Kara: Is it a tummy ache or is it a food allergy? Welcome back to

Is it a tummy ache or a food allergy?

Kara: Allergy Actually.

. One of the most common reasons that I have patients come to see me in my office is really sorting out the symptoms they're experiencing when they eat particular foods. And understanding what those mean and if they should be really worried about what's going on.

Meagan: Whether or not they should have testing too, that's a big thing that they present as, "I'm here for testing because I have various GI symptoms." And our job is then to decide, do you really need testing? Is it this kind of testing or other kind? And how to move forward with getting you feeling better?

The Problem with "Just Test Me for Everything"

Amber: Do you guys get this? I hear the " Just test me for everything. I wanna be tested for all the foods." That's one of the things that I try to take time, and I'm sure you do too, to explain. Well, I get where you're coming from. You're coming from a place where you don't know what's making you feel bad and you wanna try to figure it out. But with food testing, we have to name the foods.

So like, you know, there's skin testing, blood testing, we have to say egg, milk, wheat. There's not like a universal food test, so part of our job is to help listen, hear the story, hear what you're experiencing, and help tease out what are the most common triggers based on what you're experiencing to help guide that testing.

Meagan: Right. It's important not to over test because we get false positives on food testing and you get it both for doing skin testing and blood testing and we see this all the time and people will come in and who have physicians who ordered this with good intent. They think that's what they're supposed to do.

Dangers of Over-testing: False Positives & Unnecessary Avoidance 

Meagan: You have, you know, for instance, had a lot of diarrhea and chronic abdominal pain, and so the first thing they think is, "Oh, food allergy. Let's do a, a panel of all the foods." And unfortunately we can get false positives doing that. And so that can lead to inappropriate avoidance which can lead to nutritional deficiencies. We also know we think at least in the younger population that aggressively avoiding foods can accidentally then potentiate anaphylaxis down the line for foods that are known to be major triggers for food allergies.

So there are a lot of caveats to food allergy that, and, and diagnosing food allergy versus intolerance that a lot of people aren't aware of.

Kara: Let's talk through kind of that conversation and kind of dissect it out a little bit. I think of our role as being, I put my Sherlock Holmes detective hat on, and really parse out, okay, what, what, is your lived experience that is bringing you in with this question? And, and what, what are those questions that are like keeping you up at night? The symptoms that are keeping you up at night because it is important to have that story and then think about what particular diagnostics or tests. Whether it is a blood test, a skin test, or a test of taking a, a food out and putting it back in where this 

Why Your Story is the Most Important Test

Meagan: need an endoscopy as well. You might need a scope. Or there's some new technology where you can get ideas about inflammation in the gut via other methods. But sometimes that may be the answer as well, that food testing isn't it at all. And you need to move on to that. So,

Amber: Yeah. And even before we even talk about the testing though, like you said, Kara, we, we need to know the details. So tell me everything, the timing. When did you feel the symptoms in relation to when you last ate? If you're thinking this is related to food, what were the symptoms? Have you noticed any patterns? You know, you're coming to us for answers, but sometimes you have the answers and you don't even realize it, looking for patterns. So that's all part of piecing out the history and helping focus down on testing. 

And then what, what do you guys recommend for testing?

Meagan: Well, it really depends on what they're, um, what they're coming in for. I have a situation that I just thought of that happens a lot is I'll have patients, for instance, who come in with eczema and they have had potentially, you know, extensive food allergy testing, whether it be prick testing or blood testing, um, prior to. And they'll say things like, "You know what? I definitely know this is corn. I'm avoiding corn. That was positive on my test. And you know, I wanna know what else I need to avoid a.k.a because I'm still suffering from the disease."

And so my goal is often, I really want to keep foods in people's diet. I would love everyone to be able to eat everything, and I know that's not realistic, but I don't want people to avoid things they don't have to. And so I'm often gently reminding patients that, well, if it didn't go away, and you're, you're still eating it, it's not causing it. Right? Like if you're not eating, I mean, or that might have came out wrong. If you're not eating it at all and you're, you still have symptoms, that's not the problem. 

The Ripple Effect of Food Avoidance on Family & Social Life

Amber: That's not the problem. And food avoidance affects the whole family. You know, if one person, whether it be a child or the parent or another adult, and your family unit or social unit is avoiding a food. If you're making community meals, then a lot of times you're having to adjust the whole family's diet or make two meals. It can affect your budget, it can affect socialization with other families, eating at restaurants. So it's a big deal and that's why if we can focus on, okay, is it a food. One. Is it even food? We think it is, but it might not be.

