Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet

496 Pages·2003·1.51 MB·English

by  Janice M. Vickerstaff Joneja

Dealing With
FOOD ALLERGIES
A P G
RACTICAL UIDE TO
D C F
ETECTING ULPRIT OODS
E H ,
AND ATING A EALTHY
E D
NJOYABLE IET
JANICE VICKERSTAFF JONEJA,
P D, RDN
H
Bull Publishing Company
Boulder, Colorado
DEALING WITH FOOD ALLERGIES
Copyright©2003byJaniceVickerstaffJoneja
Allrightsreserved.Noportionofthisbookmaybereproducedinanyform
orbyanymeanswithoutwrittenpermissionofthepublisher.
BullPublishingCompany
P.O.Box1377
Boulder,CO80306
800-676-2855
www.bullpub.com
ISBN0-923521-64-X
ManufacturedintheUnitedStatesofAmerica
LibraryofCongressCataloging-in-PublicationData
Joneja,JaniceVickerstaff.
Dealingwithfoodallergies:apracticalguidetodetecting
culpritfoodsandeatingahealthy,enjoyablediet/
byJaniceVickerstaffJoneja
p. cm.
Includesindex.
ISBN0-923521-64-X
1.Foodallergy—Popularworks.I.Title.
RC596.J6652003
616.97’5—dc21
2002151489
PUBLISHER:JamesBull
DESIGNANDCOMPOSITION:ShadowCanyonGraphics
MANUSCRIPTEDITOR:MargaretMoore
PROJECTMANAGER:ErinMulligan
COVERDESIGN:Lightbourne
— CONTENTS —
PREFACE .................................................. v
PART I
THE SCIENTIFIC BACKGROUND OF FOOD ALLERGY AND FOOD INTOLERANCE:
WHAT IS REALLY GOING ON? ...................................... 1
INTRODUCTION: Let’s Talk About Food ................................ 3
CHAPTER 1: What Is Food Sensitivity? ............................. 7
CHAPTER 2: Signs and Symptoms of Food Sensitivity ................ 15
CHAPTER 3: Food Allergy ...................................... 27
CHAPTER 4: Food Intolerance ................................... 51
CHAPTER 5: Diagnosis of Food Sensitivities ........................ 77
CHAPTER 6: The Allergenic Potential of Foods ...................... 97
CHAPTER 7: Cross-Reactivity of Allergens ......................... 111
PART II
DIETARY MANAGEMENT OF FOOD ALLERGIES AND FOOD INTOLERANCES ... 121
Chapter 8: Milk Allergy and Lactose Intolerance .................. 123
Chapter 9: Egg Allergy ....................................... 151
Chapter 10: Wheat and Grain Allergy ............................ 161
Chapter 11: Soy Allergy ...................................... 181
Chapter 12: Peanut Allergy .................................... 189
Chapter 13: Nut and Seed Allergy ............................... 195
Chapter 14: Fish and Shellfish Allergy ........................... 199
Chapter 15: The “Top Ten” Allergens ............................ 203
Chapter 16: Yeast and Mold Allergy ............................. 209
Chapter 17: Nickel Allergy .................................... 215
iii
Chapter 18: Disaccharide Intolerance ............................ 223
Chapter 19: Biogenic Amines Intolerance:
Histamine and Tyramine Sensitivity ................... 233
Chapter 20: Salicylate Intolerance ............................... 255
Chapter 21: Tartrazine Intolerance and Other Artificial
Color Intolerance .................................. 265
Chapter 22: Benzoate Intolerance ............................... 277
Chapter 23: Sulfite Allergy and Intolerance ....................... 287
Chapter 24: BHA and BHT Intolerance ........................... 301
Chapter 25: Nitrate and Nitrite Sensitivity ........................ 307
Chapter 26: Monosodium Glutamate (MSG) Intolerance ............. 313
PART III
Determining the Culprit Foods and Food Components:
Elimination and Challenge Procedures ......................... 321
Chapter 27: Elimination Diets: Elimination Phase .................. 325
Chapter 28: Reintroduction of Foods: Challenge Phase .............. 341
Chapter 29: The Final Diet .................................... 385
APPENDIX I
Few-Foods Elimination Diet: Recipes and Meal Plans ................. 397
APPENDIX 2
Sequential Incremental Dose Challenge ............................ 441
GLOSSARY .................................................. 463
INDEX ...................................................... 479
iv
— PREFACE —
Twenty-five years ago I found myself in a strange dilemma. My training as a
scientistandmythinkingandemotionalresponseasamotherlandedmein
asituationwhereIfelthelplessinbothroles. Myinfantsonhadbeendiagnosed
withsevereasthma.Hehadsufferedwitheczemaalmostfrombirth,firstonhis
face, hands and legs, and later on just about every area of his skin. By the time
hewasfiveyearsoldhewasdependentonoralsteroidsforcontrolofbothcon-
ditions.WheneverwetriedtoreducehisintakeofPrednisonebelow10mgper
day, he would develop severe, and on more than one occasion, life-threatening
asthma, which his pediatrician diagnosed as status asthmaticus. At the lower
dosagesofPrednisone,theeczemaonhishandsbecameextreme;frequentlythe
eczematouspatchesbecameinfectedwithcommonskinbacteria,andhisfingers
swelledtodoubletheirnormalsize.Hewouldoftengotokindergartenwearing
little white cotton gloves to cover the oozing sores and to keep in place the
steroid-containing ointment that I liberally applied to his hands.
