Food Allergy, Gluten Sensitivity and Celiac DiseaseThis article may be reprinted free of charge provided 1) that there is clear attribution to theOrthomolecular Medicine News Service, and 2) that both the OMNS free subscription linkhttp://orthomolecular.org/subscribe.html and also the OMNS archive linkhttp://orthomolecular.org/resources/omns/index.shtml are included.FOR IMMEDIATE RELEASEOrthomolecular Medicine News Service, January 21, 2014Food Allergy, Gluten Sensitivity and Celiac Disease Personal Viewpoint by Ralph Campbell, MD(OMNS Jan 21, 2014) What may have been called "food intolerance" or "food sensitivity" in the pastmay now qualify as "food allergy." On the other hand, certain conditions which mimic allergysymptoms should not come under that umbrella. We need an understanding of food allergy beforesuccessful management can be accomplished. There are no quick-fix remedies.We tend to categorize by symptomatology, which accounts for the overlap of intolerance, sensitivityor true allergy: 1) nasal symptoms of stuffy nose and sneezing; 2) bowel symptoms of intestinalcramping or gas; 3) lung symptoms of wheezing and 4) skin that itches or produces a rash.What is and Allergy, Really?For decades, allergists have considered what we might call an allergic reaction to be a true allergyonly if it is of the Th2 type (a type of immune cell) that produces measurable IgE antibodies. Theother type, Th1, produces tissue antibodies that protect against infection. When a baby is born, it nolonger has the protection of mother's antibodies, making it vulnerable to infectious diseases. Theinfant's immune system can take either route: the allergy pathway or the "fight infection" pathway.Residing in our cell membranes are hormone-like substances called prostaglandins. Treatment willbe addressed later, but for now we need to understand a bit about "good" fatty acids vs. "bad" to seehow the choice is made. Omega-6 fatty acids (as derived from grains), incorporated in aprostaglandin, leads to the allergy pathway, whereas the omega-3 fatty acids (plentiful in fish oils) ina prostaglandin influence the development of the Th1 antibodies.Heredity seems to play a part in the predisposition to develop allergies as well as the mechanism Ijust described, which is more "nurture" than "nature." The predisposed cell, upon exposure to a foodallergen (antigen), produces IgE antibodies which attach to mast cells. With further exposure, thefood antigen (a protein in the food) reacts with the IgE type of antibody causing mast cells tobreakdown and release histamine. It is the histamine, for the most part, that produces allergysymptoms. The food protein that remains intact by somehow escaping denaturing from heat ordigestive processes, can become an antigen by sneaking into the blood stream via the "leaky gutsyndrome" (the descriptive term for a porous gut) enabling distribution to cells in the nose, lungs orskin. For the gut, symptomatology may include colic-like cramping, mucus (even bloody mucus) inthe stool, or irritable bowel syndrome that can produce either diarrhea or constipation. Nasalmucosal lining sensitization produces a stuffy, itchy nose or sneezing, while skin sensitization ismanifest as eczema or topical dermatitis (both produce itching). Food allergens play a prominentpart in wheezing; but so can irritants in the air, infection, and even exercise. The preservative,sodium sulfite, although certainly not a food itself, commonly contributes to wheezing and nasalsymptoms.I put allergy reactions into two categories: "rip-snortin,'" and those fitting Dr. William G. Crook'sdescription of "hidden allergies". (Dr. Crook was a pediatric allergist and a pioneer in the science offood allergy.) Under the first category, I would include sneezing, wheezing, vomiting, intestinalcramping, hives and life-threatening, angioneurotic edema. The hidden allergies are manifest by aplugged up, itchy nose, runny nose with post-nasal drip causing a rattly cough, or mild abdominalcramping with mucus in the stool. Exposure to more than one allergen at the same time may createsymptoms where a single exposure will not--the important concept of "allergy load."The severe reactions are clearly IgE antibody related, for which there are reliable tests. Even thoughthere is documentation of milder allergies being on a different immune basis, this is given