The Diagnosis and Treatment
of Food Allergies
By Anthony Reinglas
The diagnosis of food allergies can seem complicated
because reactions to foods are often delayed and may be affected by many
factors, including insufficient rest, stress, and other allergens we are exposed
to at the same time. Indeed, it is usually impossible to determine what you are
allergic to on your own if you have more than a very few food allergies.
Therefore, medical testing and help from the right health professionals is
important. There are associations you can consult to find someone who can help
you in your area.
The treatment of food allergy can, like its diagnosis, seem complex.
Food allergy is definitely not a problem that fits the preconceived notions of
our “for every ill there is a pill” society. Food allergies are often treated
from several directions at the same time, such as eliminating allergens,
strengthening the patient nutritionally, and modifying the patient's immune
response. It is not something your doctor can do for you by himself or herself.
(Indeed, many physicians do not understand allergies other than those mediated
by IgE). As a patient with food allergies, YOU must be actively involved in your
treatment. The most important parts of your treatment YOU will do, not your
doctor. Food allergy is a very individual problem, and you know your body better
than anyone else does. It may be difficult to take action because of your
health, but if you want to get well, YOU must take responsibility for yourself.
YOU must make the necessary changes in your lifestyle. YOU must become a
well-informed, active participant in your own health care. Then YOU will be the
one to enjoy the benefits of improved health.
Elimination and challenge was the first type of testing
used for food allergies. It is still often used in the clinical ecology units of
hospitals or clinics and is considered the "gold standard" method of allergy
testing for foods. The patient either fasts for several days (in a clinic under
medical supervision) or at home eliminates the foods to be tested from the diet
for five to ten days. The suspected foods are then eaten one at a time and
symptoms are recorded. This method is difficult to use for delayed (non-IgE)
food allergies. In severely allergic patients, it can be dangerous and should be
used only under medical supervision, such as in a clinic setting.1
Intradermal or scratch skin tests are used by many conventional
allergists and are good for inhalant allergies. However, they are usually not
reliable for food allergies because they detect only IgE-mediated food
allergies, which make up only about five percent of all food reactions.2
Provocation-neutralization testing is the most common in-office, or in-vivo test
for food allergies. A small amount of a dilute extract of the food to be tested
is injected into the skin of the patient's arm or given under the tongue. Any
symptoms that result are recorded and the skin reaction is monitored. Then
injections or sublingual drops of weaker or stronger dilutions of the same food
extract are given. The dilution which does not provoke a skin reaction and
clears up the patient's symptoms is the “neutralizing dose" and is used for
neutralization treatment. This test works best with food reactions that happen
quickly whether mediated by IgE or lgG.3 It is about 80% accurate.4
Blood tests are the easiest tests for the patient to take. Hundreds of
foods can be tested using one blood sample. There are several types of tests
including RAST (Radio-Allergo-Sorbent Test), ELISA (Enzyme Linked Immuno-Sorbent
Assay), and ELISA/ACT (Enzyme Linked Immuno-Sorbent Assay/ Activated Cell Test).
RAST and ELISA tests can detect either IgE or IgG antibodies to foods in the
blood sample.5 ELISA/ACT tests can detect IgG, IgA, and IgM
antibodies, immune complexes, and cell activated reactions.6 A very
useful and accurate recent development in blood tests for food allergies is a
test that requires such a small blood sample that it can be self-administered.
This test is performed by York Nutritional Laboratories. No doctor’s order is
required for this test and you obtain your own blood sample by sticking your
finger and collecting the blood sample using the kit the laboratory provides.
York has M.D.’s on staff to help you interpret and apply your test results.
Click here to visit the
web site of ImmunoLabs, which performs doctor-prescribed and drawn blood tests.
ImmunoLabs may be able to direct you to a nearby clinic that uses their tests
for diagnosis.) Blood tests can detect delayed as well as immediate food
allergies. Food allergies that show up as positive on a blood test may be
confirmed by an elimination and challenge test.7
Special diets are the most commonly used treatment for
food allergies. If the patient is allergic to only one or two foods, eliminating
the offending foods may be the only treatment necessary. This is the course
usually taken in the case of children with peanut anaphylaxis. My father was
able to treat the milk allergy he got from drinking large quantities of milk for
an ulcer by simply eliminating dairy products.
When a patient has multiple food allergies, the offending foods must be
eliminated and all other foods should be eaten at intervals of four to five days
or longer. This is know an a "rotation" or "rotary diversified" diet. Rotation
diets are necessary for patients with multiple allergies because if you have
overt allergies to many foods, it is likely that you have slight, subclinical
allergies to many other foods that you consider safe. Eating them on a rotated
basis reduces your exposure to them and hopefully will help preserve your
tolerance for them.
