Food Allergy – IgE and Non IgE

What Is Food Allergy?

[dropcap]F[/dropcap]ood allergy is an abnormal immune response to food proteins that may damage the small intestinal  lining and produce malabsorption of food. The reaction is usually delayed which makes it difficult to identify the offending food that is causing symptoms.

Q: How does food allergy develop?

A: The gastrointestinal tract serves not only to digest and absorb foodstuffs but also to protect the body from unwanted substances. When allergic food substances are eaten, the immune response that is triggered in the gut produces inflammation with symptoms such as pain, vomiting and loose bowels.

Inflammation causes swelling of the gut lining that can interfere with the passage of nutrients through it to the body which results in malabsorption. Malabsorption deprives the body of nutrients needed for normal function.

Symptoms other than digestive may involve skin rashes, hives, and respiratory difficulties that can be distressing and life-threatening.

What Is Food Allergy In Celiac Disease and/or Gluten Sensitivity?

• Relationship between food allergy and celiac disease. Food allergy in celiac disease is an associated immune disorder. The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background. However, in a very large study, involving 909 patients with celiac disease, Ventura and his associates found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.¹
• Relationship between food allergy and presentation. A higher proportion of food allergy was reported in young children with celiac disease. Both celiac disease and food allergy are prevalent and increasingly diagnosed in children. These two conditions can both present with digestive symptoms such as vomiting and/or diarrhea in infants and young children.²
• Relationship between food allergy and damage to the small intestinal lining. Food allergy may damage the small intestinal lining and cause villous atrophy similar to that in celiac disease in very young children.
• Relationship between food allergy and leaky gut. Tight junction dysfunction (adhesion between surface cells of the small intestinal lining) in leaky gut has been shown to be a part of allergy.³
• Relationship between food allergy and non-celiac gluten-sensitive enteropathy. A study investigating the occurrence of gluten sensitivity in a group of allergic patients and to assess the effectiveness of a gluten-free diet on the improvement of symptoms in those who were diagnosed with gluten sensitivity found that a non-celiac gluten-sensitive enteropathy (small intestinal damage) commonly occurs in allergic patients. The researchers state, “Based on the high prevalence of non-celiac gluten-sensitive enteropathy in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a gluten free diet to the patients.”⁴

How Prevalent Is Food Allergy In Celiac Disease and/or Gluten Sensitivity?

• Food allergy is associated with celiac disease.⁵
• A higher rate of history of food allergy was found among infant-preschool children.⁶
• Non-celiac gluten sensitivity commonly occurs in allergic patients. Seventy-seven of 262 allergic patients were positive to mucosal damage by biopsy, but negative to the anti-gliadin (AGA), anti-endomysium (EMA) and to DQ2 and DQ8 molecules.⁴

What Are The Symptoms Of Food Allergy?

IgE food allergy is marked by any of these symptoms:

• Eczema (skin rash).
• Sudden hives or welts (distinct itchy, swollen areas of surface skin).
• Angioedema (deep swelling of skin such as around the eyes and lips).
• Asthma (difficulty getting air in and out of the lungs due to swelling of passageways).
• Rhinitis (nasal stuffiness due to swelling).
• Anaphylaxis (a life-threatening body response with inability to breathe).

Gastrointestinal reactions involve a delay of 2 hours and include enterocolitis (gut inflammation) with these symptoms:

• Vomiting.
• Lethargy.
• Bloody stools.
• Edema or swelling of intestinal lining.
• Damage to the small intestine is similiar to a gastrointestinal virus response.
• Heiner’s syndrome marks a lung response.

How Does Food Allergy In Celiac Disease and/or Gluten Sensitivity Develop?

• Food allergy involves the immune system that is triggered primarily by an IgE antibody response.
• Considerable evidence now suggests that non-IgE mechanisms may also be involved in the development of food allergy.⁷ Non-IgE mechanisms involve leaky gut and an imbalance of gut bacteria called dysbiosis.

• Leaky gut that develops from gluten sensitivity may predispose to food allergy by abnormally allowing undigested and foreign proteins into the body which then trigger the production of antibodies to them.⁸
• Dysbiosis may predipose to food allergy because while a healthy gut microbe population protects the gut lining from inflammation, an unhealthy population cannot.

Does Food Allergy Respond To Gluten-Free Diet?

The gluten free diet may improve food allergy by removing inflammation and damage caused by gluten to the small intestine.

