Food sensitivity case report

Original Internist, Sept, 2006 by Betty Wedman-St Louis

More and more patients are arriving with pre-determined "agendas." BL was convinced she had food allergies after "reading several websites." In November 1993, following a thorough nutrition history and three-day food diary review, BL was instructed on what testing options would be appropriate to determine which foods were causing intolerance, considering the most common causes are wheat, milk, fish, eggs, shellfish, peanuts, tree nuts, and soy. (1)

BL stated she did not want skin prick testing which could pose a health risk because of possible anaphylaxis when the skin is pierced with protein extracts. Furthermore, the reliability of testing may not produce satisfactory results because mast cell responses can differ on site and age. Moreover, it was a time consuming regime that would not fit neatly into BL's life.

After discussing the validity, convenience and cost of ELISA (Enzyme-Linked Immunosorbent Assay) testing, we reviewed clinical contradictions like duplicity in antigen testing. (2,3,4) BL decided that alleviating her symptoms of migraine headaches, rhinitis, irritable bowel, and joint pain was worth sending her blood to two laboratories for an IgG Food Sensitivity Assay. IgG antibody tests have been available since the early 1990s, but there has been little research assessing diagnostic reliability, so this seemed like a reasonable request.

It wasn't until the results were reported that concern arose on how to explain the differences in the reported sensitivities noted on each test results. Lab 1 reported severe reaction to eggs; Lab 2 reported high reaction to eggs. Similarities in mild reactions varied, except that both laboratories reported milk. Lab 1 reported six mild to moderate reactions in a 45-food panel, and Lab 2 reported fifteen mild reactions in a 102-food panel. A food elimination diet was outlined omitting eggs, and BL was sent home with a symptom chart to complete in four weeks.

Two years later BL was back to see if "her allergies had changed." Friends and relatives had told her that people "lost their allergies" if they have been following an elimination diet. Not satisfied to select one laboratory for a repeat ELISA test, the previously selected labs were each sent blood samples. Lab 1 reported an equally severe reaction to egg, and added milk to this category (BL had been eating more cheese, ice cream and yogurt than previously). Three foods--kidney bean, almond, and pinto bean--were reported a second time as mild to moderate. Eight foods in a 90-food antibody panel showed reaction. Lab 2 again reported egg reaction (but somewhat reduced from November 1993). An increased reaction was noted in bananas, clams, and sesame--foods that BL had increased in consumption since 1993. Ten foods out of 102 had mild to moderate reactions reported.

Both laboratories reported consistent IgG antigen reactions to BL's most sensitive foods--eggs, milk, kidney beans--in 1993 and 1995. A rotation diet was emphasized to eliminate and/or reduce exposure to these antigens.

BL returned in 1997 to find out what was wrong because her "food allergies were causing lots of distress again." An updated history revealed some dietary liberties, but major lifestyle stresses in her employment and personal life were noted. Blood tests were again sent to the same labs and a third one was added for reference.

Lab 1 reported five severe food antigen reactions: eggs, milk, almonds, garlic, and ginger (almond and ginger had previously been moderate reactions). Out of a 90-food antibody assay, 27 foods were mild to moderate reactions--one-third of the food antigens on the panel reported reactivity in this increased time of stress. Lab 2 reported moderate reactivity in eggs, milk, and sesame. Nine out of 102 foods tested reported sensitivity reactions.

Explaining the results to BL was made easier when the results from Lab 3 combined the results from both Lab 1 and 2. Egg, garlic and persimmon were the highest reaction foods reported by Lab 3. Confirmation of yeast, kidney bean, mushroom, peanut, soybean, almond, cheese, and ginger sensitivities helped stress the need to use these foods on an occasional basis instead of daily choice.

Results from the June 2002 IgG ELISA test from Lab 1 verify that major food antigens identified do not disappear. Severity may reduce, as in the case of milk (severe 1997, moderate 2002), garlic (severe 1997, moderate 2002), and almond (severe 1997, moderate 2002) when foods are omitted from the diet.

Mild to moderate IgG reactions on ELISA tests may be related to frequency of consumption. Elevated levels of IgG food antigens increase in the blood each time an irritating food is eaten.

While IgG food antibody tests are not perfect, they can be an effective measure of immunoglobins that cause inflammatory reactions in the digestive tract. The ELISA food antigen test provided this patient an opportunity to live a more symptom-free life and realize that food sensitivities may be permanent and can be made worse by stress. IgG testing needs to be as routine in medicine as ordering a Complete Blood Count (CBC) and Metabolic Panel. Once food sensitivities are identified, an elimination or rotation diet can be designed to reduce symptoms.