The American Academy of Allergy and Immunology`s Committee on Adverse Reactions to Foods in cooperation with the National Institute of Allergy and Infectious Diseases compiled a monograph in 1984 outlining the "state of the art" in adverse reactions to foods (NIH Publication 84-2442 July 1984). The categories of possible adverse reactions to foods they listed are outlined below:

IMMUNOLOGIC

I. Generalized reactions: ANAPHYLAXIS

II. Skin reactions: URTICARIA/ANGIOEDEMA (hives), ATOPIC DERMATITIS (eczema), DERMATITIS HERPETIFORMIS

III. Respiratory System Reactions: ALLERGIC RHINITIS & CONJUNCTIVITIS, SEROUS OTITIS MEDIA (earache), BRONCHIAL ASTHMA, HEINER`S SYNDROME (milk-induced)

IV. Gastrointestinal Tract Reactions: ALLERGIC GASTROENTERITIS, EOSINOPHILIC GASTROENTERITIS, GASTROINTESTINAL BLEEDING, PROTEIN-LOSING ENTEROPATHY, CELIAC DISEASE (Gluten-sensitivity), ULCERATIVE COLITIS, ORAL AND PHAYNGEAL PRURITIS (itching), NONSPECIFIC PERIORAL RASH, PERIANAL RASH (Diaper rash), COLIC

V. Nervous System Reactions: HEADACHES, CLUSTER HEADACHE, SINUS HEADACHE, MIGRAINES

VI. Behavioral Reactions: TENSION-FATIGUE SYNDROME, ATTENTION-DEFICIT DISORDER (hyperactivity)

VII. Miscellaneous: VASCULITIS, SUDDEN INFANT DEATH SYNDROME (SIDS), THROMBOCYTOPENIA, ENURESIS (loss of bladder control; bedwetting), CARDIAC ARRTHYMIA, MUSCULOSKELETAL SYMPTOMS

NON-IMMUNOLOGIC

I. Anaphylactoid Reactions

II. Poisoning from natural toxic agents

III. Poisoning from food contamination by infectious agents

IV. Natural pharmacologic agents in foods (ex: goitrogenic: cabbage family, turnip, soybeans, and possibly watercress, radishes, rapeseed, and mustard.)

V. Metabolic reactions as a result of food ingestion

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As you can see there are many ways that food can cause reactions. Although technically, only those reactions that involve the immune system, and specifically include the involvement of IgE (an immunoglobulin associated with a rapid onset of symptoms), are called "Food Allergies." Beyond food allergies, there are a variety of other immune mechanisms by which the body can react and there are even more ways the body can react to food without involving the immune system. Because of this, we term those reactions that involve the immune system in a primary/principle way as being "hypersensitivities" and the non-immune based reactions as "intolerances."

There are many ways to try to assess food hypersensitivities and/or intolerances. Each has limitations:

1. Allergy skin tests are rapid, inexpensive, and considered by traditional allergist to be accurate. They can be helpful when positive but do not include non-IgE mediated immune reactions to foods or other ingested agents.
2. Blood tests include methods to detect allergies caused by IgE (typically rapid onset) or IgG (typically slower and mre prolonged reactions) antibodies. Drawing blood is required, they can be expensive, but have the advantage of having a wider array of foods available than skin tests. Tests using IgG may help identify foods that cause delayed reactions but may only indicate recent or recurrent intake or poor digestion rather than allergic or hypersensitivity reactions. Other immunologic tests include the ELISA/ACT/LRA that reportedly reveals other type of immune reactions. There are over 300 items available but it is expensive. If foods/items reactive on an ELISA/ACT/LRA are avoided as outlined by the laboratory, scientific studies have shown improvement in immune-related conditions but not always observed in my practice. None of the above procedures identifies foods/items that cause metabolic reactions without an immune basis.
3. Muscle tests or other Applied Kinesiology techniques can help but are dependent on the skill of the tester and are considered controversial by traditional medical doctors. Electromagnetic and resistance type tests use a similar basis for finding intolerances but also depend on the skill of the tester, the device being used, and are controversial.
4. A Diet Diary with food avoidance of "high-risk" foods or by use of defined rotational diets often provides the most convincing information and is without any financial expense. See the section on Mini-Food Meals for a practical way of testing foods.

What kinds of conditions might Food Allergies be worth exploring?

1. Recurring ear infections: food allergies are important in 85-93% by causing the lining of the eustachian tube and middle ear to swell and produce more mucus. The result is stagnant and excessive mucus, which is perfect for bacteria to overgrow. In one study, 14% had food allergies, 16% had inhaled allergies, and 70% had both. Proper food avoidance works in 92%!
2. Autoimmune Conditions such as SLE, MS, RA, etc.
3. Atopic Dermatitis and unexplained rashes
4. Irritable Bowel Syndrome and Dyspepsia
5. Frequent colds, chronic sinusitis, bronchitis, and asthma.
6. Behavioral Problems like ADD, ADHD, ODD, Autism, etc. Although not considered a treatment for these conditions, many children's behavior improves dramatically with the proper dietary restrictions.

The type of testing required warrants a discussion between the patient and Dr. Kaslow to determine which method is best.