Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet PDF
Preview Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet
Dealing With FOOD ALLERGIES A P G RACTICAL UIDE TO D C F ETECTING ULPRIT OODS E H , AND ATING A EALTHY E D NJOYABLE IET JANICE VICKERSTAFF JONEJA, P D, RDN H Bull Publishing Company Boulder, Colorado DEALING WITH FOOD ALLERGIES Copyright©2003byJaniceVickerstaffJoneja Allrightsreserved.Noportionofthisbookmaybereproducedinanyform orbyanymeanswithoutwrittenpermissionofthepublisher. BullPublishingCompany P.O.Box1377 Boulder,CO80306 800-676-2855 www.bullpub.com ISBN0-923521-64-X ManufacturedintheUnitedStatesofAmerica LibraryofCongressCataloging-in-PublicationData Joneja,JaniceVickerstaff. Dealingwithfoodallergies:apracticalguidetodetecting culpritfoodsandeatingahealthy,enjoyablediet/ byJaniceVickerstaffJoneja p. cm. Includesindex. ISBN0-923521-64-X 1.Foodallergy—Popularworks.I.Title. RC596.J6652003 616.97’5—dc21 2002151489 PUBLISHER:JamesBull DESIGNANDCOMPOSITION:ShadowCanyonGraphics MANUSCRIPTEDITOR:MargaretMoore PROJECTMANAGER:ErinMulligan COVERDESIGN:Lightbourne — CONTENTS — PREFACE .................................................. v PART I THE SCIENTIFIC BACKGROUND OF FOOD ALLERGY AND FOOD INTOLERANCE: WHAT IS REALLY GOING ON? ...................................... 1 INTRODUCTION: Let’s Talk About Food ................................ 3 CHAPTER 1: What Is Food Sensitivity? ............................. 7 CHAPTER 2: Signs and Symptoms of Food Sensitivity ................ 15 CHAPTER 3: Food Allergy ...................................... 27 CHAPTER 4: Food Intolerance ................................... 51 CHAPTER 5: Diagnosis of Food Sensitivities ........................ 77 CHAPTER 6: The Allergenic Potential of Foods ...................... 97 CHAPTER 7: Cross-Reactivity of Allergens ......................... 111 PART II DIETARY MANAGEMENT OF FOOD ALLERGIES AND FOOD INTOLERANCES ... 121 Chapter 8: Milk Allergy and Lactose Intolerance .................. 123 Chapter 9: Egg Allergy ....................................... 151 Chapter 10: Wheat and Grain Allergy ............................ 161 Chapter 11: Soy Allergy ...................................... 181 Chapter 12: Peanut Allergy .................................... 189 Chapter 13: Nut and Seed Allergy ............................... 195 Chapter 14: Fish and Shellfish Allergy ........................... 199 Chapter 15: The “Top Ten” Allergens ............................ 203 Chapter 16: Yeast and Mold Allergy ............................. 209 Chapter 17: Nickel Allergy .................................... 215 iii Chapter 18: Disaccharide Intolerance ............................ 223 Chapter 19: Biogenic Amines Intolerance: Histamine and Tyramine Sensitivity ................... 233 Chapter 20: Salicylate Intolerance ............................... 255 Chapter 21: Tartrazine Intolerance and Other Artificial Color Intolerance .................................. 265 Chapter 22: Benzoate Intolerance ............................... 277 Chapter 23: Sulfite Allergy and Intolerance ....................... 287 Chapter 24: BHA and BHT Intolerance ........................... 301 Chapter 25: Nitrate and Nitrite Sensitivity ........................ 307 Chapter 26: Monosodium Glutamate (MSG) Intolerance ............. 313 PART III Determining the Culprit Foods and Food Components: Elimination and Challenge Procedures ......................... 321 Chapter 27: Elimination Diets: Elimination Phase .................. 325 Chapter 28: Reintroduction of Foods: Challenge Phase .............. 341 Chapter 29: The Final Diet .................................... 385 APPENDIX I Few-Foods Elimination Diet: Recipes and Meal Plans ................. 397 APPENDIX 2 Sequential Incremental Dose Challenge ............................ 441 GLOSSARY .................................................. 463 INDEX ...................................................... 479 iv — PREFACE — Twenty-five years ago I found myself in a strange dilemma. My training as a scientistandmythinkingandemotionalresponseasamotherlandedmein asituationwhereIfelthelplessinbothroles. Myinfantsonhadbeendiagnosed withsevereasthma.Hehadsufferedwitheczemaalmostfrombirth,firstonhis face, hands and legs, and later on just about every area of his skin. By the time hewasfiveyearsoldhewasdependentonoralsteroidsforcontrolofbothcon- ditions.WheneverwetriedtoreducehisintakeofPrednisonebelow10mgper day, he would develop severe, and on more than one occasion, life-threatening asthma, which his pediatrician diagnosed as status asthmaticus. At the lower dosagesofPrednisone,theeczemaonhishandsbecameextreme;frequentlythe eczematouspatchesbecameinfectedwithcommonskinbacteria,andhisfingers swelledtodoubletheirnormalsize.Hewouldoftengotokindergartenwearing little white cotton gloves to cover the oozing sores and to keep in place the steroid-containing