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Food Allergies Today: An Expert Q & A

There are many unknowns in the food allergy world today. Why are food allergies on the rise? What can I do to prevent my child from developing a food allergy? How do I find out if I have a food allergy or intolerance, or if my child has one? With the help of two of our medical advisors, Dr. Jordan Scott and Dr. John Lee, we have answered some of these common food allergy questions to help you dine with confidence! Let’s get started.

1) What is a food allergy and how does it differ from a food intolerance?

A food allergy is an immune system reaction. Your immune system is comprised of five different types of immunoglobulins/antibodies (IgA, IgD, IgE, IgG, and IgM). If you have a food allergy, IgE is the responsive antibody. When exposed to a food allergen, IgE attaches to the allergen, mistaking it as a foreign intruder. This IgE-allergen compound then binds to immune cells, triggering a release of histamine and other chemicals that produce an allergic reaction. Symptoms can affect the central nervous, respiratory, and gastrointestinal systems, and produce epidermal symptoms such as hives, rashes, or eczema. In the most extreme cases, a food-allergic reaction produces anaphylaxis, a life-threatening response that requires immediate medical treatment.

Food intolerances often affect gastrointestinal function, but they can also impact the central nervous system, respiratory health, and skin. The main difference between a food allergy and intolerance is that, although intolerance symptoms can be severe, they are not life threatening and will not produce anaphylaxis.

2) What are the leading theories for the significant increase in food allergies? 

Between 1997 and 2011, food allergies among children increased approximately 50 percent, according to the CDC. Unfortunately, there is no clear answer as to why. Below are some of the leading theories, in no particular order.

Theory One: Changes in our food system

Over the past few decades, our agricultural system has undergone a considerable transformation, including the introduction of GMOs (genetically modified organisms), increased pesticide application, and the addition of numerous chemicals to our foods. This theory suggests that these chemicals and modified foods are affecting our bodies and immune systems, particularly our gut health, thereby increasing our susceptibility to food allergies and intolerances.

Theory Two: Hygiene hypothesis

The second theory is the “hygiene hypothesis,” suggesting that our modern world is too clean, and our reduced exposure to bacteria is weakening our immune systems. Some research also suggests that the overuse of antibiotics in animals and the rise of prescription medication is killing the good bacteria in our gut alongside the bad.

Theory Three: Epigenetics

Some research indicates epigenetics are responsible for the rapid increase in food allergies—heritable changes in gene expression that don’t change the underlying DNA sequence. Epigenetic changes can be the product of environmental or other external factors, like diet or smoking, or the result of natural occurrence. Research is continuing to uncover the role of epigenetics in a variety of human disorders and fatal diseases.

Theory Four: Delayed allergen exposure

In the past few years, a growing body of research is suggesting that we may not be introducing children early enough to common allergens. In February 2015, the LEAP Study results came out, debunking the previously accepted practice of discouraging exposure to peanut among high-risk infants. This misguided approach may have contributed to the rise of peanut allergies and other food allergies.

3) What are the current methods for diagnosing a food allergy? How have they changed in the past several years? 

To diagnose a food allergy, an allergist performs one of two tests (or both): a blood test (such as an ImmunoCAP test) and/or a skin prick test. The blood test measures the level of allergen-specific IgE antibodies present in the blood. Skin prick tests are exactly as they sound: the allergists pricks the patient’s arm or back with a sterile small probe containing a tiny amount of the food allergen. A food allergy diagnosis is confirmed if a wheal (a raised white bump surrounded by a small circle of red irritated skin) develops around the contact area.

In some cases, an allergist may suggest a food elimination diet to pinpoint the offending food. They may also recommend an oral food challenge.

In an oral food challenge, an allergist administers tiny amounts of the potential allergen in gradually increasing doses over a set period of time (usually 1-3 hours). The patient is closely monitored in the event the food produces an allergic reaction, and epinephrine is always on hand in case of a reaction.

To date, oral food challenges are considered the gold standard for food allergy diagnosis. Skin prick and blood tests aid in diagnosis, but they are prone to error—false positives are not uncommon. For this reason, many allergists avoid blanket food allergy screening, and carefully choose which foods to test. Skin prick tests and blood tests have been standard practice for aiding in allergy diagnosis for the past two decades.