If it is food, is it one food or is it kind of a category of things? And is it something we need to strictly avoid, or is it something we can limit? Like for dairy intolerance, lactose intolerance, I always tell people, you're not allergic, so you don't have the, what we would call life-threatening allergy or IgE mediated allergy. So if you want to have a milkshake on your birthday, go for it. You won't die. You might feel like you're gonna die, but you'd be making that choice. 

Meagan: I always tell people sometimes you just need the bowl of queso and you just deal with the consequences. You have a similar thing for, for 

Kara: You

The Surprising Link Between a Diverse Diet & Gut Health

Kara:  know, my well, I grew up about five minutes from the Wisconsin border, and nachos happened to be probably one of my favorite things. I think one of the other aspects that comes up it, from, even from the health standpoint of, certainly the, the lifestyle and the budget and the frustration. Like, that is very important.

But then, you know, the, the counter is like, but if this is gonna be a more natural way to improve my health, my gut health, like I wanna do it.

The data would say that those who eat the most variety, especially when it comes to plant-based foods, upwards of 30 different types of plants within a week, they have the best health outcomes.

So, you know, that sounds like a lot. It includes fruits, it includes vegetables. Beans and legumes, nuts and seeds, as long as you aren't truly allergic. Herbs and spices. It is that variety, eating the rainbow, the variety of flavors, and all of those bioactive compounds that really help reinforce a healthy microbiome, healthy, you know, gut mucosal surface and mucus lining.

And really aid in that production of what we call the short chain fatty acids, which are anti-inflammatory. And so when we see folks narrow down their diet, and narrow it down and narrow it down and narrow it down, not only does it make their world smaller externally, it's also making that microbiome smaller and less helpful.

Meagan: That's a really excellent point. 

Amber: That is really good. And I guess we should clarify if someone has IgE mediated allergy to a specific food, say peanut, they should strictly avoid it. Everyone should do everything they can to help that person avoid it. What we're talking about is if you're experiencing symptoms that you think might be caused by food, but they're not life-threatening symptoms, all too many times people just take foods out of their diet and no one ever and leave them and no one ever advises how to, how to put them back in. So that's a lot of the work we do is liberalizing people's 

Kara: Yeah. Why don't we talk a little bit about what true food allergy looks and acts like, because I think that is really helpful to set that, that picture of what that experience is like? 

What a TRUE Food Allergy Reaction Looks Like (IgE-Mediated)

Meagan: Got it. So when we say true food allergy, again as allergists, we're talking about immediate hypersensitivity, which is mediated by a protein called IgE. And what happens if you have IgE that is specific for a particular food, when you consume that food, you have symptoms that consist of and not limited to, but things including hives, swelling, you can have problems breathing. You can have circulatory collapse, so you can pass out, your blood pressure can go down. You can also have things like stuffy nose, eye symptoms things like that that occur. But it's important to know that we, we look at this as a whole sort of reaction.

I have people who really want food testing for stuffy nose sometimes, and I have to explain, well, that's, it concur within, you know, within a reaction. But chronic stuffy nose is not going to be due to a food. And so that's how I explain it to my patients. So if the food doesn't try to kill you, you probably don't have a true allergy. You probably have a food intolerance.

There are other types of allergy that for a food, different immunologic mechanisms that we're not gonna go into, such as celiac disease and something called FPIES, they're as food protein induced Food Protein Induced Enterocolitis Syndrome and Proctocolitis.

There's all sorts of different things, but one of the things is that if food, literally, if you have a reaction where you are having some of those symptoms, and again, in simplistic terms, if it tries to kill you, and that's happened on more than one occasion, especially, then we consider that an immediate hypersensitivity or true food allergy. 

Amber: Yes. And those are conditions that you really should see an allergist. There's so much that goes into diagnosing it, knowing exactly what you're allergic to. Are you allergic to other things? Taking a deeper history there, making sure you have epinephrine and that all caregivers, especially for children that caregivers, schools, know how to use it, have accessible epinephrine.

The Importance of a Care Plan for Food Allergies

Amber: So there's a lot that goes into diagnosing a food allergy and making sure you have a good care plan. And we'll in a future episode, dive into some new treatments for food allergy. But at a basic level, identifying it and having a, a treatment plan for anaphylaxis is key. 

Kara: So we wanna hear your questions, hear your experiences. Leave those in the comments. Make sure to subscribe. If you're enjoying these episodes, make sure to share it with your your group text and the mom, mom thread and your Girl Scout troop, to other soccer moms. We wanna hear from you, so leave those questions below.

And until next time, thank you. This is 

Allergy 

Actually.

​