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I'm quickly beoming a soy allergy scholar because of my daughter's proven IGE allergy to all legumes, most notably peanut and soy. She only gets D, very similar to MC , and its fairly chronic, although worse when she ingests soy.
I've learned that her case is almost surely caused by cross reaction to birch pollen proteins (most cited connection: Bet v 1 in birch pollen is very similar to Gly m 4 in soy and peanuts, but other proteins are also implicated). What I haven't been able to understand is why she lacks the oral allergy syndrome symptoms like mouth tingling, and reactions to raw apples and carrots. She also seems to react to cooked soy, whereas oral allergy syndrome generally happens with raw foods. The proteins are said to be suficiently altered by cooking. Yet she gets abdominal pain and explosive D from most cooked soy.
And now I think I know why... T lymphocytes specific for Bet v 1 also cross-react with these dietary proteins, and T lymphocytes can be responsible for symptoms of intestinal inflammation (as we know all too well). So whereas her digestive process might break down the proteins enough to prevent a typical allergic reaction, her T cells can cause a reaction further down. I think we could demonstrate this phenomenon in MCers!
Gastrointestinal degradation of Bet v 1-related food allergens destroys their histamine-releasing, but not T cell-activating, property. Our data emphasize that birch pollen-related foods are relevant activators of pollen-specific T cells.
Zizzle wrote:So whereas her digestive process might break down the proteins enough to prevent a typical allergic reaction
Classic allergy symptoms do not originate in the stomach, so that observation is irrelevant. In classic oral allergy, the reaction begins when the food touches the mucosa in the mouth (in some cases, even the lips), and it's reinforced during it's trip through the esophagus. By the time the food reaches the stomach, the reaction is already a done deal, and any time delay in the presentation of clinical symptoms is due simply to the logistics of the immune system processes involved in generating sufficient inflammation to allow the respective clinical symptoms to develop and present. No digestion is necessary (or even possible, in such a short amount of time).
You're very likely correct about T cells being the primary problem in your daughter's case, though. If she shows an immediate reaction (10 to 15 minutes or so), it's a classic allergic response, based on the production of IgE antibodies, and anaphylaxis is possible (though not necessarily likely). If she shows a delayed reaction (hours), then it's an IgA reaction (due to a T cell response), which can also eventually generate IgG antibodies. In the latter case, anaphylaxis is not a consideration. It's certainly not impossible to be subject to both conditions, however.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Had the blessed GI appointment this morning. She was very nice, but I can't say I learned anything new, even though she took her time with us. She doesn't suspect crohn's or UC (neither do I), she trusts the negative TTG test for celiac (even though we agreed that it can miss early cases), she doesn't think there's value in doing genetic testing for celiac, given my HLADQ2, bc so many people have it, and celiac could happen without it in some cases. She ordered stool testing for ova and parasites and giardia and cryptospiridium, which apparently can persist and cause long-tern infections. She also ordered stool testing for malabsorption of fats, lactose and fructose, and suggested we do a trial elimination of fruit juices and most fruit to test for fructose malabsorption. She said her next step would be an upper endoscopy and sigmoidoscopy with biopsies to look for signs of food allergy. It requires 15 minutes of sedation. We would only do this after pollen season, and assuming everything else checks out. I wonder if it would be at all helpful. I asked how it diagnoses food allergy, and she said biopsies of the esophagus would show inflammation consistent with allergy. But then what? I'm already going off the assumption that there is mucosal inflammation involved. What could we learn that would alter our approach?
When we talked about the legume allergies, she had never heard of birch pollen cross-reactivity ("but [she's] not an allergist"). She said this could be a GI system-only allergy, or simply a food intolerance (but didn't expand on the mechanism of intolerances). She was OK with reintroducing a few legumes (with an Epi-Pen handy) to see what happens. She did say they suspect inhaled pollen (which is later ingested) could be a contributor to GI allergy symptoms during pollen season, so we'll see if the D worsens as pollen counts go up (even though she'll be on Allegra and Nasonex).
As far as the timing of my daughter's reactions, here's an example: a bean sprout caused a tummy ache within 3-5 minutes of ingesting it, and was followed by a trip to the bathroom within 5-10 minutes with explosive D. Does that point to classic or delayed reaction?
Zizzle wrote:As far as the timing of my daughter's reactions, here's an example: a bean sprout caused a tummy ache within 3-5 minutes of ingesting it, and was followed by a trip to the bathroom within 5-10 minutes with explosive D. Does that point to classic or delayed reaction?
That appears to be a mast cell reaction, apparently confined to the GI tract. If there were no classic allergy symptoms (runny nose, watery eyes, sneezing, rash, itching, etc., then it obviously didn't trigger an IgE-based reaction (which rules out a classic allergy). And D that quickly could not come from a T cell buildup — that would require at least several hours to develop. Therefore, IMO it would have to be caused by immediate, massive mast cell degranulation.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Zizzle wrote:She also ordered stool testing for malabsorption of fats, lactose and fructose
I didn't realize that a stool test exists for fructose malabsorption. I know there is a difference between fructose malabsorption and fructose intolerance, however. Tex, didn't you say that the breath test for fructose intolerance isn't reliable when someone is having digestive problems?
Poor little kid. It's got to be hard to watch her deal with similar issues at such a young age. I hope you can figure some of this out for her, Zizzle.
Gloria
You never know what you can do until you have to do it.
Gloria wrote:Tex, didn't you say that the breath test for fructose intolerance isn't reliable when someone is having digestive problems?
The test depends on certain species of gut bacteria to ferment the fructose in order to produce the gas. A high percentage of people with digestive system diseases either have SIBO, are on a special diet, or because of the disease or diseases themselves, have a skewed gut bacteria population balance, so there's a very good chance that the test result will be compromised.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I had the breath test for SIBO and the result was below their threshold for being positive, meaning I was exhaling the gas they look for, but not enough to meet the required range for diagnosis. I wonder if I should have pursued that further, especially since my symptoms seem to disappear on antibiotics. But I suppose there isn't a long term treatment for SIBO, just short term antibiotics, right?
Gloria, I also wasn't aware that there was a stool test for fructose malabsorption. She ordered it on a prescription pad as if any lab can do it.
Incidentally, I got a call from my mom in Guatemala tonight. She's dealing with a 4th positive test for giardia, and lots of pain and indigestion as a result. She's been treated 3 times in the last year, and it seems she can't fully rid herself of the cysts (or maybe her water or food sources continue to be contaminated?) But my dad never gets sick. It seems to reactivate her gastritis and ulcer symptoms (Previously treated for H.Pylori). She's really suffering, and I have no advice for her, besides easy to digest foods and probiotics to replenish what all the treatments have done to her gut flora.
Anyway, I'm curious about chronic giardia now, and am looking forward to my daughter's stool tests. Imagine if it was this simple? But I doubt it.
Zizzle wrote:But I suppose there isn't a long term treatment for SIBO, just short term antibiotics, right?
Probiotics are a long-term option.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
, and its fairly chronic, although worse when she ingests soy.