4) What are some common allergic reaction symptoms?

It’s first important to note that no two allergic reactions are the same, and just because you have a mild reaction to a small bit of sesame one day, doesn’t mean symptoms will present in the same way the next time you ingest that same small amount. Below are the most common symptoms to an allergic reaction.  

Mild symptoms include: itchy or runny nose, sneezing, itchy mouth, a few hives or mild itch, and mild nausea or discomfort.

Severe symptoms include: shortness of breath, wheezing, repetitive cough, pale or bluish skin, faintness, weak pulse, dizziness, tight or hoarse throat, trouble breathing or swallowing, significant swelling of the tongue or lips, hives or widespread redness, repetitive vomiting or severe diarrhea, anxiety or confusion, or some combination thereof.

It’s important that food-allergic individuals also be aware of biphasic anaphylaxis. A biphasic allergic reaction is a second episode of anaphylaxes that typically occurs within the first several hours after the initial anaphylactic event. The symptoms of biphasic anaphylaxis can be more severe than the initial reaction. Due to the risk of biphasic anaphylaxis, a doctor may require that you remain in the hospital for several hours after an anaphylactic event for monitoring.

5) What are the most common misconceptions about food allergies? 

There are several misconceptions about food allergies. Below are a few that we hear most frequently:

Food allergies aren’t real—False. Food allergies are real. They are a response to the body’s immune system upon exposure to an allergen. The immune system misinterprets the food as a harmful invader and releases histamine and other chemicals to protect the body from perceived harm.

Food allergies aren’t life threatening—False. If an allergic reaction becomes severe, it can lead to anaphylaxis—a potentially fatal allergic reaction that involves the rapid onset of swelling which can obstruct air passageways. Symptoms of an allergic reaction may be isolated to one major system in the body (e.g., wheezing or difficulty breathing), or can involve multiple systems (e.g., lungs, heart, throat, mouth, skin, or gut), and typically present within minutes after a person ingests the offending food.

Each allergic reaction becomes increasingly worse—Not necessarily. Allergic reactions can be unpredictable. The severity of a reaction is based on a number of factors, including: the amount of the allergenic food ingested, the person’s degree of sensitivity to that food, if exercise is involved, if they are sick, if alcohol is present in their body, and if certain medications are being used (for example, NSAIDS may increase the severity of a reaction). A person with food allergies might not always experience the same symptoms each time.

A food can be made less allergenic by cooking it—Partially true. Because a food allergy is an immune system response to a protein in a food, the protein remains in the food during heating, so it cannot be cooked out. The exception to this rule is sometimes seen in highly processed foods, and with milk and egg allergies—some people are able to consume these foods after heating, such as baked goods. Ask your allergist before trying this at home.

Adults don’t develop food allergies—False. Though most food allergies start in childhood, they can develop at any age.

Peanuts are the only food that cause severe reactions—False. While peanuts are the leading trigger of food-related anaphylaxis, any food can elicit a severe reaction—other common foods include seafood, milk, wheat, eggs, and sesame seeds.

One small bite is ok—If someone has a severe food allergy, and is highly sensitive to small amounts, even a tiny bite can trigger anaphylaxis. It is well documented that allergic individuals can experience severe reactions to trace amounts of an allergen in their food.

6) What are the three most important things a food-allergic individual can communicate to their friends, family, and co-workers?

First, alert your “tribe” (friends, family, work colleagues, caregivers) of your food allergies and their accompanying health risk. Also note the various ways you can be exposed (e.g., ingestion, touch, and inhalation).

Second, let them know what symptoms to watch for in case of a reaction.

Finally, tell them where you keep your emergency medications and teach them how to use an epinephrine auto-injector. Share your doctor-provided food allergy action plan, if you have one. Often parents with food-allergic children have one to serve as a guide for caregivers. The American Academy of Pediatrics recently published a customizable Allergy and Anaphylaxis Emergency Plan.

7) What role do you see technology playing in the lives of individuals with food allergies and how they manage them now, and in future? 

Food allergies have increased at an alarming rate over the past two decades. The silver lining is that we’re putting more research dollars and efforts into allergy education, management, and prevention. Numerous start-ups are spearheading this effort with cutting-edge technologies and innovation. This Spokin article published in January highlights several. Until we find a cure, technology is going to become a necessary part of how we manage food allergies.

