Tag Archives: food allergies

Craig Friesen: Understanding Food Allergies and Food Intolerance in DGBIs

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Dr. Craig Friesen gave our group an excellent update on food allergy and disorders of brain-gut interaction (DGBIs).  His main disclosure was that he is not an allergist. My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of his slides.

Key points:

  • Food allergies are common affecting 6-10% of the population. In infants, milk and egg are common allergens. Nut allergies are more frequently seen in children
  • There are likely hundreds of genes that can predispose towards allergies
  • Food exposures, especially in the 4-6 month range, have been associated with a lower risk of food allergies
  • Food trigger symptoms are present in most patients with DGBIs; however, the lines between immune mechanisms and non-immune mechanisms are often blurry
  • Food allergy testing (skin prick testing, IgE-based blood tests) is not recommended in the absence of systemic symptoms due to poor specificity (perhaps ~10%). Obtaining a careful history is a very important part of determining allergies. Double-blind challenges, which are rarely done, are still considered “gold standard” for diagnosis
  • Mucosal endoscopic provocation (research tool) often discloses localized immune reaction; it does not correlate with skin prick testing or IgE-based blood tests
  • After prior sensitization/food allergies, stressful conditions may create similar symptoms as allergic exposures. This can be mediated by histamine and tryptase/mast cells
  • It is rare for food allergen restriction to “fix” a DGBI. Occasionally, food allergies may be part of the problem. Dietary restrictions may lead to weight loss and contribute to ARFID
  • IgG-based allergy testing (widely available) is not recommended; IgG antibodies are usually indicative of tolerance
  • Environmental pollen counts are associated with increased DGBI symptoms, increased mucosal eosinophils, and less sleep
  • Environmental allergen testing can sometimes be helpful in identifying cross-reacting foods
  • Alpha-gal syndrome. Consider testing in those with symptoms triggered by meat ingestion, and those with refractory symptoms. In pediatric patients, often no rash is identified and many will ‘outgrow’ allergy
  • Oral immunotherapy can be effective in improving tolerance for allergic foods; however, up to 70% will redevelop intolerance
  • When mucosal eosinophilia is identified, there are a number of potential treatments including dietary restrictions, mast cell stabilizers, antihistamines, and steroids

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Nutrition4Kids and Nutrition4IBD

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My colleague and partner, Stan Cohen, along with his outstanding advisory board, have put together two terrific (free) resources for both children and adults:

Both are up-to-date, user-friendly, authoritative and attractive websites that feature advice families can trust to help them understand their disease and options to live as full a life as possible. Between the two, there are:

  • Over 700 articles
    • Nutrition4Kids Categories: Eating at different ages, Healthy lifestyle, Nutrients, Diseases and disorders and Patient experience
    • Nutrition4IBD Categories: Understanding IBD, Treatment Options, Nutrition for IBD and Patient options.
  • Over 60 videos including 35 on food allergies (including FPIES and eosinophilic disorders) and 14 on tube-feedings, including one about a lacrosse player that is quite inspirational.
  • Amazing tools:
    • A food log and a symptom diary that patients can download to record how they are doing
    • a BMI calculator
    • a table of milk alternatives (created by our nutritionist Bailey Koch)
    • a tool which provides over 150,000 food labels for restaurant and packaged foods.
    • a cool tool where a patient can indicate their age, gender, whether they’re breastfeeding or pregnant (even which trimester they’re in), and it will tell what’s in over 200,000 foods and what nutrients and calories they need.
  • Healthy recipes with their nutrient values per serving.
  • This website relies on a group of 42 contributors including many from our group, psychologists, speech-language pathologists, nurses, dietitians, and families.
  • Other practices can link to our site, so they can share our medically-curated and accurate content and tools with their patient-families.

Georgia AAP Nutrition Symposium 2019: Food Allergy Immunotherapy

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This year’s Georgia AAP Nutrition Symposium featured lectures targeting the NICU graduates (yesterday) and children with allergies. My notes from these lectures could contain errors of omission or transcription.

Luqman Seidu — Food Allergy Immunotherapy: it’ll drive you nutty

Key Points:

  • Currently, it is hard to quantitate food-related mortality/anaphylaxis. It is much more common to have anaphylaxis due to medications.
  • Immunotherapy –can establish tolerance but needs to be considered in terms of efficacy, safety, ease of compliance.   Goal is sustained unresponsiveness so that there is an end in sight to treatment.
  • Multiple modalities, SLIT (sublingual and then swallowed), OIT (oral), EPIT (Epicutaneous therapy), OIT with anti-IgE therapy
  • 1 peanut =250-300 mg (important number to keep in mind, as many studies aim for ~1000 mg, which is ability to ingest ~3 peanuts).
  • EPIT -peanut patch.  1-yr study –goal was 1000 mg or 10-fold increase in tolerance without reaction.  97% compliance with study. Safer approach and better adherence but takes longer to get response.  Lower response at 1 yr –takes ~2 yr to get similar response
  • OIT therapy allows more rapid attainment of tolerance but lower compliance and higher rates of systemic reactions compared to EPIT.  A standardized product will be available soon; an FDA advisory committee has approved a peanut product (Palforzia). (NPR has reported on this as well: Peanut Allergy Treatment Palforzia)
  • Anti-IgE therapy (eg. Xolair).  Can use to desensitize for multiple foods at the same time.

Though not discussed in this talk, it is important for GI physicians to recognize that oral immunotherapy has been shown to trigger new onset EoE in 2.7% (AJ Lucendo et al. Ann Allergy Asthma Immunol 2014; 113: 624-9).

Related blog posts:

 

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) and changes in diet should be confirmed by prescribing physician.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.