Food Allergies and Sensitivities
• Allergies, Food
Principal Proposed Natural Treatments
• Elimination Diet; Hypoallergenic Infant Formula
Other Proposed Natural Treatments
• Bromelain; Probiotics; Proteolytic Enzymes; Thymus Extract
A food allergy is defined as an abnormal immune reaction caused by the ingestion of a food or food additive. The most dramatic form of food allergy reaction occurs within minutes, usually in response to certain foods such as shellfish, peanuts, or strawberries. The effects are similar to those of a bee sting allergy, involving hives, itching, swelling in the throat, and difficulty breathing; this immediate type of allergic reaction can be life-threatening.
Other food allergy reactions are more delayed, causing relatively subtle symptoms over days or weeks. 1 These include gastrointestinal problems (constipation, diarrhea, gas, cramping, and bloating), rashes, and headaches. However, because such delayed reactions are relatively vague and can have other causes, it has remained a controversial subject in medicine.
Some food allergy-like reactions do not actually involve the immune system. These are termed food sensitivities (or food intolerance). In most cases, the cause of such sensitivities is unknown.
Delayed-type food allergies and sensitivities might play a role in many diseases, including asthma , attention deficit disorder , rheumatoid arthritis , vaginal yeast infections , canker sores , colic , ear infections , eczema , irritable bowel syndrome , migraine headaches , psoriasis , chronic sinus infections, ulcerative colitis , Crohn's disease , and celiac disease. 2-9,64, 68 However, not all experts agree; practitioners of natural medicine tend to be more enthusiastic about the food allergy theory of disease than conventional practitioners.
Conventional treatment for immediate-type food allergy reactions includes desensitization (allergy shots), emergency epinephrine (adrenaline) kits for self-injection, and the antihistamine diphenhydramine (Benadryl).
Delayed-type food allergies are much more difficult to identify and treat. Although skin and blood tests are sometimes used, their reliability is questionable. 10-16,65,66 A particular blood test called ALCAT has shown some promise, but much more study is necessary to establish its accuracy. 17 The double-blind food challenge is the only truly reliable way to identify delayed-type food allergies. This method uses some means of disguising the possibly allergenic food, usually by mixing it with other, nonallergenic foods. Individuals are randomly given either the possibly allergenic food or placebo on a number of occasions separated by 1 or more days. Neither the physician nor the participant knows which is real possibly allergenic food and which is not. Evaluation of the response can then determine whether an allergic response is really present or not. Studies suggest that perhaps only one-third of people who believe they are allergic to a given food actually experience an allergic reaction when they are given it in a double-blind fashion; in addition, reactions are often milder than individuals believe. 18,19
Although it is the most accurate way of determining food allergies, the double-blind food challenge is still mostly used in research. The elimination diet with food challenges (described below) is the most common technique in use.
Another conventional approach for delayed-type food allergies is oral cromolyn (a drug sometimes used in an inhaled form for treating asthma and other allergic illnesses). 20 A double-blind, placebo-controlled study of 14 children with milk and other food allergies found that cromolyn was effective in preventing allergic reactions in 11 of 13 cases, whereas placebo was effective in only 3 of 9 cases. 21 In another study, 32 individuals were given cromolyn one half hour before meals and at bedtime. 22 If their food allergy symptoms were prevented, the participants were entered into a double-blind, placebo-controlled crossover study using cromoglycate. Of the 31 people who completed the study, 24 experienced relief of gastrointestinal symptoms when taking cromolyn as compared to 2 when taking placebo. In addition, systemic allergic reactions were also blocked with the cromolyn. Unfortunately, the drug also had many side effects.
Principal Proposed Natural Treatments
There are no well-documented natural treatments for food allergies. The most obvious approach would be to remove known allergenic foods from the diet. Some alternative practitioners offer lab tests to identify such allergens. However, as described above, no lab tests have been proven accurate for this purpose.
The elimination diet is another approach for identifying allergenic foods. This method involves starting with a highly restricted diet consisting only of foods that are seldom allergenic, such as rice, yams, and turkey. If dietary restriction leads to resolution or improvement of symptoms, foods are then reintroduced one by one to see which, if any, will trigger reactions. 23 There is some evidence that the elimination diet may be effective for chronic or recurrent hives ; 24-26 it has been tried for many other conditions as well, including irritable bowel syndrome , 27-34,68asthma , 35chronic ear infections , 55,56reflux esophagitis , 36 and Crohn's disease . 37,38
Still another method involves simply eliminating the most common allergens. Cow's milk protein intolerance is thought to be the most common childhood allergy, 39 followed by allergies to eggs, peanuts, nuts, and fish. Some evidence indicates that use of special hypoallergenic infant formulas rather than cow's milk formula may help prevent eczema , urticaria , and food-induced digestive distress. 40,41,67,69 In addition, eliminating cow's milk from the diets of breastfeeding infants and their nursing mothers might reduce symptoms of infantile colic , 42-51 although not all studies have found benefit. 52-54
In hopes of preventing food allergies and diseases related to them, some authorities recommend that pregnant and breastfeeding mothers as well as their children should avoid allergenic foods. 57-61 However, it is not clear if this method actually provides any benefit. For example, one study evaluated 165 children at high risk of developing allergic symptoms. 62 Careful avoidance of allergenic foods in the diets of the mothers and infants did not reduce the later development of eczema, asthma, hay fever, or food allergy symptoms.