8) What will be important for future food allergy diagnoses and treatment?

With food allergy diagnoses at an all-time high, it will become increasingly important to have improved diagnostic tools available to better understand who is at risk for severe reactions. New therapies to help people better manage their allergies are being developed every day. One example is oral immunotherapy, or OIT. OIT is a method of food desensitization that involves re-introducing the immune system to the allergenic food via oral ingestion in gradually increasing amounts over time, with the goal of eventual tolerance. Another example is the Viaskin® patch, otherwise known as the peanut patch. This approach uses epicutaneous immunotherapy. After applying the patch to your skin, the allergen is concentrated in the top layers of the skin, where it activates the immune system by targeting antigen-presenting cells without passage of the antigen into the bloodstream. The peanut patch recently entered Phase III clinical trials. Products are also currently being developed for milk and egg.

Is desensitization the future of food allergies? Or is a cure on the horizon? Only time will tell. Until then, innovation, research, heightened awareness, and education are paving the way for a brighter food allergy future.

If you have additional questions you’d like our experts to answer, please send them to Meg at mnohe@allergyamulet.com. We’d love to hear from you!

- The Allergy Amulet Team

 

These questions, and their corresponding responses, were written by the Allergy Amulet team and reviewed by Allergy Amulet advisors, Dr. Jordan Scott and Dr. John Lee.

Dr. Scott is an allergist/immunologist and operates several private allergy clinics throughout the Boston area. He is on the board of overseers at Boston Children’s Hospital, and the past president of the Massachusetts Allergy and Asthma Society. Dr. Scott is an allergy/immunology instructor at the University of Massachusetts.

Dr. Lee is the clinical director of the food allergy program at Boston Children’s Hospital. Dr. Lee is widely recognized for his work in food allergy, and his commitment to patient health.

 

 

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Dear Mother, Dear Daughter

In the spirit of Mother’s Day, two of our food allergy mavens at Allergy Amulet wrote letters to their mom and daughter, respectively, about their food allergy journeys together. Abi Barnes, Allergy Amulet’s CEO and Co-Founder, has lived with food allergies her entire life. Meg Nohe, Allergy Amulet’s Director of Strategic Development, has a daughter with food allergies. We hope you enjoy.

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Dear Mom,

I sometimes look back at my childhood and think, This is why I have a dog. By Darwin’s logic, I should never have made it.

You raised the textbook definition of “bubble girl”: severe asthma, eczema, and the only kid I remember growing up with food allergies. And you did it all before food allergy labeling laws existed, at a time when most folks had never encountered a food-allergic child, and when food allergy organizations and advocacy groups were nonexistent. Pizza joints didn’t know what to make of a child who was allergic to tomato sauce. I like to think you’re the reason “white pizza” is now a thing. Dad and Grandma were particularly dumbfounded: How is the daughter of a long line of Mainers allergic to lobster?

I remember sitting in Nurse Losey’s office in elementary school during recess, hooked up to my nebulizer, watching classmates walk into the infirmary with bruises and scrapes on their knees seeking antiseptic and a bandage. They would glance over at me in wonder, as I breathed in clouds of white smoke from a long tube connected to a noisy white box. Nurse Losey, with her kind eyes and motherly demeanor, would smile at me and carefully close the infirmary curtains around me, shielding me from stares.

Needless to say, there were days when I felt different.

But you worked hard to create a cocoon of normalcy around me. On friends' birthdays and school events, you’d arrive with white pizza and plain vanilla cupcakes so that I didn’t feel left out. You’d adeptly deflect attention away from my special accommodations. Most kids probably didn’t even know that I was always a heartbeat away from the hospital. I also don’t remember ever being teased or taunted as a kid for my food allergies or asthma, although I’m sure it happened from time to time. You also encouraged me to talk openly about my food allergies and asthma—it was nothing to be embarrassed about, you’d say.

You were my life raft as a child. You and your fanny pack full of antihistamines, epinephrine, and inhalers. I can only imagine the stress and fear that accompanied my fragile condition. The terror that must have filled your bones when I would say those four words: “My mouth feels itchy.”

