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immune system
food sensitivities
diagnoses
definition and etiology
definition: Having either an immediate or delayed reaction to an ingested food.
etiology: Food sensitivities can be defined as inappropriate and uncomfortable clinical signs and symptoms following the ingestion of food. The reaction may or may not be dependent on an immune reaction and may involve either a protein, large carbohydrate, other food component, or an unnatural food additive (coloring, preservative, etc.).
Here are the terms that are used to describe the various food reactions adapted from the Academy of Allergy and Immunology (per Pizzorno and Murray).
Adverse reaction (sensitivity) to a food: A general term that can be applied to a clinical abnormal response attributed to an ingested food or food additive (FOFA).
Food hypersensitivity (allergy): An immune-mediated response to a FOFA.
Food anaphylaxis: A classic allergic hypersensitivity reaction involving the release of IgE and chemical mediators.
Food intolerance: A general term used to describe adverse reactions and measurable signs not necessarily attributable to an immune response.
Food toxicity (poisoning): A term used to imply an adverse effect as a result of a direct action of a FOFA upon the patient without involving the immune system. Toxins may come from within the food or may be created by microorganisms or parasites inhabiting the food.
Food idiosyncrasy: A quantitatively abnormal response to a FOFA that differs from its physiologic or pharmacologic effect. Although the reaction is similar to hypersensitivity, it does not involve the immune system. These types of reactions occur in specific groups of people and there is probably a genetic component.
Anaphylactoid food reaction: An anaphylaxis-type FOFA reaction as a result of the release of chemical mediators independent of the immune system, which mimic the signs and symptoms of food allergy.
Pharmacologic food reaction: An adverse reaction to a FOFA as a result of a naturally derived or added chemical which produces a drug-like or pharmaceutical effect in the host.
Metabolic food reaction: An adverse reaction to a FOFA as a result of the effect of the food substance upon the metabolism of the patient.
Clinical ecologists classify allergies in two ways:
cyclic: accounts for 80-90% of all allergies and occurs after repetitive eating of the same food. After a time of abstinence (may take up to 4 months), the food may be reintroduced and often no reactions will occur unless the patient again begins repetitive eating.
fixed allergies: This type of allergy occurs no matter when a food is eaten; the time span between eating the food again is not of importance.
Theories of the causation of food sensitivities include:
Genetic predisposition: Food allergies are clearly seen as inherited genetic tendencies. Allergies commonly run in families.
Immune system mediated: Including IgE (immediate reaction), and IgG and IgM (delayed reaction). IgA can often be faulty for letting the antigen cross the mucosal lining of the intestinal tract.
Immune system disorders: Studies have shown that atopic patients have: 50% more T-helper cells; a lower immunological set point (thus they react to lower levels of antigen than the non-atopics); and lower levels of IgA, allowing entry of antigens across the intestinal mucosa.
Nonimmunological mechanisms: Including release of inflammatory mediators without the formation of antibodies.
Digestion: Factors involved include: repetitive exposure to a FOFA; improper digestion or low levels of digestive enzymes present (leaving large, undigested molecules that can be absorbed); poor integrity of the intestinal barrier, letting antigens pass through (partially digested proteins, for example).
A simpler version of the etiology might be:
A food allergy is one that elicits a Type I IgE-mediated reaction that can lead to urticaria, angioedema, hypotension, and anaphylaxis. In these cases the food particle (usually a protein or long carbohydrate) acts as a true antigen to the body's immune system. This is the rarer type of food reaction.
The most common type of food reaction is food intolerance. Although the reaction may be immediate or, most commonly, delayed up to 2 days, the patient develops symptoms after eating specific foods. Both IgE and IgG reactions are implicated, though need not be involved; anaphylaxis is not part of this clinical picture.
Also: consider a pituitary/low estrogen imbalance where the pituitary stops producing a part of ACTH which stimulates the anti-inflammatory reactions (Easley).
signs and symptoms
symptoms by system:
GI: Canker sores; celiac disease; chronic diarrhea; duodenal ulcer; gas and bloating; irritable colon; IBD; malabsorption.
GU: Bed-wetting; chronic bladder infections; nephrosis.
Immune: Chronic infections; frequent ear infections; sinusitis.
Mental/emotional: Anxiety, depression, hyperactivity, lack of concentration, insomnia or hypersomnia, confusion, irritability, mood swings.
Musculoskeletal: Bursitis; arthritis; joint pain; low back pain.
Respiratory: Asthma, chronic bronchitis; wheezing.
Skin: Acne; eczema; hives; itching; skin rash.
Miscellaneous: arrhythmia; edema; fainting; fatigue/lethargy; headaches/migraines; hypoglycemia; itchy nose or throat; puffy eyes with dark circles underneath ("allergic shiners"); horizontal creases in the lower eyelids; chronic swollen glands; chronic noncyclic fluid retention; "allergic salute" (child continually wipes nose upwards with palm of hand).
lab findings:
(+) sensitivity testing: RAST, RASP, cytotoxic, Voll/Vega/electroacupuncture, kinesiologic, intradermal, many others
(+) eosinophilia
decreased ACTH (Easley)
course and prognosis
Untreated chronic food sensitivities may progress through three stages:
hypersensitivity (when the patient elicits an acute response to the FOFA each time it is ingested)
adaptive (when the acute postprandial symptoms become less recognizable and the patient begins experiencing more chronic ailments)
maladaptive (when the person is in a persistent, constant state of biochemical dysfunction and does not even correlate his/her ailments to a food sensitivity)
In all cases, significant improvements may be achieved by appropriate diagnosis and treatment, either by desensitization or dietary changes.
differential diagnosis
Intestinal flora imbalance
Hypoglycemia
Environmental poisoning/sensitivity
Chronic Viral Fatigue Syndrome
footnotes