Food allergy is often a factor in the management of allergic patients.

Patients who have, for example, lip swelling and shortness of breath every time they eat strawberries, are exhibiting an immediate type reaction. This type of reaction is due to IgE and is called a Type I reaction. It is often diagnosed by family members because of the close association of the offending food with the symptoms. Eating the offending food and the onset of symptoms are often separated by mere seconds to several minutes. These patients must stop eating the offending food and carry an injectible form of epinephrine at all times. Antihistamines and steroids have some place in the prevention and treatment of these types of reactions. The best form of diagnosis is to do RAST testing (requires drawing blood). If the patient is to be tested with fasting and then eating the suspected food, the testing must be done in a medical facility where good personnel and equipment are at hand to reverse the reaction. (I do not recommend this type of testing routinely as it carries the risk of fatal reactions).

Most of my patients have “food intolerance” or “food sensitivity”, and may or may not react every time they eat the offending food. The patients and their families are often unaware as to the identity of the food(s) causing their symptoms. The ingestion of the food and symptoms are often separated by hours. Antihistamines do not prevent or alleviate these reactions and steroids are not helpful.

The best method of testing for “food intolerance” or “food sensitivity” is by doing a “Diet Diary” (Click link below to download a copy). The patient must write down everything (yes, everything, including toothpaste, candy, gum, medications, etc.) that they put in their mouths. There is a place to put down symptoms and any medications that are taken for the symptoms. It is very important to write down any symptom that you notice as a change from what would be normal. For example, cramps, rash, headache, cough, diarrhea, pain, colic, or anything that changes. By backtracking, it can be determined if the symptoms are occurring with or after the ingestion of any particular medication or foods.

Once the diet diary is done and the suspected foods are identified, then an elimination diet can be designed to omit the suspected foods. If the symptoms clear or improve, then the food is re-introduced. If the symptoms return or worsen, then it can be surmised that one of the offending foods has been identified.