The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2

 

Lake Mary Clinic and Panchakarma Facility: at 635 Primera Blvd. Lake Mary, Florida 32746

 

 Telephone: (561) 263-MIND (6463); option #2 or (561) 510-3833

Food Allergies

Food allergies have emerged as one of the most challenging issues in modern clinical medicine in recent years. Today, nearly 17 million Americans have a food allergy, with 1 in every 13 children being affected. It is very important to determine if your symptoms are caused by a classic food allergy involving IgE or due to other non-IgE food-related disorders such as food protein-induced enterocolitis syndrome (FPIES), food protein proctocolitis, eosinophilic esophagitis, or celiac disease (a form of food protein-induced enteropathy). All of the above conditions are classified as allergies.

A food allergy (sometimes called “food hypersensitivity”) is an adverse immune response to a food protein. Often there is confusion between the different types of food allergies, and many times a food intolerance is misdiagnosed as an allergy, which can lead to even more confusion with the treatment. A food allergy produces damaging, discomforting, and sometimes fatal reactions due to an over-vigorous immune response. The following eight foods account for 90% of all food allergies:

1. milk 2. hen’s egg 3. peanut 4. tree nuts (almonds, cashews, walnuts, pecans, pistaccios, Brasil nuts, hazelnuts, chestnuts 5. fish 6. shellfish (shrimp, lobster, crabs, crayfish) 7. soy 8. wheat

Its the protein in the food that is usually the allergic component. Allergies occur when the immune system mistakes a food protein as foreign and harmful. Normally all proteins are completely digested into their constituent amino acids which do not elicit allergic responses. However some proteins or fragments of proteins are resistant to complete digestion are identified as an allergen. Food allergies can be IgE-mediated or non IgE-mediated. There are four different types of allergic reactions (Types 1-4) but the one most renown and well-studied is the Type 1, immediate-onset, IgE-mediated hypersensitivity.

In type 1 hypersensitivity, an allergen (usually a protein) is first presented to special T-lymphocytes known as CD4+ Th2 cells specific for that allergen. These T-lymphocytes stimulate B-lymphocytes into production of IgE antibodies also specific to the allergen. The difference between a normal infectious immune response and a type 1 hypersensitivity response is that in type 1 hypersensitivity the antibody is IgE instead of IgA, IgG, or IgM. During sensitization, the IgE antibodies bind to Fc receptors on the surface of nearby tissue mast cells and blood basophils and uniquely sensitize them to the allergen. Later exposure to the same allergen results in the release of pharmacologically active mediators from the mast cells and basophils such as histamine, leukotrienes, and prostaglandins that act on the surrounding tissues. The principal effects of these molecules are vasodilation, swelling and smooth-muscle contraction.

The symptoms of IgE-mediated reactions typically involve the skin, respiratory system and gastrointestinal tract. The pathogenesis of non–IgE-mediated reactions in food allergy is not as clearly defined, but T cells and macrophages most likely play a role. Illnesses caused by these non–IgE-mediated immunologic responses to food affect the same organ systems that the IgE-mediated forms affect.

Diagnosis of Food Allergies

Currently, no single in vivo or in vitro test system permits a clear-cut diagnosis of food allergy. Controlled oral provocation tests (also called oral food challenge, OFC) are still regarded as the most reliable indicator of food allergy. Because an OFC carries a risk of serious reaction, it should be performed under the supervision of trained medical personnel with emergency treatment readily available.

If this is not available to you, the diagnosis of food allergies is best done with a combination of skin prick tests (SPT) and allergen-specific immunoglobulin E (IgE) blood tests, such as radioallergosorbent testing (RAST) or fluorescence enzyme immunoassay. Combined, these tests increase the positive predictive value of a result but they are not 100% predictive.

