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. 

 Diagnostic Tools

     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 malnutrition). 

     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 days. 

     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 patients. 

     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 symptoms. 

     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 States.  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 need it.11

     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 health. 


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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, pp. 1-2. 

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. 



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