When he was about two years old I began to notice reactions that I gradu-
allyrealisedwerebeingtriggeredbyspecificfoods.Orangejuicewouldresultin
himrunningthroughthehouse,screaming.WhenItriedtoholdhimtostopthe
rampage, I felt his whole body quivering and shaking, and it was clear that he
had no control over this reaction. Such behavior could be triggered predictably
andconsistentlybyhisdrinkingaglassoforangejuice,butoccurredatnoother
time. By the age of about four, this response had thankfully stopped. However,
whenever he drank orange, or any other citrus juice for many years, he would
start scratching, particularly his hands. This seemed a clear indication that it
most likely was an exacerbating factor for his eczema, which often starts with
itching. Another food that would consistently cause similar scratching was
chocolate.Halloweenandbirthdaypartieswereoccasionsforbartering–allthe
chocolates, chocolate cake, and cookies were assessed, and exchanged for a toy
or other desired treasure of equal value. It became a game that the whole fam-
ily enjoyed.
v
— PREFACE —
Strangely,though,wheneverImentionedthese“foodallergies”tomyson’s
doctors,theresponsewaspolitedismissal.Itislikelythat,becausehisfatherwas
also a physician, they were reluctant to openly label his mother “neurotic” and
“over-protective”assomanyparentsofallergicchildrenwereinthosedays(the
mid-1970s). Only one doctor, his respirologist, was frank enough to declare,
“There’s no such thing as food allergy!” Certainly at that time and sadly, occa-
sionally today, the idea that asthma and eczema have an allergic etiology, espe-
cially the idea that food allergy might be involved, was, and is, categorically
denied by too many medical practitioners. It was not until he was proven to be
anaphylactic to peanuts that his medical advisors would entertain the idea that
my son might also have food allergy, inaddition to his other problems.
Whatmadethewholesituationsobizarreformewasthefactthatmyearly
training in immunology took place in the university department where the
chairman was none other than Professor Philip Gell, one of the co-discoverers
of the antibody responsible for allergy (IgE),. He was also one of the first scien-
tiststodeveloptheclassificationofthehypersensitivityreactionsresponsiblefor
allergy,asystemthatisstillrecognizedtoday.InessenceIlearnedtheimmunol-
ogy of allergy from the undoubted “master” of the subject, and followed this
with research in medical microbiology and immunology, gaining a Ph.D. in the
field, and later an appointment as Assistant Professor in Microbiology at the
UniversityofBritishColumbia.AsagraduatestudentIactuallytaughtacourse
in the immunology department (at that time called the Department of
Experimental Physiology) where the science of allergy immunology had its
inception–andyetwhenitcametohelpingmyownsonwithhisallergies–Iwas
no more effective than any other parent.
Asallparentswill,Iconsultedevery“expert”inanefforttohelpmyson,but
with increasing alarm and confusion, I realized that the field of allergy, especial-
lyfoodallergy,wasfraughtwithcontroversy.Therewasaregrettablelackofsci-
entificresearch,andevenlesscredibleclinicaldata.Asaresult,thefieldwasopen
toeveryformof“alternativemedicalpractice”,rangingfromthepseudo-scientif-
ic (and therefore almost plausible) to the frankly frightening. I consulted every-
one,fromthosewhouseelectroacupuncture(Vegatests),biokinesiology(testing
musclestrengthwhilethepatientholdsavialcontainingthesuspectfood),urine
analysis, hair analysis, iridologists, practitioners of radionics, practitioners who
consult crystals – anyone who might help! This phase of my search for answers
provided one valuable piece of information: when a field lacks scientific valida-
tionthatisbasedonresearchconductedaccordingtothetenetsoftraditionalsci-
entificmethod,itisvulnerabletoinfiltrationbyanyoneofferinghope–realornot.
Thisold“snakeoil”rusewascertainlythecasewithfoodallergy.
vi
— PREFACE —
The real tragedy in this situation is the fact that, because the science is
sparse, “traditional” medical practitioners tend to avoid the field, which is then
taken over by “pseudo-scientists”. The result is that the legitimate scientist and
theethicalcliniciandonotwishtobeassociatedwithanareaofpracticelacking
scientificandmedicalvalidation.Researchintheareaisnotfundedbygranting
agencies, and allergists with the temerity to enter the arena risk losing credibil-
ity and the respect of their peers.