CAP-RAST (Radioallergosorbent) Testing

The suspected allergen (food protein, pollen, etc.) is bound to an insoluble material and the patient's serum is added. If the serum contains IgE antibodies to the allergen, those antibodies will bind to the allergen. Radio-labeled anti-human IgE antibody is added which binds to those IgE antibodies already bound to the insoluble material. The unbound anti-human IgE antibodies are washed away. The amount of remaining radioactivity is proportional to the serum IgE for the allergen. The CAP- RAST reports IgE levels on a scale from less than 0.35 (undetectable) to more than 100 in a measurement called “kUA/L” (kilounits of allergen/liter). Over time, researchers have pinpointed scores that indicate, with good accuracy (above 95 percent), that a patient is allergic to specific foods. For example, if a young child has a CAP-RAST level of more than 7 kUA/L to egg, 14 kUA/L to peanut, or 15 kUA/L to milk, it is very likely that she is allergic to that food.

Over a period of years, an allergist can monitor CAP-RAST scores to help determine whether or not patients are outgrowing their allergies.

Fluorescence enzyme immunoassay

Similar to RAST. The suspected allergen is bound to an insoluble material and the patient's serum is added. If the serum contains IgE antibodies to the allergen, those antibodies will bind to the allergen. Next, anti-human IgE antibody which is bound to an enzyme is added which binds to those IgE antibodies already bound to the insoluble material. Lastly, a substrate is added which is catalyzed by the enzyme into a product which is fluorescent and can be quantified by a detector.

Immunoglobulin G (IgG) blood tests, intradermal testing, magnet testing, kinesiology, and stool testing have no place in diagnosing the presence of allergies that can lead to anaphylaxis.

Beware of This Pseudoscientific Scam: IgG blood testing

Blood tests for total immunoglobulin G (IgG) or its subtype (IgG4) against foods are ubiquitously promoted for the diagnosis of food-induced allergy. The concept has become very popular on the internet as an alternative method to the more traditional method of skin testing (which does have value). The companies that promote IgG4 testing seem almost trying to convince people that there are “hidden” allergies which, though not causing overt symptoms, are adversely affecting one’s health.

However, science does not support the use of IgG or IgG4 levels in the diagnosis and management of food allergies. These tests utilize enzyme-linked immunosorbent assay-type and radioallergosorbent-type assays (very impressive!) for blood IgG4 against hundreds of different foods for toddlers, adolescents and adults. However, many people show positive IgG4 results without corresponding allergic symptoms. These findings, combined with the lack of convincing evidence for histamine-releasing properties of IgG4 in humans, and lack of any controlled studies objectively evaluating the diagnostic value of IgG4 testing in food allergy, make it extremely doubtful that food-specific IgG4 has an effector role in food allergies. These tests generate a list of hundreds of foods several pages long which purportedly identify foods that the person is allergic to, leading to the unnecessary avoidance of many foods.

The real scientific value of IgG4 testing is the following. The finding of elevated amounts of IgG4 against a food indicates that the individual has simply been repeatedly exposed to its food components and recognized by the immune system. Almost every food we eat has IgG4 associated with it. In most instances despite high IgG4 titers, the person does not report any clinical signs or symptoms. IgG4, therefore, is not a factor which induces hypersensitivity, but rather is an indicator for immunological tolerance. To be perfectly clear: food-specific IgG4 indicates neither current nor imminent food allergy or food intolerance, but rather a physiological response of the immune system after exposure to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in cases of food-related complaints.[2] Patients though often desperate for solutions, need to be careful about companies that suggest they have ways to uncover “undiagnosed allergies” through IgG or IgG4 testing.

It’s worth noting that IgE skin prick tests (SPT) can identify foods to which there is an allergy if there is an unequivocal weal which develops, usually defined as equal to or greater than 5 mm. Some clinicians use 3 mm as the “positive” threshold. SPT’s detect food-specific IgE antibodies attached to the surfaces of mast cells in the superficial layers of the skin. A positive SPT to a particular food can confirm (not diagnose) a suspected food allergy for which there was a previous clinical symptom. However a negative SPT does not rule out an allergy to any food substance. SPT’s are only used to confirm clinical signs of allergy.

Ayurvedic Treatment of Food Allergy

The MainTreatment

Avoidance. There is currently no cure for food allergies (allopathic or Ayurvedic), and the available treatments only alleviate the symptoms of a food-induced allergic reaction. Once a specific food allergy has been established, the best Ayurvedic treatment for food allergies is to avoid the food(s) that causes the allergy. Ayurveda clearly advises that a person with food allergy use his intelligence and will to simply adjust his diet and lifestyle accordingly:

Whatever becomes suitable for an individual due to regular use is known as “oka-satmyam” (the healthy adjustment to a particular diet of behavior due to practice). <br/ > However, there are certainly also ways to diminish the severity of some food allergies which are described in detail in Ayurvedic texts.