littleattention, especially in infants with cow's milk allergy and the fact that they are often outgrownwithout the benefit of treatment.Detection and TreatmentIn a recent, very detailed study (1), a few workable, simple concepts come through among a maze ofimmunology jargon that only a few can comprehend. They contend that food allergy is increasingdue to taking the Th2 pathway. A September 17, 2013 Reuter's Health article by Lorraine L.Janeczko reports the findings of Dr. Peter Gillet, a gastroenterologist at the Royal Hospital for SickChildren in Edinburgh. He feels there has been a 64% rise in food allergy over a twenty year period,there. Also America and several other countries are showing large rises. The rate of rise is muchgreater in a more recent five year period. However the increase is attributed to more awareness andmore testing in which only IgE mediated allergy is accepted. This leaves me to believe there aremany more undetected cases "out there".The immunology study describes different types of tests, including the old standard of the prick orscratch skin test in which an antigen is scratched into the skin where the formation of a hive-likewheal is proof of allergy. They are taking new looks at old tests and treatment that were rejected inthe past: oral specific, the "regular and gradual administration of escalating doses" and sublingual,in which the antigen rapidly enters the blood stream. In desensitizing a patient to a potent antigen,such as peanut, these methods are undertaken in the presence of a doctor who is prepared for theworst. Intricate immune pathways are presented in the article. The good news comes from theadmission that they are "far from understanding the complex mechanisms leading to the successfulresults in allergen-specific immunology." We don't need to hold our breath while waiting for the fulldevelopment of the new paradigm, but rather, utilize what we already know that works. A furtheradmission is that the gold standard for testing for food allergy still is the oral challenge. This isstrengthened by observing the short-comings of some of the tests in which the test occasionally maybe negative, but the patient can still have a bad reaction with future contact. The flip side is that thetest may be positive, but the patient has no clinical signs of allergy after exposure.I know that for the pediatric population the elimination-and-challenge test is totally adequate andreliable for detecting food allergies and items like food colorings and other food additives.Remember thatSymptoms arise within 2 hours after ingestion for most allergy problems, and that burning anditching sensations in the mouth or palate come immediately.Make a list of everything ingested that brings on those symptoms. Find commonality from your liststhat leads to "suspects."Withdraw the suspects from the diet and note whether the allergy symptoms disappear.If adding back the suspect, one at a time, causes a return of symptoms, you have nailed a suspect.After a time of freedom from a reaction, periodically present a small, isolated challenge to see if theproblem is still there. If not, reintroduce the food by gradually increasing doses.Real Help with Vitamin CHistamine, released in an allergic reaction, is the main chemical responsible for symptoms.Antihistamines are commonly prescribed. As with most medicines, there are side effects, mostcommonly drowsiness. Newer antihistamines claim to have less of this effect and to diminishsymptoms better, but my personal experience does not bear this out. Response to these drugs is onan individual basis and varies. Fortunately, there is a natural remedy, without side-effects, thatreally works. That is vitamin C, due to vitamin C's ability to neutralize histamine. The minimalamount in a daily multivitamin or an orange won't do the trick, but for many adults 2,000 mg every 2hours until symptoms subside, will. I have had this experience with my patients. According toweight, scale down the amount, but don't hesitate to give repeated doses if the initial dose doesn'tfinish the job.Not Allergy, but Allergy Look-AlikesCertain foods, such as red wines (with or without sulfites) and moldy cheeses create histaminerelease that is not on an allergy basis. Infection in the respiratory tree can create similar symptoms.No one is allergic to running, but in some, exercise triggers wheezing.Lactose