George F. Kroker, MD FACAAI Treatment Philosophy for Food Allergy & Concept Overview.

George F. Kroker, MD FACAAI

Treatment Philosophy for Food Allergy & Concept

Overview

Copyright 2015 Allergy Associates of La Crosse

The Total Load Concept


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


Cumulative Food Ingestion & Load

Day Number

2 3 4 5 61

Initial Food Ingestion

Total CumulativeFood Allergen Load

AllergicThreshold


Critical Mass Concepts

Time

“Bad Day”AllergicThreshold

“Bad Day”

The “Sometimes” Patient


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’)


Altered Intestinal Permeability & Food Allergy

The “screen inthe window”

metaphor


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


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


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


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


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


Thank you

Next: Supporting Scientific Evidence for Food Allergy & Concept Overview

Mary Morris MD

George F. Kroker, MD FACAAI Treatment Philosophy for Food Allergy & Concept Overview.

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