A Functional Medicine Approach to Food Allergies: Specialty Testing and Treatment Options

Over the last few decades, reactions to foods have been on the rise. More than 32 million Americans have a diagnosed food allergy, with 1 in 13 children being impacted. Allergies range from mild to severe but should not be ignored as they can cause a range of symptoms and affect overall health. Addressing food allergies through elimination and internal support is important and may help manage symptoms. Here are the details of common food allergens and how to approach them if you find yourself in this situation.

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What are Food Allergies?

When your immune system adversely reacts to certain foods, this may indicate that you have developed a food allergy. Your body has natural defense mechanisms, including immunoglobulins which are normally present to fight off infectious microbes. In an allergic reaction, Immunoglobulin E (IgE antibodies) will respond to foods that your body recognizes as foreign invaders and then mounts an immune response. This response can result in a spectrum of signs and symptoms ranging from mild to anaphylactic. Due to the severity that some individuals may have to their food allergen, avoidance of that particular food or cross-contamination is highly recommended.

Food Allergy Symptoms

If you have an allergic reaction to food items, it typically presents with symptoms involving the gastrointestinal tract, skin, respiratory tract, and/or cardiovascular system. Here are the most common symptoms that occur within minutes and up to two hours of ingesting a food allergen:

• Hives
• Anaphylaxis
• Shortness of breath
• Tight and scratchy throat
• Trouble swallowing
• Swelling of the tongue impacts breathing and the ability to talk
• Wheezing
• Continuous coughing
• Vomiting with or without stomach cramps
• Blue skin discoloration or pale appearance
• Weak pulse
• Dizziness or feeling you may faint
• Shock or circulatory collapse
• Secondary Rhinitis

What Are The Most Common Food Allergies?

An IgE reaction to foods is more common in children before the age of 5 as they are introduced to new foods. In recent years we are seeing a higher incidence of the elderly population developing food allergies, possibly due to gut health, immune system changes, and age-related factors, including microbiome diversity. With that being said, nine common food allergies are present in pediatrics and adults. These are Eggs, Cow's milk, Peanuts, Fish, Shellfish, Soy, Tree nuts, Wheat, and Sesame. The first eight out of the nine common allergens account for about 90% of all food allergy reactions.

What is the Difference Between Food Allergy, Food Sensitivity, and Food Intolerance?

Distinguishing the difference between the three food reaction types-food allergy, food sensitivity, and food intolerance- can help direct therapeutic interventions. In this article, the focus is on food allergies which is an IgE-specific immune response. During an allergic reaction, the body immediately recognizes the food as a foreign invader and activates immune cells, resulting in the symptoms mentioned above.

Food sensitivity is often mistaken for food intolerance, but they are different types of reactions. In a food sensitivity reaction, there is a delayed immune response involving immunoglobulins G (IgG). This topic is quite controversial as some literature indicates that IgG antibodies are transient immune markers and not an accurate representation of an overt reaction. On the other hand, evidence suggests allergic-like symptoms null of a positive IgE allergy test can result in positive IgG food sensitivity results. Symptoms of food sensitivity can range from rashes, asthma, urticaria, abdominal pain, constipation, diarrhea, migraines, chronic fatigue, and even hair loss. Multiple instances show that when a symptomatic individual eliminates the culprit food(s), there can be a significant improvement in symptoms.

Similarly to food sensitivity is a food intolerance, which differs as a non-immunological response. This type of reaction is due to your body being unable to process and break down a disagreeable food. It is typically due to an enzyme deficiency in cases such as lactose intolerance, which is the body's inability to break down milk sugar.

Food Allergy Testing

There are two primary ways of testing food allergies: via blood or a skin prick test.

Food Allergy Blood Test (IgE)

Testing for common food allergies can be done through a blood test. While individual markers can be done on the nine most common food allergies, obtaining a comprehensive allergen panel can provide more insight. Mosaic Diagnostics has a 93-item IgE Food Allergy Advanced Test, which helps determine if a food allergy is impacting your health.

Food Allergy Skin Prick Test

The gold standard for testing a food allergy is a Skin Prick Test (SPT), also known as a Scratch Test. This test is typically done in the office of an allergy specialist. The test is performed in arrays on either the back (young kids) or the forearm. This entails dividing the testing area up into uniform regions with a spot to test each antigen (liquid food solution). A drop of each food solution will be placed in its testing area, and then a small probe or scratch to the skin with be introduced to allow the solution to get below the skin. The solution sits for up to 30 minutes, during which a white raised bump or wheal formation will indicate an allergic reaction. It's important to note that 50-60% of all SPT can produce a "false positive" for a variety of reasons. Confirming a scratch test to your clinical picture is essential. Additional ways to confirm an allergy are to do an oral food challenge or elimination diet.

Functional Medicine Labs That Can Help Individualize Support for Patients With Food Allergies

Certain labs can help personalize support plans for those with food allergies. Below are the most commonly run labs for this purpose:

Gut Testing

Gastrointestinal integrity and functioning are vital to proper digestion and assimilation of foods. Leaky gut, which is the breakdown of the tight junctions in the intestinal lining resulting in dysfunctional absorption and immune stimulation, has been correlated to both food allergies and sensitivities. KBMO Diagnostics has a Gut Barrier Pane that looks at markers associated with intestinal permeability. This includes key gut integrity indicators such as Zonulin, anti-Zonulin, and antibodies to immunoglobulins A and M. Determining if a leaky gut is playing a role can help direct support for health restoration.