intolerance may cause intestinal distress of gas and mild cramping, similar to that derivedfrom food sensitization, and act much like irritable bowel syndrome. Interestingly, there is a strongfamilial tendency for its development. Those of Asian decent are much more susceptible. Althoughstraight cow's milk is poorly tolerated, the good news is that milk treated with lactose digestingprobiotics, such as Lactobacillus acidophilus, is well tolerated. After weaning, many Asian infants goon to some form of fermented milk.Gluten Sensitivity and Celiac DiseaseDr. Tom O'Bryan's article, "The Conundrum of Gluten Sensitivity," published in the National HealthFederation's publication, Health Freedom News, showed that he had done his homework concerningthe newer diagnostic tests that are providing a new look at gluten sensitivity as well as out-and-outceliac disease. He also described signs and symptoms of celiac disease outside the intestinal tract,which broadens its scope. I wish to provide a different slant on the subject that is derived from apediatric point of view that extends from old time through current technological advances.In my pediatric practice, I saw and successfully managed many cases of wheat allergy. At the sametime, I had only one patient with classic celiac disease: a scrawny infant with the pathetic, heart-rending look of starvation and a flat area where his buttocks should be; a picture right out of thetextbook. The best and only diagnostic tool for food allergy at that time was the food challenge. Inthe previously mentioned article in Immunotherapy by Enrique Gomez et al, the oral challenge wassaid to be the current gold standard as well. When positive, the infant/toddler was kept off of wheatfor a time and periodically challenged, since wheat allergy, and the even more common cow's milkallergy, were known to clear spontaneously after a period of abstinence. Besides intestinal allergysymptoms, an infant with wheat allergy often exhibits nasal allergy signs which appear very shortlyafter ingestion of the allergen, making the relationship obvious.I see a continuum of simple allergy to the auto-immune condition of celiac disease. I can't agree thatit isn't celiac disease until the intestinal villi are completely destroyed. It is a process. True, once theimmune system response is under way, the only way to stop it is to refrain from intake of any of thegluten-containing grains. Intestinal biopsy that searches for destroyed villi is the only reliable test.Discovering the multiple double-, triple- or polypeptides of gluten can lead to lots of tests. Sincethere are false negatives as well as false positives results to the tests, and all require blood-letting,even if I had had access to them, I would have not employed them.Scientific curiosity drives us to look for the precise causes of disease. But if the motive for suchspecificity is to enable developing target patentable pharmaceuticals, it would be better not to look.Avoiding the antigen does the job well enough.Diagnoses IncreaseWhat I am seeing, especially in well-educated young people who have computer savvy, is self-diagnosis of gluten sensitivity derived from bombardment by the press, the Internet highway and TVnews. It seems to be the in vogue diagnosis to have. An industry (much like the cholesterol industry)of gluten-free foods is springing up. It is difficult to motivate the "gluten-free" adherents to obtaindifferentiation between simple wheat allergy and celiac disease. What has happened?Dr. O'Bryan's article and the Enrique Gomez article referred to above, agree that there has been amarked increase of incidence in the last few decades. A 2010 Medscape article referred to a Mayostudy by Joseph Murray in which they analyzed stored blood samples of Air Force recruits in the1950s for gluten antibodies. These antibodies were practically non-existent in the 50s samples butthe article mentioned a large increase in incidence in the last three decades. Auto-immune diseases,in general, are on the increase. I believe that at the heart of these problems is the way we abuse ourimmune systems by direct attacks and nutritional deficiencies. Both diets and environmental toxinsexposure have changed exponentially since the 50s.Most current diets are very deficient in the vitamins that are essential as co-factors of enzymes thatkeep our metabolic wheels