Increase Agni and Decrease Ama

Every time we eat we send our food through a complex and intricate cascade of biochemical transformations which incorporate the “foreign” food substance into our own “self”. Digestion and assimilation of our food is an amazing and precise activity which has not been adequately understood by modern western medicine. What is known is that digestion is an energy-dependent process which begins even before we put anything in our mouths. Digestion begins in the mind with what is termed the cerebral phase of digestion. This means that in anticipation of the meal the brain sends signals to begin the manufacture and release of digestive juices and enzymes. The quantity of these juices may be determined by how strong one’s appetite is. Appetite, according to Ayurveda, originates from a set of digestive fires known as agnis. Agni is a Sanskrit word which means “fire”. Actually, the modern understanding of digestion and the Ayurvedic understanding are remarkably similar up to a point. Ayurveda describes the process of digestion as requiring a precise amount of fire (agni), neither too little nor too much. When your appetite is strong it means your fire is burning high; conversely, when the body requires nourishment it signals agni to burn higher which creates a heightened appetite. When agni is burning high, then the digestive organs and the individual cells of all bodily tissues can best digest and assimilate food substances and convert them into tissues and energy and not fat and toxins.

In the Ayurvedic teaching, digestion refers not only to the (gross) absorption of foods through the lining of the small intestine and into the blood stream, but also includes the assimilation of that food at the (subtle) cellular and sub-cellular--i.e. mitochondrial--level. Individuals who have food allergies always have disturbances in their gross and subtle digestion. Incomplete and inefficient digestion creates a toxic endogenous byproduct known as āma. Āma has attributes of both an energy and a substance. It is a white, sticky material which adheres to and obstructs the various channels through which bodily nutrient and wastes flow throughout the body. Cholesterol plaques in the arterial walls would be an accurate way of visualizing one example of āma. Another common example of āma is the white, sticky coating you may see on your tongue--especially in the morning--which comes from the blood. However, besides blood and lymph āma also blocks the circulation of energies throughout the body. Due to its widespread capacity to disrupt normal flows and communications in the physiology, āma is the common cause of a wide variety of diseases and conditions. Ama initially combines with the blood plasma just as it is created from the ingested foods being absorbed in the small intestines; this Ama-Plasma complex circulates throughout the body and settles in rakta dhatu, the formed blood cells.

Signs and Symptoms of Ama

Bloating, gas, decreased appetite, disturbed taste, stickiness in the mouth, indigestion, lethargy, clouded thinking, muscle aches, stiffness, skin blotches, low grade fever, foul odors (breath, sweat, urine, stools, phlegm), sinking stool, mucous in stool, cloudy urine.

Pulse: slow, deep, dull, wide and slippery. The tongue has a characteristic thick, whitish and slimy coating.

Modern signs of āma can include: elevated blood sugar levels, elevated serum triglycerides, depression, unexplained fever, rheumatoid factor, leukocytosis or leukocytopenia (high or low white blood cells), excess anti-bodies (IgE, IgG), fungal infection, blood urea, gout, high IgE levels from allergic reactions, gallstones (excess bile), kidney stones incompletely metabolized calcium and oxalates, modestly elevated liver enzymes (ALT, AST).

This accumulation of āma in the formed blood tissues (rakta dhatu) causes a disturbance in the way in which immune surveillance occurs. It creates disturbances in important cytokines and other chemical mediators of the immune response (dhatwagnis). Consequently, IgE increases throughout the body and the prodromal symptoms (poorvarupas) of food allergy begin to manifest followed by the actual symptoms (rupas). In allergic individuals it creates so many of the symptoms we see including urticaria, rash, swelling, fatigue, difficulty breathing, bloating, food cravings, and weight gain.

From the several preceding paragraphs above, we clearly see elucidated the general Ayurvedic approach to the treatment of food allergies: increase agni and reduce āma. Among the prescribed ways to maintain balanced agni (sāmagni) and avoid an accumulation of āma is to eat not only according to one’s prakriti, but also according to the season.