My concern and confusion were increased to an alarming extent with the
events that occurred in my son’s thirteenth year. For several months he had
beenexperiencingseveremigraines.Attheirworsttheyhappenedthreeorfour
timesaweekwithseverepainandvomiting.Hewouldspendtwenty-fourhours
in his darkened bedroom with each episode. Finally he was hospitalized, and
every appropriate test was conducted. Special care was taken with these tests,
since his own father was the only neurologist (and, incidentally, the only psy-
chiatrist – he is, and was, a Fellow of the Royal College of Physicians and
Surgeons of Canada in both specialties) in town at the time. No pathology was
detectedthatcouldaccountforthemigraines.Hispediatricianprescribeda“par-
entectomy”;shehadreachedtheconclusionthatstresswithinthefamily home
was responsible for our son’s problems, and suggested that we should consider
making arrangements for his living elsewhere. {As an aside, later he did attend
boarding school, from Grade 9 to 12, where his allergies were in fact far worse
thantheyhadbeenathome!}.Fortunatelyforus,hisparentswhowereindan-
ger of living the rest of our lives in the shadow of the guilt engendered by the
thoughtthatwealonewereresponsibleforthedebilitatingill-healthofouronly
son,acauseforthemigraineswasdiscovered.Onceagainitwasrelatedtofood.
Basedonhisobservationthathefeltnauseatedandillaftereatingmeat,our
sondecidedtobecomeastrictvegetarian.Inaccordancewithhisrequest,when
he returned home from his two-week stay in the hospital, with symptoms
unchanged in severity and frequency, I provided meals completely free from
foodderivedfromanyanimalsource.Themostamazingandgratifyingresultof
thisdrasticchangeindietwasthatheimmediatelyandcompletelybecamefree
from migraines! For several years he remained a strict vegan in his food choic-
es.Hedidnoteatanymeat,poultry,fish,egg,milk,ormilkproducts.Hefound
that ice cream, milk, cheese or other milk-based food caused immediate vomit-
ing.Inspiteofhiscontinuinganaphylacticreactiontopeanuts(eventhesmall-
est quantity of peanut as a “hidden ingredient” in a food, accidentally eaten,
resulted in immediate throat swelling and the onset of anaphylaxis, requiring
promptmedicalintervention)hewasabletoeatanyotherlegumewithimpuni-
ty.Thiswasfortunate,sincehismainsourcesofproteinweredriedpeas,beans,
lentils, and soy. I became an expert in bean-based gourmet cooking!
vii
— PREFACE —
Theonlytimethathehasexperiencedadistressingrecurrenceofheadaches
sincehisthirteenthbirthdayiswhenhehaseatenporkorbeef.Yearslater,asa
result of careful food challenges, we discovered that the primary cause of his
migraineswaspork,followedtoalesserextentbybeef.Althoughheisnotnow
vegetarian,aslongasheavoidspork,beef,andfoodscontainingthesemeatshe
remainsfreefromthosedistressingmigraineheadaches.Interestingly,asaresult
of our careful food challenges, we discovered that he is also highly sensitive to
sulfites—asituationthatInowknowtobequitecommoninsteroid-dependent
asthmatics.(ThemethodsthatweuseforspecificfoodchallengesintheAllergy
Nutrition Clinic are provided in great detail in the book).
Themostimportantoutcomeoftheexperienceswithmyson’sallergiccon-
ditions (and to some extent, my daughter’s) was, for me, the realization that in
spite of my specialized knowledge about the scientific bases of the clinical signs
I was witnessing at first hand, I, and the medical specialists involved in their
care, were unable to be of any real assistance in addressing the cause(s) of my
children’s allergic diseases. The recognition of the limited resources available to
my children, to me, and to the untold numbers of people in similar situations
haspromptedmetopursuewhathasbeenmyprimaryobjectiveinthepastfif-
teenyears.WhereaspreviouslyIwasalaboratoryscientist,conductingresearch
into the mechanisms responsible for microbial and immunological diseases, now
Iamfocusedontheclinicalapplicationoftheknowledgegainedfromlaborato-
ryscienceforthebenefitofpeopleexperiencingtheresultsofsuchdiseases.This
type of “evidence-based” research is becoming increasingly important in medi-
cine,andinnocontextisitmorevalidthaninthepursuitofunderstandingand
controllingthedifferentwaysinwhichourbodiesinteractwiththefoodweeat
—especially when the food that should nurture becomes a cause of distress.
In 1991 I was instrumental in the establishment of a unique service—the
Allergy Nutrition Research Program at Vancouver Hospital and Health Sciences
CentreinVancouver,BritishColumbia.Theprogramcomprisesthreecomponents:
◆ Anoutpatientclinicwherepatientscanobtainhelpintheidentificationand
management of their adverse reactions to foods. A physician’s referral is
requiredforallpatientsattendingtheAllergyNutritionClinic.Todatemore
than 3,000 patients and their families have obtained assistance in the man-
agement of their food sensitivities in the clinic.
◆ An information resource, which provides information on current research
infoodallergyforhealthcareprofessionalssuchasphysicians,publichealth
nurses and dietitians. The dissemination of this material includes seminars,
lectures, workshops, radio and television interviews, the publication of
books, manuals, audio and video resources, and articles in peer-reviewed
medical and scientific journals.
viii