turning. Recommended Daily Allowances (RDAs) are barely able toprevent classic deficiency diseases like rickets or beriberi. I could fill pages with citations about theeffect of environmental toxins on the immune system. A recent boon for those who treat allergyproblems has been the gain in knowledge of omega-3 fatty acids (FAs). Whether the young immunesystem takes the Th1 pathway or the Th2 pathway that produces measurable IgE antibodies whichmark "big time" allergies, is largely determined by the ratio of omega-6 FAs to omega-3 FAs. Ratherthan having closer to the ideal of 2:1, current diets create a ratio more like 20:1.The make-up of ourprostaglandins (hormone-like substances in cell walls--ready to spring into action--is determined bythe essential fatty acids in the mix: those provoking inflammation and clumping of platelets or thosedoing the opposite. The "leaky gut syndrome" concept is getting some new, deserved attention. Justwhat causes the gut permeability that can allow whole proteins to sneak from the gut into the bloodstream and promote the antibody formation of simple allergy or auto-immunity in which theantibodies mistake normal body cells as foreign invaders?ConclusionWe might keep trying to satisfy our scientific curiosity by seeking to pin-point the causes of foodallergy, and auto-immune diseases that can be documented by specific tests. But should we wait for,or expect to be able to rely 100% on, new tests while other more straightforward, proven diagnostictools are available? Let's not get bogged down with minutia. Rather, let us attempt to get straight,understandable information to the public that possibly could get them on a helpful, less cumbersomeand less expensive track. Immune systems aren't functioning like they used to. A tangible effect isnoted with antibody levels in response to various vaccines that are producing antibody levels wellbelow the expected. I feel that the rapid rise in auto-immune diseases is getting away from us. Toooften, drugs are not meeting our expectations. Let us concentrate on ways to improve immunehealth while continuing to identify the agents that weaken our immune systems. Immune healthcannot be isolated from general health. Since it is nearly impossible in our culture to achieve acompletely healthy diet, the intake of optimal amounts of vitamin supplements is essential.(Dr. Ralph Campbell, board-certified in pediatrics, is also an octogenarian orchard farmer. He livesand works in Montana.)References:1. Gomez E et al. Immunotherapy, 2013, 5(7): 755-768http://www.ncbi.nlm.nih.gov/pubmed/?term=Immunotherapy%2C+2013+5%287%29%3A+755-768+GomezFor further reading:Campbell R, Saul AW. The Vitamin Cure for Children's Health Problems. Laguna Beach, CA: BasicHealth Publications, 2012.Downing D. The Vitamin Cure for Allergies. Laguna Beach, CA: Basic Health Publications, 2010.Nutritional Medicine is Orthomolecular MedicineOrthomolecular medicine uses safe, effective nutritional therapy to fight illness. For moreinformation: http://www.orthomolecular.orgFind a DoctorTo locate an orthomolecular physician near you:http://orthomolecular.org/resources/omns/v06n09.shtmlThe peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercialinformational resource.Editorial Review Board:Ian Brighthope, M.D. (Australia)Ralph K. Campbell, M.D. (USA)Carolyn Dean, M.D., N.D. (USA)Damien Downing, M.D. (United Kingdom)Dean Elledge, D.D.S., M.S. (USA)Michael Ellis, M.D. (Australia)Martin P. Gallagher, M.D., D.C. (USA)Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)William B. Grant, Ph.D. (USA)Steve Hickey, Ph.D. (United Kingdom)Michael Janson, M.D. (USA)Robert E. Jenkins, D.C. (USA)Bo H. Jonsson, M.D., Ph.D. (Sweden)Peter H. Lauda, M.D. (Austria)Thomas Levy, M.D., J.D. (USA)Stuart Lindsey, Pharm.D. (USA)Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)Karin Munsterhjelm-Ahumada, M.D. (Finland)Erik Paterson, M.D. (Canada)W. Todd Penberthy, Ph.D. (USA)Gert E. Schuitemaker, Ph.D. (Netherlands)Robert G. Smith, Ph.D. (USA)Jagan Nathan Vamanan, M.D. (India)Atsuo Yanagisawa, M.D., Ph.D. (Japan)Andrew W. Saul, Ph.D. (USA), Editor and contact person. Email: omns@orthomolecular.org This is acomments-only address; OMNS is unable to respond to individual reader emails. However, readersare encouraged to write in with their viewpoints. 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