The sixth chapter of the Sutra Sthana in the Charaka Samhita elegantly states:

He who knows the relationship between season, diet and regimen obtains increased strength and complexion for correct foods eaten in the correct season.

What follows this statement are details of what to eat and not eat in specific seasons.

In addition to attention to the seasons, Ayurveda prescribes the following measures to both increase agni and reduce āma.

Anti-āma Diet: Emphasize pungent, bitter, astringent tastes

  • Fruits: No sweet fruit, only sour and astringent - cranberry, lemon, lime, grapefruit, kiwi
  • Vegetables: No root/sweet vegetables (too heavy). No mushrooms. Favor steamed vegetables and steamed sprouts. Diet can include 20% raw foods including salad greens.
  • Grains: No bread/pastries. Temporarily eliminate wheat and oats. Foods to favor: kichari, barley, quinoa, amaranth, millet, rye
  • Beans: Mung beans (pre-soaked) are the best
  • Nuts: None
  • Dairy: No cheese or yogurt. No milk except small amount of goats' milk (slightly astringent)
  • Animal Foods: Only turkey (dark) if needed. No shellfish, chicken, fish, red meat, pork, eggs
  • Oils: None. Ghee acceptable in small quantities (2 teaspoons/day)
  • Sweeteners: None. All forms of sugar are āma-forming. Raw honey in very small amounts (2 teaspoons/day) is acceptable.
  • Beverages: Ginger, cinnamon, cardamom, fennel, chamomile, rose hip, peppermint, dandelion root teas; unsweetened pomegranate, lemon and cranberry juices (diluted with water 1:1).
  • Spices: All except nutmeg, vanilla extract, and poppy seeds. Especially include: black pepper, mustard seed, cardamom, parsley, anise, cayenne, cloves, turmeric, rosemary, fenugreek, asafoetida, horseradish, garlic, and ginger

Specific Anti-Āma Therapies:

The general idea behind the reversal and removal of āma is to not provide any excess nutrition to the body which has become defective and is therefore producing āma. In clinical application, this is achieved most readily by reducing daily food intake or through fasting. Fasting (upavasa) is advocated--for adults only--as a bona fide approach to the treatment of food allergies when āma is found to be present. Like any other therapy, it is prescribed and supervised only by an experienced physician.

Other supportive therapies to reduce āma include: sweating (swedana), regularly sipping hot water (ushnodaka), exposure to wind (maruta), exposure to sun (atapa), and regular exercise (vyayāma) of moderate to vigorous intensity.

Panchakarma detoxification therapies are most effective when they follow a preparatory period of some or all of the above approaches.

Herbal Medicines Used to Treat Food Allergies

Herbal medicines do not play a major role in the Ayurvedic management of food allergies. Although safe, there is no compelling research which shows their efficacy for this purpose.

There are several herbs classified as rasayana, which have been traditionally used for the prevention as well as the treatment of allergic disorders including food allergies. Rasayana loosely translates to “juice increasing” and refers to herbs which have a general tonic effect for all the tissues of the body, not just one specific tissue. These gentle herbs which include: Ocimum sanctum, Withania somnifera, Emblica officinalis, Asparagus racemosus, and Bacopa monniera . These are routinely administered to the babies as well as the pregnant and/or lactating mothers in order to optimize the baby's immune system. Non-rasayana herbs (Plumbago zeylanica, Inula racemosa, Piper longum, Tylophora asthmatica, Tinospora cordifolia, and Petasites hybridus) are used exclusively in adults. The immunomodulator effects of both rasayana and non-rasayana herbs are being shown in clinical and in vitro studies. However, we still lack well-designed studies demonstrating the utility of these drugs in the management of food-related problems.

Nat Inst Allerg and Infec Dis, July 2004. Food Allergy

American Academy of Allergy, Asthma, and Immunology. "Five Things Physicians and Patients Should Question". Choosing Wisely: an initiative of the ABIM Foundation, August 14, 2012

Arora D, Kumar M. Food allergies--leads from Ayurveda. Indian J Med Sci 2003;57:57-63