Food Allergy/Eosinophilic Esophagitis

peanutsFood allergies occur when the immune system over-reacts to food proteins, producing a range of symptoms and conditions from major (asthma/anaphylaxis) to minor (eczema, allergic rhinitis). While any food can trigger allergy, the most common are eggs, milk, peanut, soy, fish, shellfish, tree nuts and wheat. The prevalence of food allergies is increasing: a CDC report showed an 18% rise in food allergies among US children since the 1990s. Long thought of as primarily genetic, environmental exposures also play a role in food allergy development. For example, children aged 7 and 12 months receiving 3 or more courses of antibiotics develop almost twice the rate of food allergies of those who do not; the hygiene hypothesis.[26]  For years, evidence suggested that delaying introduction of particular foods (cow milk, eggs, peanuts) to infants helped to delay eczema (skin allergy) onset.[24] However, a recent, very important study is likely reversing this idea.

While children often “out grow” them, food allergy history relates to certain gene types/allergic tendencies (atopy); medical providers should consider food allergy history when evaluating adults with atopic, or allergic, conditions.

Generally, there are 2 types of food allergies: IgE and non-IgE-antibody mediated. The IgE-type generally affects the upper and lower respiratory tracks and skin. Symptoms can vary from mild throat/lip itching/tingling (often to foods contaminated by pollen) or nasal congestion/running to severe trachea/bronchi/lung swelling and closure (asthma attack). The skin may demonstrate mild redness to severe angioedema (firm, red swelling). In anaphylaxis, the most severe case, lungs may completely close and blood vessels dilate (cardiovascular collapse); it can be lethal. Nausea, vomiting, abdominal pain and some diarrhea may accompany any food allergy.

Non-IgE mediated allergies present differently. Allergic gastroenteritis (often caused by shellfish) presents as severe cramping and diarrhea without fever or much vomiting. In eosinophilic esophagitis, typical symptoms include abdominal pain, nausea and feeling full right after eating. Others note reflux, especially with the feeling that food is “stuck in the throat”. This problem does not respond well to acid blockage, but may respond to inhaled steroids, or to esophageal dilation, if scarring has occurred.

Click here learn more about how allergy responses occur in the body.

Identifying the cause of allergies may require some detective work. Not only the cause, but the amount, associated factors (alcohol, exercise, NSAIDs), and treatment responses need clarification as well. A diet diary is key; blood or skin testing narrows down confounding presentations. When testing fails to clarify the offending agent, elimination diets, and, occasionally, physician-supervised food challenges are required.

Neither Western/conventional nor Eastern medicines can eliminate food allergy; strict abstinence from the offending food, including avoidance of any cross-contamination, is the only treatment. This often requires family and institutional assistance, especially for severe allergies. For example, a daycare center caring for a severely peanut-allergic child should not have peanut-containing products on premises. While avoiding processed food products is encouraged, those who do eat commercial or restaurant foods must query labels/staff about food contents. Those with severe allergies should avoid certain restaurants altogether. For example, Southeast Asian restaurants often serve peanut and shellfish, and cross-contamination may be difficult to avoid.

Western/conventional treatment of severe allergic reactions should never be supplanted by alternative medicine of any kind. Each severely allergic patient should have a clear emergency management plan and wear medical identification jewelry. Asthma, anaphylaxis or any other severe allergic reaction to an offending food must be acutely treated with conventional medications: epinephrine (pen), bronchodilators, corticosteroids, antihistamines/H2 blockers. Those with food-related chronic allergic rhinitis may benefit from inhaled nasal steroid or daily medications used in asthma (leukotriene inhibitors (like Singulair), inhaled steroids, etc). Immunotherapy (“allergy shots”, serial desensitization to the substance) helps some: a sublingual (under the tongue) version may be available soon.[1]

In Traditional Chinese Medicine (TCM), food allergy is considered a sign of significant derangement of the body’s overall “balance” (homeostasis). In children, “Immature Yin and Wei Qi” can be the root of food allergy. Usually, these children are “Jing/Kidney System Deficient” at birth, and may also demonstrate frequent upper respiratory tract/ear infections, dental carries, urinary abnormalities, and, sometimes, severe childhood infections or mononucleosis. For adults, food allergies may onset in the 20s-30s, and mimic the imbalances of allergic rhinitis: “Wei Qi (defensive energy /immune system) Deficiency”, “Internal Cold”, “Spleen Yang Deficiency” (“Spleen System failing to transport Fluids”), and/or “Lung System Excess or Deficiency”. Each food allergy sufferer needs to have “Spleen Qi and Wei Qi strengthened” in hopes of ameliorating responses to offending agents.

Because of the multiple causes, different people require different treatments at different times to address food allergy. Both TCM and Ayurveda link refined carbohydrates, glutinous, oily/friend, cold and unrefined dairy products to food allergy/intolerance tendency.

As a complex problem, usually multiple treatment modalities are used. Acupuncture and Chinese Herbal Medicine especially address the underlying problem. Most dramatically, One-Needle Allergy Desensitization Therapy may actually eliminate or attenuate certain allergic responses, and significantly reduce IgE-type food allergy symptoms. Following the dietary principles of Ayurveda, India’s traditional medical system, very much strengthens digestion (“Spleen Qi” in TCM) and teaches satisfying meal preparation using foods less commonly allergenic: vegetables, legumes, rice, and spices.[2,3]

Learn more about Food Allergies

Learn more Eosinophilic Esophagitis here

Obtain Food Allergy Management Plans here

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1] Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles:

Allergic and Environmental Asthma: an Overview of Asthma
William F Kelly III, MD  Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Staff physician, Division of Pulmonary/Critical Care Medicine, Department of Medicine, Walter Reed National Military Medical Center

Allergic Rhinitis
Javed Sheikh, MD  Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Food Allergies
Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Atopic Dermatitis
Brian S Kim, MD  Clinical Instructor, Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania

Seborrheic Dermatitis
Samuel T Selden, MD  Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Psoriasis
Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Urticaria
M Scott Linscott, MD, FACEP  Adjunct Professor of Surgery (Clinical), Division of Emergency Medicine, University of Utah School of Medicine

Cholinergic Urticaria
Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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