By Chelsea Fuchs MS, dietetic intern at Teachers College, Columbia University
This post is the second part of my series on integrative nutrition and the management of food intolerances and allergies in children. Since the first post purely focused on food intolerances, I would now like to turn our attention to an integrative approach to the treatment and management of pediatric food allergies and sensitivities, a major concern among parents today. As I mentioned in my first post, integrative and functional nutrition embodies a systems-oriented, whole person approach, and combines clinical wisdom with integrative methods to make personalized recommendations for the prevention and management of a variety of acute and chronic conditions. To help explain the integrative school of thought when it comes to food allergies and sensitivities, I once again turn to Mary Beth Augustine, a leading expert in the field of integrative and functional nutrition, and a Registered Dietitian and Certified Nutritionist at the Beth Israel Continuum Center for Health and Healing.
When it comes to food allergies and sensitivities, Ms. Augustine prefers using the term “adverse food reactions.” From an integrative perspective, this concept is important because traditional allergy testing won’t pick up certain conditions. For example, a condition called eosinophilic gastritis, which results in a specific type of white blood cell causing injury and inflammation to the stomach, would not be detectable on a traditional IgG or IgE food allergy test. However, this condition would be detectable if an individual were to undergo an elimination diet, followed by a food challenge. Ms. Augustine’s approach when it comes to adverse food reactions is to start with an elimination diet and remove the suspected allergen. If however, the elimination diet is inconclusive, further allergy testing might be warranted.
At the Beth Israel Continuum Center for Health and Healing, both IgE and IgG testing for adverse food reactions are conducted. IgE food allergies and sensitivities are defined as immediate responses to a foreign substance that has entered the body, and it is usually performed as part of an initial screen for allergies. IgG food allergy and sensitivity testing look at antibodies that provide long-term resistance to infections, and this test is most often done in an integrative setting. Although many conventional allergists will argue that IgG testing is not valid, research studies have continually validated IgG testing, and this method of diagnosis should not be discounted, according to Ms. Augustine. Other types of allergy testing the center offers to include ALCAT testing, which identifies cellular reactions to food, chemicals, and herbs; and LEAP testing, which looks at cytokine mediators of allergies, such as interleukins and inflammatory cytokines. Finally, the center uses histamine testing if a patient presents with skin, sinus, or digestive symptoms.
After the test results are obtained, Ms. Augustine’s primary line of treatment is to remove the offending foods with an elimination diet. Similar to her protocol for food intolerances, this is followed by a food provocation phase, where the trigger food is added back to the diet 2-3 times per day for a 5-7 day period. In the integrative community, an elimination diet will consider the following allergens as potential offenders: gluten, dairy, soy, corn, citrus, nuts, and nightshades. Some integrative nutritionists will add strawberries, fish, and shellfish to this list as well.
While the elimination diet is her first line of approach, Ms. Augustine does use supplementation as a secondary line of therapy, depending on a particular patient’s condition or symptoms. For example, quercetin and NAC are two common supplements that Ms. Augustine recommends, due to their potent antihistamine action. Molecular D-Histamine, produced by the company Orthomolecular, is a multi-ingredient supplement that Ms. Augustine recommends as well, and this particular supplement contains quercetin, NAC, and nettles, a trifecta that is commonly used in integrative medicine in the management of food allergies. When it comes to a gluten sensitivity, Ms. Augustine will also recommend a digestive enzyme that digests glueoomorphin, called DPP-IV. This enzyme is helpful if trace amounts of gluten were to be digested, or if a product was contaminated with gluten. Of course, with any supplement, the strength of the evidence should be considered, and safety should always come before effectiveness. In addition to these factors, when recommending a supplement, Ms. Augustine considers what research has concluded from clinical trials in humans, animals, and laboratory studies, adverse effects, reasonably foreseeable side effects, dose-response reaction, drug-nutrient interactions, administration of treatment, when to start and stop the supplement, dietary supplement brand quality, purity, and identity, etc. The Natural Standard research database http://www.naturalstandard.com/ and the Natural Medicine Comprehensive Database, and, Consumer Labs are great resources for more information about foods, herbs, and supplements:
If you or your child presents with an adverse food reaction, it is also important to make sure you are receiving appropriate nutrition from dietary sources as well. For example, Ms. Augustine notes that if a child has a dairy allergy, it is important to make sure calcium and vitamin D needs are met from non-dairy sources, like rice milk fortified with calcium and vitamin D, dark leafy greens, vitamin D enhanced mushrooms and eggs, etc. There is also a myriad of online resources available, such as SparkPeople or LiveStrong that might be helpful. These sites enable an individual to enter their food and get a digital intake for 10-14 days, in order to see if they are meeting their nutrient needs. Since Ms. Augustine points out that most kids eat such a repetitive diet that they lack a broad spectrum of nutrients, to begin with, she strives to focus on general nutrition and nutritional adequacy as part of any treatment plan.
Another dietary approach that can be taken in the management of adverse food reactions is an anti-inflammatory diet. This involves avoiding processed carbs that spike blood sugar and cause inflammation and avoiding detrimental fats, like saturated fats, omega-6 fats, and trans fats that promote inflammation. Instead, the patient should strive to incorporate whole-grain, complex sources of carbohydrates as well as monounsaturated fatty acids, which help to reduce inflammation. The anti-inflammatory diet is also based on the premise that antioxidant-rich foods, like berries and dark, leafy greens, should be incorporated into the diet on a regular basis, as antioxidants play a huge role in decreasing inflammation–and most Americans only get ¼-1/3 of their antioxidant needs.
Finally, Ms. Augustine notes that while there are standards of practice and professional performance for clinicians working with this population, there is also a lot of depth and complexity of food allergies and food intolerances. These issues are not something you can easily write an algorithm or protocol for, and the educational approach may change depending on the person’s symptoms. Additionally, having a knowledgeable, skilled, and well-trained provider is essential in the proper management of food allergies and intolerances. For more information, the Food Allergy and Anaphylaxis Network provides a wealth of research and education that is worth exploring: http://www.foodallergy.org.
For more information on the Continuum Center for Health and Healing and Mary Beth Augustine, click here: http://www.healthandhealingny.org/center/staff_augustine.asp