You’re a rare breed, Mom. Always have been. Anyone who knows you would say the same. You’re uncannily selfless and kind; a wellspring of creativity and optimism. And you’re fiercely genuine—a quality I constantly strive to emulate. To say that I am fortunate to have you as a mother would be an understatement. I wouldn’t have made it this far without you.   

Once a life raft, now an anchor. Thank you for first keeping me afloat, and now ever grounded. With love. Happy Mother’s Day.

Abi

P.S. Dad, I know you helped out too, but it’s not your day… ;)

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My sweet E,

I’ve often been told that a mother should always trust her instincts—that motherly intuition goes beyond scientific explanation.

A few months after you were born, I remember having this gut feeling that something was not quite right when it came to food—you had countless stomach issues, unexplained discomfort, and trouble with weight gain. We tried removing dairy and soy from your diet, administering medication for your reflux, and nothing worked. At one year old, we found out that you were allergic to peanuts and tree nuts.

And it all made sense.

I went through a flood of different emotions after your diagnosis: first fear for your safety and social adjustment as you grew older, and then anxiety over what I didn’t yet understand about managing food allergies. There was also guilt. Guilt that I spent a year not knowing about your allergies. Was it something I caused when you were in utero? Could we have prevented this? Did I fail you by not identifying the symptoms?

At the time, no one in our family had food allergies. After blaming myself for a few months, I accepted the fact that I didn’t know what I didn’t know, and decided to put my energy and efforts into ­­­­­­­­­being your advocate and cheerleader. At nights when you went to bed I researched food allergies and watched educational seminars. I trained our “tribe” to ensure you would always be safe when I wasn’t around. I quit my job in medical device branding to throw all my time and efforts into figuring out my “place” in the world of food allergy advocacy and education. Was part of this guilt-driven? A little. But mostly, I realized that there are SO MANY children like you deeply affected by food allergies, and I wanted to do anything I could to help your voices be heard.

Fast forward to 2017—we’ve been a food allergy family for a few years and you’re THRIVING! You still have nut allergies, but you’ve outgrown a couple of them, and we’ve completed oral immunotherapy for several others. You’ve learned to advocate some for yourself, and talk openly about your allergies without fear or embarrassment. And I’m SO PROUD!

I’m also thankful that we’re walking this journey together in 2017 versus decades previous. FDA food allergen labeling has come so far; and thanks to living in the digital era, we’ve been able to join a support network that we might not have had otherwise. Then there’s technology (like the Allergy Amulet), immunotherapies to help manage food allergies, and lots of food allergy innovation going on today. And I’m grateful.

Who knows, ten years from now maybe you’ll be desensitized to all of your food allergies, or maybe you’ll have outgrown them! It’s hard to even imagine that this phase of life may become a distant memory.

While this path is not one I would have chosen for you, I’m so blessed to walk it alongside you. And that’s where I’ll be. Love you always.

Mom

 

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Four Easy Steps to Improve Gut Health

We’ve all heard the saying “You are what you eat.” Though true, a more accurate saying would be “You are what you digest and absorb.” The difference is in the gut. Gut health is essential to whole-body health. Over 50% percent of our immune cells reside in the intestines (a component of the gut), which means that the food and bacteria that enter that space have a huge impact on our immune system.

Before we discuss strategies to improve gut health, here’s a crash course on the gut:

The gut (gastrointestinal tract) is the long tube that starts at the mouth and ends at the rectum (see image). It is lined with millions of cells which act as a barrier between the food we ingest and our bloodstream. A weakened lining (intestinal permeability) allows food particles to enter the bloodstream, which can trigger an immune response, including an allergic reaction. This response is different from one triggered by a food intolerance, which instead affects the body’s ability to digest food.  

The correlation between gut health and food allergies is still largely unknown. However, a growing body of research suggests that gut health and food allergies are closely intertwined. 

What IS clear is that gut health plays an important role in maintaining a healthy immune system. Accordingly, below are four steps you can take to improve your gut health.

1.     Add bone broth to your diet.

You can help maximize gut nutrient absorption and preserve the integrity of the gut barrier by consuming glutamine-rich foods like bone broth. There are many healing nutrients and anti-inflammatory properties in bone broth such as glutamine. Glutamine is an anti-inflammatory nutrient known for its role in gut healing. Bone broth also contains minerals in a form the body can easily absorb.

