Natural treatments for food allergies and sensitivities

Definition: Treatment of food allergies and sensitivities to food.

Principal proposed natural treatments: Elimination diet, hypoallergenic infant formula, immunotherapy (desensitization)

Other proposed natural treatments: Bromelain, probiotics, proteolytic enzymes, thymus extract

Introduction

A food allergy is an abnormal immune reaction caused by the ingestion of a food or food additive. The most dramatic form of food allergy reaction, known as anaphylaxis, occurs within minutes, usually in response to certain foods such as shellfish, peanuts, or strawberries. The effects are similar to those of a bee sting allergy, involving hives, itching, swelling in the throat, and difficulty breathing; this immediate type of allergic reaction can be life-threatening.

Other food allergy reactions are more delayed, causing relatively subtle symptoms over days or weeks. These symptoms include gastrointestinal problems (constipation, diarrhea, gas, cramping, and bloating), rashes, and headaches. However, because such delayed reactions are relatively vague and can have other causes, they have remained a controversial subject in medicine.

Some reactions that are similar to those from food allergies, but do not actually involve the immune system, are termed "food sensitivities" or "food intolerances." In most cases, the cause of such sensitivities is unknown.

Delayed-type food allergies and sensitivities might play a role in many diseases, including asthma, attention deficit hyperactivity disorder (ADHD), rheumatoid arthritis, vaginal yeast infection, canker sores, colic, ear infection, eczema, irritable bowel syndrome, migraine headache, psoriasis, chronic sinus infection, ulcerative colitis, Crohn’s disease, and celiac disease. However, not all experts agree; practitioners of natural medicine tend to be more enthusiastic about the food allergy theory of disease than conventional practitioners.

Conventional treatment for immediate-type food allergy reactions includes desensitization (allergy shots), emergency epinephrine (adrenaline) kits for self-injection, and the antihistamine diphenhydramine (Benadryl). Delayed-type food allergies are much more difficult to identify and treat. Although skin and blood tests are sometimes used, their reliability is questionable. A particular blood test called ALCAT is nearly 84 percent accurate when testing for food allergies and 96 percent accurate when testing for allergies to food additives double blind trials.

The double-blind food challenge is the only truly reliable way to identify delayed-type food allergies. This method uses some means of disguising the possibly allergenic food, usually by mixing it with other, nonallergenic foods. Persons are randomly given either the possibly allergenic food or placebo on a number of occasions separated by one or more days. Neither the physician nor the participant knows what food is truly allergenic and what is not. Evaluation of the response can then determine whether an allergic response is present. Studies suggest that perhaps only one-third of people who believe they are allergic to a given food actually experience an allergic reaction when they are given it in a double-blind fashion; in addition, reactions are often milder than persons believe.

Although it is the most accurate way of determining food allergies, the double-blind food challenge is still mostly used in research. The elimination diet with food challenges is the most common technique in use.

Another conventional approach for delayed-type food allergies is oral cromolyn (a drug sometimes used in an inhaled form for treating asthma and other allergic illnesses). A double-blind, placebo-controlled study of fourteen children with milk and other food allergies found that cromolyn was effective in preventing allergic reactions in eleven of thirteen cases, whereas placebo was effective in only three of nine cases. In another study, thirty-two persons were given cromolyn one-half hour before meals and at bedtime. If their food allergy symptoms were prevented, the participants were entered into a double-blind, placebo-controlled crossover study using cromoglycate. Of the thirty-one people who completed the study, twenty-four experienced relief of gastrointestinal symptoms when taking cromolyn compared with two when taking placebo. In addition, systemic allergic reactions were blocked with the cromolyn. The drug also had many side effects.

Principal Proposed Natural Treatments

There are few well-documented natural treatments for food allergies. The most obvious approach is to remove known allergenic foods from the diet. Some alternative practitioners offer laboratory tests to identify such allergens. However, no lab tests have been proven accurate for this purpose.