Doctors prescribe rotation diets of varying degrees of strictness
depending on the severity of your allergies. On the most strict diets each food
is eaten only once on its rotation day and the length of the rotation cycle may
be much longer than four to five days. One very allergic person I talked to had
been put on a one food per meal, three meals per day, twelve day cycle diet by a
prominent allergy clinic. (However, a diet this extreme may lead to
Some doctors consider rotation diets with very long cycles to be
counterproductive.8 For most patients, a four to five day interval
between eating foods gives the best masking of symptoms. A longer cycle may lead
to "unmasking;" the patient reacts to and "loses" yet another food. However,
there are patients who find that some foods agree with them better if they are
rotated at longer intervals. I personally have many foods that I can tolerate if
I eat them at one week or two week intervals, but which will bother me if I eat
them every fourth to fifth day. The ideal rotation interval can vary from
patient to patient and from food to food, but should never be less than four
On most patients’ rotation diets each food may be eaten more than once
on the rotation day and the cycle is usually four to five days long. The
rotation day can be any twenty-four hour period, not necessarily a calendar day.
This means that leftovers from dinner can be eaten for tomorrow’s lunch. No food
should be eaten in extremely large quantities. (For example, rice should not
make up half of the food you eat on its rotation day). As long as many foods are
included in the diet, this is an easy rule to follow. However, if patients
become allergic to almost all foods and find themselves left with only two or
three foods per rotation day, they will of necessity be eating those foods in
large quantities. In this situation they will probably eventually become
sensitive to the few foods they are eating. Efforts must be made to seek out new
and unusual foods so the number of foods they are eating can be increased.
On a rotation diet, foods are rotated according to their biological
classification in food families because foods in the same family have similar
antigens. Usually the entire family is kept on the same rotation day. However,
some doctors allow their less severely allergic patients to eat a different
member of certain families on each day of the cycle. The families most often
treated this way are the grain family and the cattle family. The rotation diet
in the book this web site is excerpted from, 5 Years Without Food: The Food
Allergy Survival Guide, treats the grain and cattle families this way. If
your doctor advises against, for example, eating a different grain every day,
simply eliminate grains from three days (or two days, if he allows you to
“split” the grain family, as in the next paragraph) and instead eat the listed
non-grain alternative on those days.
On a rotation diet, food families that are not a major problem for you
can be “split.” This means that you eat some of the foods in the family on, for
example, day 1 of a four day cycle, and others of them on day 3. I like to split
the vegetable families that contain dark green leafy vegetables so I can eat
some of these extremely nutritious foods every day. Using the rotation diet in
5 Years Without Food: The Food Allergy Survival Guide, you could eat
goosefoot family vegetables on days 1 and 3 (chard on day 1 and spinach on day
3, for example) and cabbage family vegetables on days 2 and 4 (collards on day 2
and arugula on day 4, for example).
When you first start on rotation, you may find it easiest to follow a
set rotation diet such as the one in 5 Years Without Food: The Food Allergy
Survival Guide. However, after a while you may tire of eating the same
combinations of foods every fourth day. For variety you may wish to rotate
different categories of foods on different lengths of cycles. For example,
rotate your grains or non-grain alternatives, oils (and other foods in the same
family), and fruit sweeteners used in baking (and therefore also the fruits they
come from) on a four day cycle, so leftover baked goods from Monday can be
frozen and eaten on Friday. Rotate meats or other protein foods and vegetables
on longer cycles. Decide each day what vegetables and proteins you want to eat
and record them so you can be sure you have not eaten the same or related foods
for at least four days. Rotating foods at longer intervals this way may also
improve your tolerance for them, although this is not the case for all
Since most food allergies are not “fixed,” after you have avoided your
problem foods for several months, your doctor may advise you to try to
reintroduce them into your diet. When you are ready to liberalize your diet, you
should eat your problem foods in moderate amounts and on a strictly rotated
basis. You may find that you can eat some of them every fourth day with no
problems, but that others must be rotated at longer intervals in order for you
to tolerate them. For example, after six months of avoidance, my son, Joel, was
able to add most of his problem foods back into his diet at five day intervals,
but he could eat corn only once or twice a month. If he ate it weekly, his
eczema would flare up. Several years ago when I was able to eat grains
occasionally, I could eat one serving about once a month during the winter
months without having problems. If I ate them more often or during pollen
season, I could not tolerate them.
Medications and supplements may be used to help deal with food allergy
symptoms. GastrocromTM is a prescription medication that can give
people with food allergies some relief. It is sodium cromolyn, a drug which is
taken by inhalation for hay fever and asthma and orally for food allergies. It
must be used before exposure to an allergen, and works by preventing the release
of histamine and other chemicals which initiate and mediate the allergic
response. Because GastrocromTM suppresses symptoms without having any
effect at all on the causes of food allergies, I have heard of patients getting
progressively worse while taking it, although they may initially feel better.
Other allergy medications such as antihistamines may also help suppress your
Digestive enzymes help you break down your food into smaller less
allergenic molecules, thus decreasing your reaction to the foods you eat. They
can be quite useful for short term use as part of the recovery process. Because
digestive enzymes are large complex protein molecules, you may not want to use
them for long periods of time without rotating the sources they come from or you
could become allergic to the enzyme preparations themselves.