The thought of making bone broth is intimidating to many, but the process is surprisingly simple. Plus bones are not hard to find! Tips and recipe here.

2.     Consume probiotic and prebiotic-rich foods.

The gut microbiome stores all bacteria in the large intestine. These bacteria feed off of the food and fiber we eat. Probiotics are the actual bacteria in the gut, whereas prebiotics are the foods that feed those bacteria.

How does bacteria relate to food allergies? Good bacteria help regulate inflammatory responses in the gut (like an allergic reaction). These bacteria teach our immune system how to tolerate dietary proteins and other allergens in the environment. For example, research has shown that certain strains of bacteria in the Clostridia family may desensitize individuals to food allergens.  

Probiotic-rich foods include: sauerkraut, kimchee, kombucha, miso, tempeh, and dairy sources (kefir, yogurt, cottage cheese) that say “contains live cultures.”

Prebiotic-rich foods include: asparagus, garlic, legumes, flaxseed, onion, leeks, chicory root, Jerusalem artichokes, bananas, leafy greens, oats, and potatoes (cooked with a slight crunch left).

3.     Avoid microbe killers and digestion disruptors.

If you were walking barefoot and stepped on a sharp woodchip that got stuck in your foot, what is the first thing you would do? Would you remove the woodchip or would you add ointment and a bandage? No-brainer, right? You’d remove the woodchip. So, when it comes to gut health, we need to first start by removing those foods from our diet that harm the gut. This means different things for different people. Research has shown that for some individuals, gluten, dairy, eggs, or soy can trigger gut inflammation—even without symptoms. Others may experience symptoms after ingesting certain foods like citrus, chocolate, or MSG. Depending on the person, the process of identifying which foods may be harming your gut varies. Many people maintain a healthy gut simply by avoiding processed foods. The synthetic ingredients found in most processed foods are generally harmful to gut health. Beyond that, to identify which individual foods may be affecting your gut and immune system, it is helpful to get an individual assessment from a dietitian, nutritionist, or healthcare provider who practices integrative or functional medicine.

To keep the gut microbiome healthy, it also helps to avoid frequent antibiotic and antacid use. Though antibiotics kill bad bacteria, they also kill the good, leaving our gut ill-equipped to do its job. And make sure to always consume probiotics during and after antibiotic use.

4.     Stick to real food!

Unfortunately, our modern diet tends to be packed with junk food. Processed foods, refined sugars, and artificial ingredients wreak havoc on our gut. By consuming whole foods on a daily basis (this is especially important for kids), the gut not only gets the fiber it needs to feed the good bacteria, but also gets a boatload of micronutrients to fuel the immune system.

Recipes and guides here!

 

This guest post was written by Robyn Johnson: MS, RDN, and LD—Integrative Dietitian Nutritionist.

 

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Should I Go Gluten-Free? Break it Down for Me

 

 

Google “gluten free” and you get roughly 150,000,000 results.

Clearly, the topic of gluten is trending.  You probably know at least one person that has cut gluten from their diet.  This begs the question: Is eating gluten-free a fad?  Will it pass by us eventually à la fat-free diets?  And what about the choice of whether or not you should go gluten-free?  Friends, that question is one we hear a lot.  And we want to help you find the answer.

Without having a severe gluten intolerance or celiac disease, it can be tough to know if it’s worth it, right?  How do you know if you have a gluten intolerance, celiac disease, or a sensitivity?  Well, while there is a test that can identify whether or not you have celiac disease, the only surefire way to know if you have a sensitivity is by eliminating gluten from your diet and seeing how your body responds after gradually reintroducing it thereafter.

To start, it’s important to understand the different types of gluten sensitivities.  These varying sensitivities can have different OR similar symptoms—and it’s often much more than just a bad stomachache.  Here’s a deeper look at the different sensitivities so you can better identify how gluten may be impacting you:

1. Gluten is a BIG problem for you (e.g., celiac disease)

Celiac disease is on the rise.  The condition, also called celiac sprue, coeliac, and gluten-sensitive enteropathy, once considered rare now affects more people than ever: 1 in 100.  Many physicians believe it is a grossly undiagnosed disease, and some doctors now regularly screen anyone with severe digestive complaints for the troubling illness.  The reality is that celiac is more than an uncomfortable condition—it can be life threatening, and is characterized by autoimmune antibodies.  It’s important to understand that celiac CANNOT cause anaphylaxis—a severe and potentially life-threatening allergic reaction—unlike a wheat allergy, for example.  Most people will not die from the immediate symptoms of celiac disease. However, left untreated, it can lead to several other conditions, some of which can be fatal.