Other Proposed Treatments for Food Allergies and Sensitivities
Digestive enzymes such as bromelain and other proteolytic enzymes have been proposed as a treatment for food allergies, based on the reasonable idea that digesting offending proteins will reduce allergic reactions to them. However, there is no real evidence as yet that they are effective against food allergies.
Thymus extract is a supplement derived from the thymus gland of cows. Highly preliminary evidence suggests that by normalizing immune function, thymus extracts may be helpful for food allergies. 63 However, there are significant safety issues, and this study did not prove the supplement to be effective. See the Thymus article for details.
Probiotics (eg, Lactobacillus species) are friendly bacteria that have been studied for their ability to prevent or treat respiratory allergies and various gastrointestinal symptoms, most notably diarrhea. However, at least study found that probiotics were not helpful in treating cow’s milk allergy among infants. 70
1. Carroccio A, Montalto G, Custro N, et al. Evidence of very delayed clinical reactions to cow's milk in cow's milk-intolerant patients. Allergy. 2000;55:574-579.
2. Nsouli TM, Nsouli SM, Linde RE, et al. Role of food allergy in serous otitis media. Ann Allergy. 1994;73:215-219.
3. Smith MA, Youngs GR, Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet. 1985;2:1064.
4. Kitts D, Yuan Y, Joneja J, et al. Adverse reactions to food constituents: allergy, intolerance, and autoimmunity. Can J Physiol Pharmacol. 1997;75:241-254.
5. Ballegaard M, Bjergstrom A, Brondum S, et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32:569-571.
6. Pearson M, Teahon K, Levi AJ, et al. Food intolerance and Crohn's disease. Gut. 1993;34:783-787.
7. Ruokonen J, Paganus A, Lehti H. Elimination diets in the treatment of secretory otitis media. Int J Pediatr Otorhinolaryngol. 1982;4:39-46.
8. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187-1189.
9. Knoflach P, Park BH, Cunningham R, et al. Serum antibodies to cow's milk proteins in ulcerative colitis and Crohn's disease. Gastroenterology. 1987;92:479-485.
10. King HC, King WP. Alternatives in the diagnosis and treatment of food allergies. Otolaryngol Clin North Am. 1998;31:141-156.
11. Bahna SL. Management of food allergies. Ann Allergy. 1984;53:678-682.
12. Bindslev-Jensen C, Skov PS, Madsen F, et al. Food allergy and food intolerance—what is the difference. Ann Allergy. 1994;72:317-320.
13. Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892-1897.
14. Metcalfe DD. Food allergy. Prim Care. 1998;25:819-829.
15. Golbert TM. A review of controversial diagnostic and therapeutic techniques employed in allergy. J Allergy Clin Immunol. 1975;56:170-190.
16. Zuberbier T, Chantraine-Hess S, Hartmann K, et al. Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study. Acta Derm Venereol. 1995;75:484-487.
17. Hoj L. Diagnostic value of ALCAT test in intolerance to food additives compared with double-blind placebo-controlled (DBPC) oral challenges [abstract]. J Allergy Clin Immunol. 1996;97:336.
18. Rodriguez J, Crespo JF, Burks W, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol. 2000;106:968-972.
19. Geha RS, Beiser A, Ren C, et al. Multicenter, double-blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. J Allergy Clin Immunol. 2000;106:973-980.
20. Bahna SL. Management of food allergies. Ann Allergy. 1984;53:678-682.
21. Kocoshis S, Gryboski JD. Use of cromolyn in combined gastrointestinal allergy. JAMA. 1979;242:1169-1173.
22. Gerrard JW. Oral cromoglycate: its value in the treatment of adverse reactions to foods. Ann Allergy. 1979;42:135-138.
23. King HC, King WP. Alternatives in the diagnosis and treatment of food allergies. Otolaryngol Clin North Am. 1998;31:141-156.
24. Zuberbier T, Chantraine-Hess S, Hartmann K, et al. Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study. Acta Derm Venereol. 1995;75:484-487.
25. Juhlin L. Additives and chronic urticaria. Ann Allergy. 1987;59:119-123.
26. Supramaniam G, Warner JO. Artificial food additive intolerance in patients with angio-oedema and urticaria. Lancet. 1986;2:907-909.
27. Smith MA, Youngs GR, and Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet. 1985;2:1064.
28. McKee AM, Prior A, and Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol. 1987;9:526-528.
29. Jones VA, McLaughlan P, Shorthouse M, et al. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet. 1982;2:1115-1117.
30. Parker TJ, Naylor SJ, Riordan AM, et al. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Hum Nutr Diet. 1995;8:159-166.
31. Ballegaard M, Bjergstrom A, Brondum S, et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32:569-571.
32. Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892-1897.
33. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187-1189.
34. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187-1189.
