The Expert's Guide to Navigating Food Allergies and Intolerances with David Stukus, MD
Dec 11, 2023
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Dr. David Stukus, an expert in food allergies and intolerances, discusses the differences between food allergies, intolerances, and sensitivities. He explains various testing methods, debunks misconceptions about preventing food allergies, and explores the link between food allergies and eczema. The conversation also covers histamine intolerance and the importance of seeking evidence-based information.
Food allergies are caused by IgE antibodies and result in immediate reactions, while intolerances are related to difficulty digesting certain substances.
Clinical history and symptoms are crucial in identifying food allergies and intolerances, and oral food challenges are the gold standard for diagnosis.
The mainstay of food allergy treatment is avoidance, but desensitization and other therapies show promise for managing allergies.
Deep dives
Food allergy, food intolerance, and food sensitivity
Food allergy is caused by IgE antibodies and results in immediate reactions after eating a food. Symptoms include hives, swelling, vomiting, and even anaphylaxis. Intolerances do not involve the immune system and are related to difficulty digesting certain substances, such as lactose intolerance. Food sensitivities lack a clear medical definition and are often attributed to non-immunologic adverse effects from eating certain foods.
Testing for food allergies and intolerances
Clinical history and symptoms are crucial in identifying food allergies and intolerances. Clinical tests, such as skin prick tests and blood tests, can help to confirm the presence of IgE antibodies. However, these tests are not foolproof and can result in false positive results. The gold standard for diagnosing food allergies is an oral food challenge, where patients gradually consume increasing amounts of the allergen under medical supervision. Other forms of testing, like IgG tests or intolerance panels, lack scientific validation and should be approached with caution.
Treating food allergies
The mainstay of food allergy treatment is identifying allergens and avoiding accidental ingestion. There is currently no known cure for food allergies, and avoidance remains the best approach. However, desensitization or oral immunotherapy is becoming increasingly common. It involves daily ingestion of small amounts of the allergenic food, gradually increasing the dosage over time. This process can increase the threshold for allergic reactions and provide protection if accidental ingestion occurs. Other treatment options, such as sublingual immunotherapy and biologic injections to block IgE antibodies, are being studied and show promise.
Outgrowing food allergies
Children with milk, egg, wheat, or soy allergies often outgrow them by school age, while peanut, tree nut, and seafood allergies tend to persist into adulthood. The reasons why some people outgrow allergies and others do not are not fully understood. Factors such as immune system differences and genetic predispositions may play a role. Retesting every 12 months is important to track possible changes in allergies and to ensure that foods are not unnecessarily avoided.
Food allergies and related topics
The prevalence of food allergies appears to be increasing, although determining precise numbers can be challenging. Some hypotheses, like the hygiene hypothesis, suggest that increased cleanliness and reduced exposure to bacteria and parasites may contribute to the rise in food allergies. It is important to note that a comprehensive understanding of food allergies and related topics requires careful consideration of the entire body of evidence, and it is advisable to consult reputable professional organizations and experts in the field for accurate and up-to-date information.
Food allergies, intolerances, and sensitivities can occur towards nearly any food. These adverse food reactions can have a negative impact on health so it is important that they are correctly diagnosed and managed. Unfortuantely, there is A LOT of misleading information about this topic.
On this week's episode of the podcast, Dr. David Stukus joins us to discuss the science behind these topics. In this episode we discuss:
The difference between food allergy, intolerance, and sensitivity
How to test allergies, and intolerances
IgE testing, IgG testing, MRT,
The dangers of screening for food allergies and intolerances
