Food Allergy Information

Food allergies are traditionally treated by avoidance of the food to which the patient reacts. This has proven very successful when an individual has only a few food allergies and the food item can clearly be determined and eliminated from the diet. However, there are many individuals that have numerous foods to which they react limiting daily activities and producing severe illness yet not life threatening anaphylaxis that cannot practically be eliminated from the diet. In these individuals a more aggressive intervention may be indicated with food neutralization immunotherapy

Type of Reactions

Individuals with food reactions present with varying types of reactions affecting different target organs. The best recognized mechanisms are those that are IgE mediated producing anaphylaxis or uticaria. Types II, III and IV reactions also occur frequently affecting one or more organ systems producing the wide variety of clinical symptoms. These symptoms will vary from headaches, mental confusion, irritability, hyperactivity, panic, muscle spasm, shortness of breath, nausea, and seizure type activity to diarrhea and abdominal bloating. It is with these more systemic non-anaphylaxic type reactions that food neutralized treatment is very helpful in giving relief to the patient.

Indications for Neutralization Treatment

Food neutralization treatment is indicated in the following circumstances: 

1. The food in question may be such an essential part of the everyday environment that exposure is unavoidable.

2. Multiple food sensitivities that restrict choice and availability of common foods forcing the patient to search out rare and expensive foods.

3. Multiple food sensitivities that prevents the patient from having an adequate nutritional diet.

4. The level of IgE-mediated sensitivity to a common food may be so acute that the patient cannot avoid anaphylactic accidents caused by unexpected traces of allergen.

Patient Approach

Once the physician has ascertained by history that a patient has a high probability of food allergies and has performed a physical examination, allergy testing using the Provocation-Neutralization technique.  One food is tested at a time observing the wheal response as well as recording the symptoms. The initial foods selected for testing should be those commonly eaten such as diary, corn, wheat, cane sugar, bakers and brewers yeast and soy as well as those that are hidden is many food products such as coconut. If foods that are frequently associated with anaphylaxis are to be tested, (i.e. peanuts, egg and shellfish) testing should only be done after less reactive foods are tested establishing a base line for that individuals reactions and an idea of a safe initial testing dose.

During the initial visit the patient is instructed on a Four-Day Rotation Diet. This instruction acquaints the patient with the food families, teaches them how to eat foods on a non-repetitive basis (not repeating the individual food in four days), combining different food into one meal without repeating the food family and visually giving them foods to eat from a dietary plan. This instruction allays the patient fears that they “will not have anything to eat”.

Patients that are chemically, food additive or preservative sensitive should use organic (chemically less contaminated) foods. Reactions may occur to contaminates in the food confusing the patient and the treatment. Foods should be cooked with an electric heat source or microwave oven to avoid extraneous contamination from gas fumes. Cookware should be glass or stainless steel. Water used in the food preparation and for drinking should be filtered or preferably glass bottled from a pure spring source never treated with chlorine or other purifying chemicals. (I have had patients react to the phosphate used in the purifying process).

It is also important that the patient be instructed to ingest a small amount of the food to be tested within four days prior to the testing of that specific food. This exposure creates the most accurate testing conditions. However, careful instructions should be given not to eat those foods that the patient knows produce anaphylactic or anaphalactoid type reactions. It is not necessary to eat those foods prior to testing.

Very reactive patients may tolerate only one or two food allergy tests a day due to delayed or persistent symptoms from the testing. Generally when the neutralized dose is achieved the patients symptoms are relieved and additional tests may be performed. During the first days of testing it is important not to get over zealous with testing numerous food items until the physician and the testing technician develops a feel for the amount of testing that individual patient can tolerate. An experienced and well-trained testing technician increases patient satisfaction and avoids “overloading” the patient with too many tests or repeated reactions.

Treatment Plan

 Avoid the most reactive foods. This is very important and often ignored by the treating physician that believes that neutralization immunothearpy will stop all reactions regardless of the severity of the reaction. The patient’s goal is to feel better. Avoidance is the quickest response method of treatment.  Utilize the rotation diet and eliminate the most reactive or symptom provoking food items.  Over the following weeks with the use of immunothearpy the patient will generally build up enough tolerance to the treated foods that the least reactive foods can be reintroduced into their Four-Day Rotation diet. One food should be introduced at a time. Occasionally a patient will have a “fixed” food allergy where they remain so sensitive despite prolonged neutralization therapy that they must avoid permanently the specific food item to remain symptom free.

Special attention must be given to the patient that is lactose or gluten intolerant. Do not confuse these diseases with an allergic sensitivity to the individual grains that contain gluten or dairy products. Both an allergic response and intolerance may exist in the same patient. Remember that neutralization food treatment for dairy or wheat will not stop the inflammatory reaction to gluten or the hyper-osmotic effect of lactose in the bowel. Strict avoidance is the treatment of choice for the gluten and lactose intolerant patient. It is my experience that those intolerant individuals generally have numerous other food sensitivities affecting the bowel and are responsive to food neutralization therapy resulting in decreased symptoms. When initiating neutralization therapy in the more reactive patient, close monitoring is necessary as their neutralizing treatment dose may change necessitating retesting.

Treatment Frequency

The Frequency of food immunotherapy treatment utilizing the neutralization dose may vary widely. For the average patient therapy is prescribed every 4-7 days using the prescribed dose from the combined food treatment vial prepared from the patients provocation-neutralization testing. For those individuals with more severe debilitating reactions daily use of the food antigens may be necessary and is indicated. This can vary from one combined food injection in the morning containing the foods to be eaten that day or one combined food injection before each meal containing the foods to be eaten for that meal. Repeating the injection after the meal may be beneficial if symptoms are reoccurring or persistent.

Frequent follow up of the patient is necessary following the individualized instruction on how to self-administer the treatment doses. Rarely do reactions occur to the neutralized treatment doses, however if a reaction occurs the patient should be prepared having received a prescription and instruction on emergency measures in the use of antihistamine (preferably liquid as it is absorbed faster) and injectable adrenaline. 

Conclusion   

Food allergy treatment based on the Provocation-Neutralization technique of testing and treatment with optimal immunotherapy doses is effective in reducing reactions in many patients leading to an improved quality of life. However, when possible avoidance of the most reactive foods is ideal in addition to utilizing a rotation diet allowing intermittent exposure to the less reactive foods.     

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