The elimination diet is another approach for identifying allergenic foods. This method involves starting with a highly restricted diet consisting only of foods that are seldom allergenic, such as rice, yams, and turkey. If dietary restriction leads to resolution or improvement of symptoms, foods are then reintroduced one by one to see which, if any, will trigger reactions. There is some evidence that the elimination diet may be effective for chronic or recurrent hives; it has been tried for many other conditions too, including irritable bowel syndrome, asthma, chronic ear infections, reflux esophagitis, and Crohn’s disease.

Still another method involves simply eliminating the most common allergens. Cow’s milk protein intolerance is thought to be the most common childhood allergy, followed by allergies to eggs, peanuts, nuts, and fish. Some evidence indicates that the use of special hypoallergenic infant formulas rather than cow’s milk formula may help prevent eczema, urticaria, and food-induced digestive distress. In addition, eliminating cow’s milk from the diets of breast-feeding infants and their nursing mothers might reduce symptoms of infantile colic, although not all studies have found benefit. Those with lactose intolerance can generally find dairy-substitute replacements for common foods like milk and ice cream.

Food sensitivities or intolerances will similarly benefit from eliminating the aggravating factor from the diet. However, the less well-defined nature of intolerances means that identifying the food causing the problem can be difficult. This can be especially challenging when patients are led to believe they may have certain intolerances by popular media sources, when in fact another factor may be the source of their discomfort. Some cases are relatively straightforward, such as celiac disease, in which gluten (a protein in wheat and some other grains) triggers chronic gastrointestinal problems. Celiac disease resembles a true food allergy in that it involves the immune system, though there is no risk of anaphylaxis. Some practitioners recommend eliminating gluten in cases of food intolerance even in the absence of celiac diseases, and the concept of gluten intolerance as grown highly popular in the early twenty-first century.

In hopes of preventing food allergies and diseases related to them, some experts recommend that pregnant women and women who are breast-feeding (and their children) should avoid allergenic foods. However, it is not clear if this method actually provides any benefit. For example, one study evaluated 165 children at high risk of developing allergic symptoms. Careful avoidance of allergenic foods in the diets of the mothers and infants did not reduce the later development of eczema, asthma, hay fever, or food allergy symptoms.

In contrast to the avoidance and elimination approaches, a method known as oral immunotherapy (OIT), sublingual immunotherapy (SLIT), or desensitization has gained significant attention. Mostly studied in the case of peanut allergies, this therapy involves the administration of small doses of the allergen and increasing the dose over time until the patient has developed immunity to the food. It has been investigated as both a preventative and a treatment method. A growing body of scientific studies suggests that performing desensitization on children, beginning as young as four to eleven months old, is most effective.

Despite several successful trials, however, oral immunotherapy remains unapproved by the US Food and Drug Administration (FDA), as there are still concerns regarding its long-term safety. It also comes with a significant risk of anaphylaxis if the incorrect dose is administered. A variant form of immunotherapy using a wearable patch to deliver the allergen, known as epicutaneous immunotherapy (EPIT), has also been explored. Similarly, studies have shown that in cases of milk and egg allergies, some children who are fed small amounts of these foods that have been baked can outgrow their allergy faster. The tolerance for baked milk and eggs is thought to be due to changes in the proteins in these foods due to high temperatures. However further studies are needed before the baked-food approach can be evaluated as a treatment, and it is important to note that baking is not effective for other common food allergens, such as peanuts.

Other Proposed Treatments

Digestive enzymes such as bromelain and other proteolytic enzymes have been proposed as a treatment for food allergies, based on the reasonable idea that digesting offending proteins will reduce allergic reactions to them. However, there is no real evidence that they are effective against food allergies.

Thymus extract is a supplement derived from the thymus gland of cows. Preliminary evidence suggests that by normalizing immune function, thymus extracts may be helpful for food allergies. However, there are significant safety issues, and this study did not prove the supplement to be effective.

Probiotics (such as Lactobacillus species) are friendly bacteria that have been studied for their ability to prevent or treat respiratory allergies and various gastrointestinal symptoms, most notably diarrhea. However, at least one study found that probiotics were not helpful in treating cow’s milk allergy among infants. More research is needed before definitive conclusions can be reached about the efficacy of probiotics in treating or preventing food allergies and intolerances.

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