ointment that I liberally applied to his hands. When he was about two years old I began to notice reactions that I gradu- allyrealisedwerebeingtriggeredbyspecificfoods.Orangejuicewouldresultin himrunningthroughthehouse,screaming.WhenItriedtoholdhimtostopthe rampage, I felt his whole body quivering and shaking, and it was clear that he had no control over this reaction. Such behavior could be triggered predictably andconsistentlybyhisdrinkingaglassoforangejuice,butoccurredatnoother time. By the age of about four, this response had thankfully stopped. However, whenever he drank orange, or any other citrus juice for many years, he would start scratching, particularly his hands. This seemed a clear indication that it most likely was an exacerbating factor for his eczema, which often starts with itching. Another food that would consistently cause similar scratching was chocolate.Halloweenandbirthdaypartieswereoccasionsforbartering–allthe chocolates, chocolate cake, and cookies were assessed, and exchanged for a toy or other desired treasure of equal value. It became a game that the whole fam- ily enjoyed. v — PREFACE — Strangely,though,wheneverImentionedthese“foodallergies”tomyson’s doctors,theresponsewaspolitedismissal.Itislikelythat,becausehisfatherwas also a physician, they were reluctant to openly label his mother “neurotic” and “over-protective”assomanyparentsofallergicchildrenwereinthosedays(the mid-1970s). Only one doctor, his respirologist, was frank enough to declare, “There’s no such thing as food allergy!” Certainly at that time and sadly, occa- sionally today, the idea that asthma and eczema have an allergic etiology, espe- cially the idea that food allergy might be involved, was, and is, categorically denied by too many medical practitioners. It was not until he was proven to be anaphylactic to peanuts that his medical advisors would entertain the idea that my son might also have food allergy, inaddition to his other problems. Whatmadethewholesituationsobizarreformewasthefactthatmyearly training in immunology took place in the university department where the chairman was none other than Professor Philip Gell, one of the co-discoverers of the antibody responsible for allergy (IgE),. He was also one of the first scien- tiststodeveloptheclassificationofthehypersensitivityreactionsresponsiblefor allergy,asystemthatisstillrecognizedtoday.InessenceIlearnedtheimmunol- ogy of allergy from the undoubted “master” of the subject, and followed this with research in medical microbiology and immunology, gaining a Ph.D. in the field, and later an appointment as Assistant Professor in Microbiology at the UniversityofBritishColumbia.AsagraduatestudentIactuallytaughtacourse in the immunology department (at that time called the Department of Experimental Physiology) where the science of allergy immunology had its inception–andyetwhenitcametohelpingmyownsonwithhisallergies–Iwas no more effective than any other parent. Asallparentswill,Iconsultedevery“expert”inanefforttohelpmyson,but with increasing alarm and confusion, I realized that the field of allergy, especial- lyfoodallergy,wasfraughtwithcontroversy.Therewasaregrettablelackofsci- entificresearch,andevenlesscredibleclinicaldata.Asaresult,thefieldwasopen toeveryformof“alternativemedicalpractice”,rangingfromthepseudo-scientif- ic (and therefore almost plausible) to the frankly frightening. I consulted every- one,fromthosewhouseelectroacupuncture(Vegatests),biokinesiology(testing musclestrengthwhilethepatientholdsavialcontainingthesuspectfood),urine analysis, hair analysis, iridologists, practitioners of radionics, practitioners who consult crystals – anyone who might help! This phase of my search for answers provided one valuable piece of information: when a field lacks scientific valida- tionthatisbasedonresearchconductedaccordingtothetenetsoftraditionalsci- entificmethod,itisvulnerabletoinfiltrationbyanyoneofferinghope–realornot. Thisold“snakeoil”rusewascertainlythecasewithfoodallergy. vi — PREFACE — The real tragedy in this situation is the fact that, because the science is sparse, “traditional” medical practitioners tend to avoid the field, which is then taken over by “pseudo-scientists”. The result is that the legitimate scientist and theethicalcliniciandonotwishtobeassociatedwithanareaofpracticelacking scientificandmedicalvalidation.Researchintheareaisnotfundedbygranting agencies, and allergists with the temerity to enter the arena risk losing credibil- ity and the respect of their peers. My concern and confusion were increased to an alarming extent with the events that occurred in my son’s thirteenth year. For several months he had beenexperiencingseveremigraines.Attheirworsttheyhappenedthreeorfour timesaweekwithseverepainandvomiting.Hewouldspendtwenty-fourhours in his darkened bedroom with each episode. Finally he was hospitalized, and every appropriate test was conducted. Special care was taken with these tests, since his own father was the only neurologist (and, incidentally, the only psy- chiatrist – he is, and was, a Fellow of the Royal College of Physicians and Surgeons of Canada in both specialties) in town at the time. No pathology was detectedthatcouldaccountforthemigraines.Hispediatricianprescribeda“par- entectomy”;shehadreachedtheconclusionthatstresswithinthefamily home was responsible for our son’s problems, and suggested that we should consider making arrangements for his living elsewhere. {As an aside, later he did attend boarding school, from Grade 9 to 12, where his allergies were in fact far worse thantheyhadbeenathome!