●      Common symptoms: Stomach pain, chronic diarrhea, bloating, fatigue, floating or foul smelling stool, depression, fatigue, infertility, and weight loss.

●      Associated symptoms & conditions: Itchy rash, peripheral neuropathy, ataxia, osteoporosis, behavioral changes, irregular menstrual cycle, infertility, Addison’s disease, fibromyalgia, autism, anxiety/depression, chronic fatigue syndrome, inflammatory bowel disease, irritable bowel syndrome, severe headaches/migraines, rheumatoid arthritis, Hashimoto’s thyroiditis, Graves disease, type 1 diabetes, pancreatic disorders, and multiple sclerosis.

●      Diagnosis: To diagnose celiac disease, your doctor will administer a blood test called a Tissue Transglutaminase Antibodies (tTG-IgA), and you must have gluten in your system at the time of the test—if you’re on a gluten-free diet the test may produce false negative results.  This test is 98% accurate in patients with celiac disease.

2. You don’t have celiac disease, but something is way off (e.g., gluten intolerance/sensitivity)

Many people experience symptoms like those of celiac disease, despite negative tTG-IgA test results and intestinal biopsies revealing no tissue damage. It is unclear what the underlying cause is for a gluten intolerance or sensitivity, and is often diagnosed based on a patient’s response to a gluten-free diet.

●      Common symptoms: Often the same as celiac, and primarily digestive distress.

●      Dietary Recommendations: Having a severe gluten intolerance is becoming increasingly common, and it can be very frustrating because it’s difficult to obtain a clear diagnosis.  Gluten sensitivity can manifest in the same way as celiac disease, but with greater variability in severity and duration.  Your best bet may be to try an elimination diet, which you can find in many of our programs!  We recommend eliminating for two months for best results.  Determining if you’re gluten sensitive is just as important as determining if you have celiac disease, because over time, the integrity of your gut health can be compromised.  Gastrointestinal health is the cornerstone of optimal health—it plays a major role in the balance of hormones, mood, cognitive function, and other aspects of overall health and well-being.

3.  Gluten doesn’t make you feel too sexy

For those that don’t have celiac disease or a diagnosed intolerance, you may just not feel so hot after you eat gluten-containing foods.  Low energy, less endurance, and overall “slowness” are common words used to describe these feelings.  By removing gluten from your diet, many in this category see a positive change in their appearance, and many professional athletes have gone gluten-free to improve athletic performance!

●      Common symptoms: Digestive distress, fatigue, energy loss, and overall blah.

●      Dietary Recommendations: We recommend eliminating gluten from your diet for two months.  Why?  Gluten is pesky and can linger in the blood stream for a long time.  Add it back into your diet gradually over time and see you how feel.

4.  Gluten ain’t no thang

You feel absolutely fine with gluten.  No cramping or chronic side effects.  Perhaps you have headaches, digestive issues, or some joint pain.  You’ve tried going gluten-free for two months and noticed zero difference.  You’re realizing maybe something else is to blame.

Our feelings?  Being gluten-free is not a fad.  We have worked with too many people who notice legitimate improvements by removing it from their diet.  With that said, it’s important to consider a few things—when you cut out gluten, you are often cutting out a lot of unhealthy food too.  You will not be able to eat most fast food, many packaged items, and other foods that simply aren’t healthy.  So you have to ask yourself, was it the gluten or was it the crummy food?  One way to determine the difference is to eat healthy sources of gluten as a trial: wheat berries, farro, and couscous are just a handful of naturally gluten-filled whole grains.  On the flip side, going gluten-free and replacing those packaged foods with gluten-free versions may not necessarily improve your health, as they’re often laden with added sugars and fats to improve flavor.  The ticket is to try removing it from your diet and trying a healthy whole foods diet (with gluten grains) to see if gluten is the cause!

SO, what do you think? 

