activation of immune cells, even in established allergies/intolerances.13
“Certain species of probiotics have been shown to be particularly beneficial in food intolerances and allergies,” she added. “A recent study by Neau et al (2016),14 studied several probiotic species and found three were particularly beneficial in T helper lymphocyte balance in mice with cow’s milk allergy. The species showing benefit were Lactobacillus salivarius, Bifidobacterium longum and Lactobacillus rhamnosus. These three species are contained within the 14 strains in Bio-Kult Advanced Multi-strain probiotics.” Cyrex Laboratories, a company interested in immune system dysregulation and autoimmunity, mentioned that laboratory testing has thoroughly advanced, which begs the question, how will technology such as this impact the future? The world will have to wait and see.
“The sophistication of laboratory testing is the greatest component of how the approach to food immune reactions has evolved,” concluded Dr. Larson. “The quality, specificity and reliability of testing is directly linked to the patient achieving the best outcome because of the accuracy of the results of the tests.”
References
1 Caio G, Volta U, Sapone A, et al. Celiac disease: A comprehensive current review. BMC Med. 2019; 17. DOI:10.1186/s12916-019-1380-z.
2 Cianferoni A. Wheat allergy: Diagnosis and management. J. Asthma Allergy. 2016; 9: 13–25.
3 Flom JD, Sicherer SH. Epidemiology of cow’s milk allergy. Nutrients. 2019; 11. DOI:10.3390/nu11051051.
4 Kim JH. Clinical and laboratory predictors of egg allergy resolution in children. Allergy, Asthma Immunol. Res. 2019; 11: 446–9.
5 Savage J, Johns CB. Food Allergy: Epidemiology and Natural History. Immunol. Allergy Clin. North Am. 2015; 35: 45–59.
6 Wai CYY, Leung NYH, Chu KH, et al. Overcoming shellfish allergy: How far have we come? Int. J. Mol. Sci. 2020; 21. DOI:10.3390/ijms21062234.
7 Leickly FE, Kloepfer KM, Slaven JE, Vitalpur G. Peanut Allergy: An Epidemiologic Analysis of a Large Database. J Pediatr 2018; 192: 223-228.e1.
8 Al-Muhsen S, Clarke AE, Kagan RS. Peanut allergy: An overview. CMAJ. 2003; 168: 1279–85. 9 Lanser BJ, Wright BL, Orgel KA, Vickery BP, Fleischer DM. Current Options for the Treatment of Food Allergy. Pediatr. Clin. North Am. 2015; 62: 1531–49.
10 Hsiao KC, Ponsonby AL, Axelrad C, et al. Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomised, double-blind, placebo-controlled trial. Lancet Child Adolesc Heal 2017; 1: 97–105.
11 Berni Canani R, Di Costanzo M, Bedogni G, et al. Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow’s milk allergy: 3-year randomized controlled trial. J Allergy Clin Immunol 2017; 139: 1906-1913.e4.
12 Loh W, Tang MLK. The epidemiology of food allergy in the global context. Int J Environ Res Public Health 2018; 15. DOI:10.3390/ijerph15092043.
13 Castellazzi AM, Valsecchi C, Caimmi S, et al. Probiotics and food allergy. Ital. J. Pediatr. 2013; 39. DOI:10.1186/1824-7288-39-47.
14 Neau E, Delannoy J, Marion C, et al. Three novel candidate probiotic strains with prophylactic properties in a murine model of cow’s milk allergy. Appl Environ Microbiol 2016; 82: 1722–33.
Healthy Take Aways
• According to Food Allergy Research & Education (FARE), 32 million Americans are living with potentially life-threatening food allergies.
• Food allergies are mediated by antibodies called immunoglobulin E (IgE), and food sensitivities are mediated by IgG and/or IgA antibodies.
• The classic food allergy can cause a relatively quick reaction (< 8 hours), with a relatively small exposure to the offending food.
For More Information:
ADM Protexin, www.bio-kult.com
Cyrex Laboratories, www.cyrexlabs.com, www.joincyrex.com
Elizabeth Livengood, ND, https://drelizabethlivengood.com/, www.restorativemethods.com
Enzyme Science, www.enzyscience.com
The Great Plains Laboratory, Inc., www.greatplainslaboratory.com
ToolBox Genomics, www.toolboxgenomics.com
