George F. Kroker, MD FACAAI Treatment Philosophy for Food Allergy & Concept Overview
Dec 27, 2015
Copyright 2015 Allergy Associates of La Crosse
Food Reactions: “The Formula”
When you do a “test” for food allergy, you are only measuring one of the two essential items that determine an allergic reaction:
Allergic Reaction =
Our testing Patient’s exposure
Allergic LoadAllergic Sensitivity x
Copyright 2015 Allergy Associates of La Crosse
Cumulative Food Ingestion & Load
Day Number
2 3 4 5 61
Initial Food Ingestion
Total CumulativeFood Allergen Load
AllergicThreshold
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Critical Mass Concepts
Time
“Bad Day”AllergicThreshold
“Bad Day”
The “Sometimes” Patient
Copyright 2015 Allergy Associates of La Crosse
Food reaction to meal: two diagnostic possibilities
Possibility 1: exposure to a single item, rarely ingested, that the pt is extremely sensitive to
Possibility 2: exposure to several items, (inhalants or foods) that the patient has moderate reaction to (“The Perfect Storm’)
Copyright 2015 Allergy Associates of La Crosse
Altered Intestinal Permeability & Food Allergy
The “screen inthe window”
metaphor
Copyright 2015 Allergy Associates of La Crosse
Increased Intestinal Permeability: Presentation
Progressive increase in food reactivity, following one or more events that have injured intestinal mucosa
Prior food allergens become more reactive, and “spreading” to new food allergens occurs
Copyright 2015 Allergy Associates of La Crosse
Altered Intestinal Permeability Causes of increased intestinal permeability
include: Acute infectious illness: Viral gastroenteritis,
food poisoning Chronic infectious illness: Protozoal
infections, yeast overgrowth secondary to antibiotics
Chronic ingestion of hidden food allergen(s) Drugs: Chronic NSAIDs, alcohol ingestion Acute anaphylactic reaction
Copyright 2015 Allergy Associates of La Crosse
Altered Intestinal Permeability: Clinical Presentations
White male with prior history of hay fever, --had acute GI bleed secondary to overdose of NSAIDs; shortly afterwards began having multiple food reactions
Alcoholic male with increasing food reactions as drinking increased
White female with chronic antibiotic use for acne, developing yeast vaginitis infections recurrently and onset of progressive multiple food reactions
White female with flareup of prior food allergens (previously in remission) following food poisoning
Copyright 2015 Allergy Associates of La Crosse
The Positive Feedback Loop in Allergy
Important principle of positive feedback loop:
Hidden food sensitivities worsen intestinal permeability AND increased intestinal permeability worsens hidden food sensitivities!
Food Sensitivities Intestinal Permeability
Copyright 2015 Allergy Associates of La Crosse
Why Treat Food Allergy? The LCM Philosophy
Simple avoidance often not possible Immunotherapy is only disease-modifying
tool available Helps stop the atopic march in children Important part of total load Improves quality of life