We hope this information helps guide you in making the decision of whether to go gluten-free.  Ultimately, the best way to find out whether a gluten-free diet is right for you is to remove it from your diet, then gauge how your body responds upon reintroduction.  We help people explore this in our 20-day nutrition program: Prescribe 20.  Because going at these things alone is never easy, and rarely successful, we believe that community is the key to success.  With our programs, we’re with you every step of the way, offering recipes, educational materials, and professional guidance.  With this support system in place, the process of discovering how to feed YOUR body isn’t so bad. Not one bit.

 Megan Morris is a certified nutritionist, Co-Founder & CEO of Prescribe Nutrition, and Founder of The Root of Health: an online digestive health resource. 

 

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OIT—Is It For Me?

Feeding your peanut-allergic child peanuts is not easy as a mother—I would know, I do it every day. Your instincts as a parent are to keep your child as far out of harm’s way as possible. But in today’s world, peanuts may be the best management tool we have for my peanut-allergic child.

Let me explain.

My daughter was born with a severe allergy to peanuts and tree nuts. For the first three years of her life, we strictly avoided these foods. She’s now four. Last April, we agreed to undergo an oral food challenge at her allergist’s office to find out if she was still allergic. Her peanut blood test numbers had dropped considerably—this blood test measures levels of Immunoglobulin E (IgE) to individual allergens in the body. IgE is the antibody that triggers food allergy symptoms. Plus, she hadn’t been exposed to peanut since she was a baby. Unfortunately, the oral food challenge outcome wasn’t as we hoped: after ingesting ¼ of a peanut, split into three gradually increasing doses over a 45-minute period, she experienced an anaphylactic event and we had to administer epinephrine. It was an emotional day, to say the least.

After discovering that she was still severely allergic to peanuts, we decided to explore oral immunotherapy: a method of food desensitization that involves re-introducing the immune system to the allergenic food in gradually increasing amounts over time, with the goal of eventual tolerance.

For our family, the results have been life changing. The same little girl that reacted to ¼ of a peanut now eats 12 peanuts daily with zero symptoms. But OIT is not necessarily for everyone, so I’d like to share our family’s journey and offer some insights into the process so that you can determine whether it’s a good fit for you or your child.

If your allergist doesn’t have a clear picture of your allergy severity, treatment may start with an oral food challenge. Once the individual has been identified as an OIT candidate, they are typically provided a juice-like beverage containing tiny amounts of the allergen. This beverage is consumed during the same two-hour period every day. Depending on how quickly a patient builds up a tolerance, your allergist may recommend coming in every week or two for an “updose”—an increase in the amount of allergen consumed. As the immune system grows more tolerant, the patient eventually moves to a powder form (which is typically sprinkled onto food), and finally to solids (e.g., whole nuts).

Importantly, OIT requires a considerable time commitment. Although updosing typically occurs every week or two, the allergen must be consumed every day to build and maintain tolerance. OIT also places constraints on physical activity. During OIT, the patient can only engage in calm, quiet activity half an hour before dosing, and at least two hours afterwards (during their observation period). This ensures that the immune system doesn’t get “revved up” unnecessarily and trigger an allergic reaction.

Is OIT perfect? Not quite. For the foreseeable future, my daughter must eat 12 peanuts with a two-hour observation period everyday. However, we can now choose the time frame each day, and expect the observation period to shorten over time. There’s also a measure of unpredictability. On two occasions, our daughter developed a couple hives after her prescribed dose, and we had to give her antihistamines. Other times, we had to lower her dose because she was sick, which can compromise the immune system. It is these situations, and the risk of producing a more serious adverse outcome, that discourages many allergists from taking up the practice. Indeed, OIT is still relatively controversial. Additionally, OIT treatments are still in their nascent stages and are not widely practiced, so there is less data and information available.

Importantly, not every food-allergic child or adult is a good candidate for OIT. For example, if a patient has severe environmental allergies, acute asthma, or eosinophilic esophagitis, they will not likely qualify for OIT. Additionally, OIT treatment is not available for all allergens—desensitization to peanuts, for example, is far more common practice than, say, shellfish.

If you think OIT may be of interest to your family, I’d encourage you to talk to your allergist and seek out additional information and guidance. You can also reach out to me at mnohe@allergyamulet.com for more on the parent perspective—I’m always up for a good food allergy chat!

- Meg, Director of Strategic Development

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