Histamine Testing

Measuring histamine can provide context to allergy-like reactions if a food allergy test is negative or be a benchmark for histamine production from an allergic reaction. Food allergies trigger an IgE immune response which in turn releases histamine as part of an inflammatory cascade. When histamine can not clear from the body, you can develop histamine intolerance. Ruling out this condition through a Histamine plasma test may be beneficial in your case.

IgG Food Sensitivity Testing

It is possible to have both food allergies and sensitivity concomitantly. Ruling out food sensitivities as a contributing factor to your symptom picture may benefit you long term. Alletess Medical Laboratory has a 96 IgG Food Sensitivity Panel blood spot test available that you can do in the comfort of your home.

Conventional Approaches for Food Allergies

Currently, there is no approved treatment option for food allergies other than avoidance of offending food and symptom management. Unlike environmental allergies, food allergens have not been approved for immunotherapy shots or low-dose oral immunotherapy drops.

Mild reactions to food allergens are managed with oral antihistamines or steroid medication. If you present with severe anaphylaxis, epinephrine is the course of action. If you have a food allergy, especially a known severe reaction, it is advisable to have a prescription-grade epinephrine auto-injector on your person at all times. Two of the common brands are EpiPen and Auvi-Q. One optimistic perspective is that about 80% of people with a wheat, milk, or egg allergy can outgrow them by 16 years old. Literature also suggests that 20 to 25% of kids can outgrow their peanut allergy, typically by 8 years old.

Complementary and Integrative Approaches for Food Allergies

Addressing food allergies from a holistic perspective can provide symptom relief and may help manage reactive foods.

Nutrition Options for Patients Who Experience Food Allergies

Avoiding a known food allergy is the standard of care. If your allergy reaction is non-anaphylactic, there is a chance that by working on other areas of your health, such as gut integrity, you may be able to manage the allergy better. An elimination or low-inflammatory diet is a great way to address gut health and immune system reactivity in the gut. Elimination diets involve the removal of known allergens while you work on supporting gut health. This diet is typically done with food sensitivities but could be beneficial if a leaky gut is a factor in your food allergy. The average elimination diet is 3-4 weeks, but with an allergy, you'll want to work with a holistic doctor that can help you determine the appropriate course of action.

Addressing gut health by implementing a Microbiome Diet can help support microflora. This entails eliminating allergens, along with common inflammatory foods like gluten, dairy, eggs, and processed foods. There are phases to this diet involving the use of digestive enzymes and probiotics to help correct underlying imbalances. Restoration of gut microflora is the ultimate goal of this nutrition plan. Low diversity in intestinal flora has been linked to IgE-mediated symptoms in infants. Supporting this could be key to maintaining tight junctions in the intestinal lining, decreasing inflammation, and creating a conducive environment for a balanced immune system.

Supplements and Herbs for Patients Who Experience Food Allergies

Natural Antihistamines

Utilizing natural antihistamines to help manage your body's histamine response to an allergen can be a supportive option in place of over-the-counter medications, which typically come with side effects such as drowsiness. Three commonly utilized evidence-based natural antihistamines are available, these are Quercetin, Bromelain, and Turmeric. All three of these have varying dosages and routines of administration, but here is a brief rundown of how you could start taking each supplement:

Quercetin should be taken twice per day for eight weeks at 50mg per day. Bromelain's average oral dosing is 40-400mg, while Turmeric has a supportive dose of 4,000 to 8,000mg/day. There are products that have a combination of these ingredients, which is sometimes helpful.

Vitamin C

Oral and intravenous Vitamin C have both been shown to support those experiencing an allergic reaction. Vitamin C is a great antioxidant, immune modulation, antihistamine, and anti-inflammatory mediator. One study looked at the use of intravenous Vitamin C (IVC) for the support of allergies. In the study, more than 50% of the participants did not take any additional medications to address their allergy-related symptoms, and they saw significant improvement using high-dose IVC. The data from this study also revealed that ascorbate deficiency is highly present in allergy conditions. The RDA for Vitamin C ranges based on age, which starts at 15mg for a one-year-old to 90mg for 19+-year-old male adults.

Omega-3 Fatty Acids

Both eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) are great anti-inflammatory resolvins for conditions like allergic reactions and gut inflammation. Omega-3 fatty acids can help manage the inflammatory process, much like corticosteroid medications, with much less risk and side effects. Incorporating omega-3 supplements or increasing foods high in EPA and DHA, such as wild-caught fish, are effective ways are increasing your Omega-3 status. Recommendations for an adult dosing of a DHA/EPA combo range from 250 to 500mg per day.

Acupuncture for Patients Who Experience Food Allergies

Utilizing acupuncture for symptom relief can be a great adjunct therapy for allergies. Allergic rhinitis, which can show up as a secondary pollen food allergy, has shown significant improvement with acupuncture treatments. Across a dozen plus papers, the use of acupuncture significantly reduced nasal irritation. The use of acupuncture has also proved improvement in urticaria characterized by hives. Seeking this integrative practice can be both relaxing and rejuvenating to your health.

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Summary

With food allergies being so prevalent in our society, it's crucial that we take a whole-person approach to address this rising concern. Determining what the actual allergen is, understanding if concomitant immune system irritations are going on, and assisting in managing symptoms can all aid in decreasing reactions and potentially improving your food allergy experience. Getting both proper conventional and functional medicine testing can provide answers that lead to a holistic approach to managing the discomfort you're experiencing.