Positive patients who followed a gluten free diet had control of symptoms as well as stabilization of the blood parameters even if allergic manifestations were not abated.⁴

6 Steps To Improve Food Allergy In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both food allergy and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁹
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹⁰
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹⁰
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹⁰.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹⁰
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹⁰
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹⁰[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (substances that cause cancer, reducing the risk by 50%) and mutagens (substances that cause genetic mutations).
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains such as brown rice, legumes such as peas, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats such as trans-fat. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Antihistamines used to treat food allergy are not known to deplete nutrients.  Ask your doctor or pharmacist if there are interactions between any medicines you are taking and food allergies. Do not stop prescribed medications without supervision.

For skin reactions. Calamine lotion is used on the affected areas of skin to relieve the itching, or over-the-counter antihistamines, such as diphenhydramine (Benadryl®) or chlorpheniramine maleate (Chlor-Trimeton®).

 [/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination that provides 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Food Allergy In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Occurrence of nonceliac gluten sensitivity in patients with allergic disease.” This study investigating the occurrence of gluten sensitivity in a group of allergic patients and to assess the effectiveness of a gluten-free diet on the improvement of symptoms in those who were diagnosed with gluten sensitivity found that a non-celiac gluten-sensitive enteropathy (small intestinal damage) commonly occurs in allergic patients. The researchers state, “Based on the high prevalence of non-celiac gluten-sensitive enteropathy in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a gluten free diet to the patients.”

262 unrelated allergic patients with gastrointestinal symptoms of obscure origin were tested for gluten sensitivity condition by biopsy. All patients were also genotyped for the typical celiac DQ2 and DQ8 molecules and investigated for antigliadin (AGA) and antiendomysial antibodies (EMA). Patients displaying mucosal lesions were invited to follow a gluten free diet.

Seventy-seven of the 262 allergic patients were positive to mucosal damage by biopsy, but negative to the anti-gliadin (AGA), anti-endomysium (EMA) and to DQ2 and DQ8 molecules. Instead, a prevalence of the DQA1*05 allele was found and anemia of inflammatory origin represented the predominant complaint in these subjects. The positive patients, who followed a gluten free diet had control of symptoms as well as stabilization of the blood parameters even if allergic manifestations were not abated.⁴

“Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease.” This study aiming to determine age-related patterns in clinical characteristics and gluten-related issues among children with confirmed celiac disease found a borderline significant higher rate of history of food allergy among infant-preschool children.

This study is a structured medical record review of biopsy-proven celiac disease patients, aged 0–19 years, between 2000 and 2010 at a large teaching hospital. Patients were divided into three age groups for comparisons of the aforementioned characteristics: infant-preschool group (0–5 years), school-aged group (6–11 years), and adolescence group (12–19 years). Children and adolescents with celiac disease were found to have age-related patterns in both the clinical presentations and gluten-related issues. More pronounced clinical and histological features were determined in younger children, whereas older children more commonly presented with solely subjective abdominal complaints or even without any GI symptoms. However, silent and atypical extraintestinal celiac disease presentations were comparable between age groups.¹¹

Sources:

1. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380. [↩]
2. Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo, Jr CA. Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease. Clin Transl Gastroenterol. 2012 February; 3(2): e9. [↩]
3. Fasano A. Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. Physiological Reviews. January 2011Vol. 91no. 151-175DOI: 10.1152/physrev.00003.2008 [↩]
4. Massari S, Liso M, De Santis L, Mazzei F, Carlone A, Mauro S, Musca F, Bozzetti MP, Minelli M. Occurrence of nonceliac gluten sensitivity in patients with allergic disease. Int Arch Allergy Immunol. 2011;155(4):389-94. doi: 10.1159/000321196. [↩] [↩] [↩] [↩]
5. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩]
6. Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo, Jr CA. Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease. Clin Transl Gastroenterol. 2012 February; 3(2): e9. Published online 2012 February 16. [↩]
7. Sabra A, Bellanti JA, Rais JM, Castro HJ, de Inocencio JM, Sabra S. IgE and non-IgE food allergy. Annals of Allergy, Asthma, & Immunology. Jun 2003;90(6 Suppl 3):71-6. [↩]
8. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩]
9. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
10. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
11. Tanpowpong P, Broder-Fingert S, Katz AJ, Camargo, Jr CA. Age-Related Patterns in Clinical Presentations and Gluten-Related Issues Among Children and Adolescents With Celiac Disease. Clin Transl Gastroenterol. 2012 February; 3(2): e9. Published online 2012 February 16. [↩]