35. Onorato J, Merland N, Terral C, et al. Placebo-controlled double-blind food challenge in asthma. J Allergy Clin Immunol. 1986;78:1139-1146.
36. Hill DJ, Heine RG, Cameron DJ, et al. Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis. J Pediatr. 2000;136:641-647.
37. Pearson M, Teahon K, Levi AJ, et al. Food intolerance and Crohn's disease. Gut. 1993;34:783-787.
38. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187-1189.
39. Carroccio A, Montalto G, Custro N, et al. Evidence of very delayed clinical reactions to cow's milk in cow's milk-intolerant patients. Allergy. 2000;55:574-579.
40. Niggemann B, Binder C, Dupont C, et al. Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol. 2001;12:78-82.
41. Kramer MS, Chalmers B, Hodnett E, et al. Promotion of breastfeeding intervention trial (PROBIT). JAMA. 2001;285:413-420.
42. Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics. 1983;71:268-271.
43. Iacono G, Carroccio A, Montalto G, et al. Severe infantile colic and food intolerance: a long-term prospective study. J Pediatr Gastroenterol Nutr. 1991;12:332-335.
44. Gerrard JW. Allergies in breastfed babies to foods ingested by the mother. Clin Rev Allergy. 1984;2:143-149.
45. Sampson HA. Infantile colic and food allergy: fact or fiction? J Pediatr. 1989;115:583-584.
46. Lothe L, Lindberg T. Cow's milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: a double-blind crossover study. Pediatrics. 1989;83:262-266.
47. Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: a double-blind study. Pediatrics. 1982;70:7-10.
48. Hill DJ, Hudson IL, Sheffield LJ, et al. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol. 1995;96:886-892.
49. Forsyth BWC. Colic and the effect of changing formulas: a double blind, multiple crossover study. J Pediatr. 1989;115:521-526.
50. Warner JO. Food allergy in fully breast-fed infants. Clin Allergy. 1980;10:133-136.
51. Isolauri E. The treatment of cow's milk allergy. Eur J Clin Nutr. 1995;49(suppl 1):S49-S55.
52. Thomas DW, McGilligan K, Eisenberg LD, et al. Infantile colic and type of milk feeding. Am J Dis Child. 1987;141:451-453.
53. Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trial. Pediatrics. 1988;81:756-761.
54. Evans RW, Allardyce RA, Fergusson DM, et al. Maternal diet and infantile colic in breast-fed infants. Lancet. 1981;1:1340-1342.
55. Nsouli TM, Nsouli SM, Linde RE, et al. Role of food allergy in serous otitis media. Ann Allergy. 1994;73:215-219.
56. Ruokonen J, Paganus A, Lehti H. Elimination diets in the treatment of secretory otitis media. Int J Pediatr Otorhinolaryngol. 1982;4:39-46.
57. Arvola T, Holmberg-Marttila D. Benefits and risks of elimination diets. Ann Med. 1999;31:293-298.
58. Iacono G, Carroccio A, Montalto G, et al. Severe infantile colic and food intolerance: a long-term prospective study. J Pediatr Gastroenterol Nutr. 1991;12:332-335.
59. Hattevig G, Sigurs N, Kjellman B. Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age. Acta Paediatr. 1999;88:7-12.
60. Zeiger RS, Heller S. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol. 1995;95:1179-1190.
61. Zeiger RS. Dietary aspects of food allergy prevention in infants and children. J Pediatr Gastroenterol Nutr. 2000;30(suppl):S77-S86
62. Zeiger RS, Heller S. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. J Allergy Clin Immunol. 1995;95:1179-1190.
63. Cavagni G, Piscopo E, Rigoli E, et al. Food allergy in children: an attempt to improve the effects of the elimination diet with an immunomodulating agent (thymomodulin). A double-blind clinical trial. Immunopharmacol Immunotoxicol. 1989;11:131-142.
64. Van Den Bogaerde J, Cahill J, Emmanuel AV, et al. Gut mucosal response to food antigens in Crohn's disease. Aliment Pharmacol Ther. 2002;16:1903-1915.
65. Morisset M, Moneret-Vautrin DA, Maadi F, Fremont S, et al. Prospective study of mustard allergy: first study with double-blind placebo-controlled food challenge trials (24 cases). Allergy. 2003;58:295-299.
66. Kim TE, Park SW, Noh G, et al. Comparison of skin prick test results between crude allergen extracts from foods and commercial allergen extracts in atopic dermatitis by double-blind placebo-controlled food challenge for milk, egg, and soybean. Yonsei Med J. 2002;43:613-620.
67. Von Berg A, Koletzko S, Grubl A, et al. The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: The German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol. 2003;111:533-534.
68. Drisko J, Bischoff B, Hall M, et al. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006;25:514-22.
69. Donmez A, Karagulle MZ, Tercan N, et al. SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int. 2005;26:168-172.
70. Hol J, van Leer EH, Elink Schuurman BE, et al. The acquisition of tolerance toward cow's milk through probiotic supplementation: A randomized controlled trial. J Allergy Clin Immunol. 2008 Apr 22.
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