}.Fortunatelyforus,hisparentswhowereindan- ger of living the rest of our lives in the shadow of the guilt engendered by the thoughtthatwealonewereresponsibleforthedebilitatingill-healthofouronly son,acauseforthemigraineswasdiscovered.Onceagainitwasrelatedtofood. Basedonhisobservationthathefeltnauseatedandillaftereatingmeat,our sondecidedtobecomeastrictvegetarian.Inaccordancewithhisrequest,when he returned home from his two-week stay in the hospital, with symptoms unchanged in severity and frequency, I provided meals completely free from foodderivedfromanyanimalsource.Themostamazingandgratifyingresultof thisdrasticchangeindietwasthatheimmediatelyandcompletelybecamefree from migraines! For several years he remained a strict vegan in his food choic- es.Hedidnoteatanymeat,poultry,fish,egg,milk,ormilkproducts.Hefound that ice cream, milk, cheese or other milk-based food caused immediate vomit- ing.Inspiteofhiscontinuinganaphylacticreactiontopeanuts(eventhesmall- est quantity of peanut as a “hidden ingredient” in a food, accidentally eaten, resulted in immediate throat swelling and the onset of anaphylaxis, requiring promptmedicalintervention)hewasabletoeatanyotherlegumewithimpuni- ty.Thiswasfortunate,sincehismainsourcesofproteinweredriedpeas,beans, lentils, and soy. I became an expert in bean-based gourmet cooking! vii — PREFACE — Theonlytimethathehasexperiencedadistressingrecurrenceofheadaches sincehisthirteenthbirthdayiswhenhehaseatenporkorbeef.Yearslater,asa result of careful food challenges, we discovered that the primary cause of his migraineswaspork,followedtoalesserextentbybeef.Althoughheisnotnow vegetarian,aslongasheavoidspork,beef,andfoodscontainingthesemeatshe remainsfreefromthosedistressingmigraineheadaches.Interestingly,asaresult of our careful food challenges, we discovered that he is also highly sensitive to sulfites—asituationthatInowknowtobequitecommoninsteroid-dependent asthmatics.(ThemethodsthatweuseforspecificfoodchallengesintheAllergy Nutrition Clinic are provided in great detail in the book). Themostimportantoutcomeoftheexperienceswithmyson’sallergiccon- ditions (and to some extent, my daughter’s) was, for me, the realization that in spite of my specialized knowledge about the scientific bases of the clinical signs I was witnessing at first hand, I, and the medical specialists involved in their care, were unable to be of any real assistance in addressing the cause(s) of my children’s allergic diseases. The recognition of the limited resources available to my children, to me, and to the untold numbers of people in similar situations haspromptedmetopursuewhathasbeenmyprimaryobjectiveinthepastfif- teenyears.WhereaspreviouslyIwasalaboratoryscientist,conductingresearch into the mechanisms responsible for microbial and immunological diseases, now Iamfocusedontheclinicalapplicationoftheknowledgegainedfromlaborato- ryscienceforthebenefitofpeopleexperiencingtheresultsofsuchdiseases.This type of “evidence-based” research is becoming increasingly important in medi- cine,andinnocontextisitmorevalidthaninthepursuitofunderstandingand controllingthedifferentwaysinwhichourbodiesinteractwiththefoodweeat —especially when the food that should nurture becomes a cause of distress. In 1991 I was instrumental in the establishment of a unique service—the Allergy Nutrition Research Program at Vancouver Hospital and Health Sciences CentreinVancouver,BritishColumbia.Theprogramcomprisesthreecomponents: ◆ Anoutpatientclinicwherepatientscanobtainhelpintheidentificationand management of their adverse reactions to foods. A physician’s referral is requiredforallpatientsattendingtheAllergyNutritionClinic.Todatemore than 3,000 patients and their families have obtained assistance in the man- agement of their food sensitivities in the clinic. ◆ An information resource, which provides information on current research infoodallergyforhealthcareprofessionalssuchasphysicians,publichealth nurses and dietitians. The dissemination of this material includes seminars, lectures, workshops, radio and television interviews, the publication of books, manuals, audio and video resources, and articles in peer-reviewed medical and scientific journals. viii
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