Vitamin C is a general anti-allergy supplement. We experience allergic
symptoms when an allergen-antibody complex causes mast cells to release
histamine and other allergy-mediating chemicals. Vitamin C helps stabilize mast
cells so they are less likely to release these substances.
Large doses of quercitin, such as 4 to 6 grams per day, may also be
helpful to some allergy patients.
Pantothenic acid is sometimes used for general allergy relief. It
supports the function of the adrenal glands which make hormones that help us
cope with allergic reactions. Bicarbonate preparations such as Alka Seltzer GoldTM,
Vital Life Bi-Carb FormulaTM, or Tri-Salts are useful as a “quick
fix” for food reactions. The pH of the body becomes more acid during an allergic
reaction, and these supplements help alkalinize the blood, thus making you feel
better. However, they should not be over-used because they neutralize stomach
acid, which is essential to good digestion and to the support of healthy
intestinal flora. Bicarbonate preparations are best used twenty minutes to an
hour following the meal to which you react so they do not interfere with the
digestion of your next meal. The bicarbonate preparations, as all supplements
you use, should be hypoallergenic themselves. Alka Seltzer GoldTM
contains corn and thus is not appropriate for corn-sensitive patients.
Immunotherapy may also be used to treat food allergies by modifying the
immune response to allergenic foods. While standard conventional allergy shots
are not effective for food allergies, two types of immunotherapy were developed
in the 1960's that are useful. In this country, neutralization is the most
widely used type of immunotherapy for food allergies. The patient is tested
using the provocation-neutralization method described at the beginning of this
part of the web site, and the dilutions of food extracts which “neutralize” the
patient's reactions are determined. These dilutions are called “neutralizing
doses.” The doctor’s office then prepares a solution containing neutralizing
doses of extracts for all the foods to which the patient is allergic. The
patient takes this neutralizing solution either under the tongue or by
self-injection. When an allergenic food is eaten, the neutralizing solution
should turn off the patient’s reaction to the food. Because neutralizing doses
change, patients must be retested frequently to keep their neutralizing drops
current and working effectively.
Enzyme potentiated desensitization (EPD) is another type of
immunotherapy which has been used in England for about thirty years and for
several years in this country. Currently, EPD is banned from use in the United
Click here to see how you can help bring it back.
EPD is used to treat inhalant allergies, adverse reactions to chemicals,
and food allergies all at the same time. It stimulates the body to make
T-suppressor lymphocytes specific for allergen suppression. These lymphocytes
retrain the body not to react to allergenic substances. An EPD shot contains
very minute amounts of allergens combined with an enzyme, beta-glucuronidase,
that causes the body to make these T-suppressor lymphocytes.9 The
shots are taken every two months at first and then at progressively longer
intervals. Many patients can discontinue EPD and remain symptom free after they
have taken about eighteen shots over a period of about seven years.10
Because the shots' effectiveness is dependent on having the correct, very low
dose exposure to allergens at the time the enzyme is given, the patient must
avoid exposure to high amounts of allergens around the time of their shots. For
severely allergic persons, it may take two to three years of treatment to
achieve good results with all food allergens, but after that, most patients'
diets are usually unrestricted except for around the time of their shots.
Retesting is never required.
Before EPD treatment is begun, factors which could interfere, such as
dysbiosis, hormonal imbalances, heavy metal toxicity, and poor nutritional
status, should be corrected as well as possible. Dr. Leo Galland estimates that
in his practice of patients with digestive problems, after he treats their
dysbiosis, nutritional and other problems, and promotes intestinal healing, only
25% of those who come to him for EPD treatment for their food allergies still
By using these options for the diagnosis and treatment of food
allergies, and especially by getting to the root of the problem, as discussed in
the next issue, those of us with food allergies can progress towards optimal
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1. Reno, Liz, MA. and Joanna Devrais,
MA. Allergy Free Eating, Celestial Arts, Berkeley, CA, 1995, p.28.
2. lbid, pp. 29-30.
3. lbid, pp. 29-30.
4. Personal communication from W. A.
Shrader, Jr., M.D., April, 1997.
5. Reno, Liz, M.A. et al, pp. 30-31.
6. Interview with Russell Jaffe,
M.D., Ph.D., "Allergy Testing,' Mastering Food Allergies Newsletter, #44,
April, 1990, p. 3.
7. Personal communication from W. A.
Shrader, Jr., M.D., April, 1997.
8. Personal communication from W. A.
Shrader, Jr., M.D., April, 1997.
9. Interview with W. A. Shrader, Jr.
M.D. “Enzyme Potentiated Desensitization (EPD): Exciting New Hope for Food
Allergies," Mastering Food Allergies Newsletter, #74, July/August 1993,
10. Interview with Len McEwen, M.D.
and W. A. Shrader, Jr. M.D. “EPD Update," Mastering Food Allergies Newsletter,
#88, November/December 1995, p. 3.
11. lbid, p. 1.