Eye-opening talk with an allergist/immunologist

[Zizzle]

I attend a food allergy support group hosted by a friend of mine, mostly for my daughter, who is IgE allergic to all legumes because of cross-reactivity to birch pollen. Last night, a local allergist came to our meeting as our new "medical advisor" and we got to pepper him with questions. Here are some things I remember, in no particular order:

1. RAST blood test numbers do not indicate severity of an allergy, and don't help predict what type of reaction you may have.
2. Allergy skin tests are more prone to false positives than RAST tests, but both are prone to false positives. You also need clinical evidence of allergy to confirm.
3. Most people with autoimmune diseases don't have allergies and vice-versa. That's because people prone to allergy have T-1 dominant immune systems, while people with autoimmunity are T-2 dominant. If you have 2 parents, one of each type, we don't know if that makes you prone to both. But autoimmunity is a shared trait in families.
4. He is a chronic urticaria with angioedema expert (my MIL has this). He says is it mostly tied to Hashimoto's Thyroiditis, and FDA is approving a drug next week that radically alleviates this condition - ZOLAIR. I think it's approved for severe asthma now, but FDA will approve for chronic urticaria.
5. He has very few food allergy patients with Mastocytic Enterocolitis, and he says few food allergy patients present with any GI problems, other than occasional Eosinophilic Esophagitis.
6. He thinks mast cells are not the cause of allergic issues, he thinks they are cells that have a tendency to accumulate in tissues that are inflamed. So he thinks inflammation comes first, then mast cell increases.
7. He does not know what is causing the increases in food allergies. It cannot be wholly explained by c-sections, regional pollen, etc. But excess hygiene among the affluent may be an issue.
8. He does not think there is a difference between GMO soy and organic soy as far as the allergens. He thinks many people with soy allergy can safely consume soy sauce (as well as soy oil and lecithin in small quantities)
9. Same goes for changes in peanut varieties over time. They have tested varieties of peanuts that are 100s of years old on allergic people and get the same responses.
9. Current research supports immunotherapy (giving increasing doses of the allergen) to people to overcome food allergies. Avoidance will become a thing of the past. Babies and children should be fed a wide variety of foods.
10. For milk and egg allergies, baked milk and egg are able to be tolerated first (by 30-50% of those allergic).
11. He admits digestive allergies have many other factors at play, not just IgE.
12. They do not know whether continuing to allow small amounts of an allergen, and allowing continued mild GI symptoms as a result, will result in IBD or other problems later. He doesn't think so.
13. Birch pollen allergy causes oral allergy syndrome year round to carrots and tree fruits like apples, peaches, plums, etc. This is a mild allergy and you don't need to avoid the foods unless the symptoms bother you. It will not become anaphylactic.
14. Food allergies are very common in Israel, particularly to sesame.
15. Immunology is a shrinking field and will not be able to enter rheumatology's well-guarded turf over autoimmune disease any time soon.

[wmonique2]

Z.,

Very interesting and some new things to learn for me. Point 6 on mast cells resonated with me. I didn't get mast cells like after a year of being dx'd.

Point 14--food allergies are common in Israel. I understand from people I know that half of the country is GF. Restaurants all serve rice cakes instead of bread automatically. Also, the sesame thing. Most bread comes with sesame seeds sprinkled and they make many sweets like Halvah with sesame seeds.

Very interesting and very good note taking from your part. Good job!

Monique

[Zizzle]

very good note taking from your part.

I didn't take any notes! Which is why I wanted to write everything down before I forget, LOL.

A couple more things, as Polly and I dream about being able to eat cheese again someday...

He said milk proteins in aged cheese like parmesan are vastly different from regular milk or fresh cheese like mozzarella. They are more altered than yogurt too. He believes some milk allergic people can eat aged cheeses. Could that mean MCers might too??

He did confirm that goat and sheep's milk have almost identical allergens to cow's milk, so they are not safer. Horse milk, on the other hand, may be more tolerated, but who wants to milk a horse?!

Regarding eczema, he said there is a huge variety of eczema triggers. It can be food, but there are definite environmental triggers, stress, and at least 2 known gene mutations than contribute to it. One gene mutation makes the skin barrier less able to resist staph infections. We all carry staph on our skin, but people with this mutation carry vastly more staph and get infected by it. That's why bleach baths are so effective for eczema, it decreases the staph population. Swimming in a pool is not the same, because you get in and out and overdry your skin in the process. Bleach baths at home are better controlled. They are recommended up to 3 times per week!!

[wmonique2]

He did confirm that goat and sheep's milk have almost identical allergens to cow's milk, so they are not safer. Horse milk, on the other hand, may be more tolerated, but who wants to milk a horse?!

Ugh! Not moi!

And bravo for remembering all of this. With my perpetual state of brain fog, I doubt I could remember any of it. Sometimes I go from one room to another in my house and I don't remember what I came into the room for. I swear this damn condition is gonna give me Alzheimer's ...

Monique

[Lesley]

Food allergies are very common in Israel, particularly to sesame.

My entire family and 100s of friends live in Israel. Not one of them displays this.

I understand from people I know that half of the country is GF. Restaurants all serve rice cakes instead of bread automatically. Also, the sesame thing. Most bread comes with sesame seeds sprinkled and they make many sweets like Halvah with sesame seeds.

Monique- not as far as I know. I asked my son and my brother (physiologist) about this. No one they know is gluten free except me. And I am in LA. To quote my brother - it's a nonsensical fad except for coeliacs. But then, he is always extreme. I suggested to him that going gluten free might help his asthma. He nearly ate me alive.
As for restaurants? I asked everyone I know. They all say you can ask for rice cakes in some restaurants, but it is not automatic.
As of last year when I was there - I had trouble because a few foods on which I rely were unavailable, even in the health food stores, such as gluten free oats and unadulterated coconut milk. If I manage to go this year (cancelled due to broken back, and not finding an affordable ticket now!) I will take these foods with me.

[wmonique2]

Hi Lesley,

Well, my niece is a nutritionist in Israel with a Masters in Public Health and she works for major hospitals and she tells me that many of the young people she knows are going GF. Maybe a fad but the young ones are adopting it. Also, when I told her that I was GF she said that most restaurants accommodate with rice cakes not just for people that are GF but for people on a diet.

Yes, you're right about easily finding foods for us. Their health food stores pale compared to ours. My niece says that she finds coconut milk now in small cans whereas in the past only in large sizes (we were discussing a recipe I make with coconut milk...).

And I did suggest that they should go GF but they just ignored me. Actually, I have a friend who always had sinusitis for her entire life and she went GF and it all cleared up for her. Your brother would be wise to listen to you.

Tickets are anything but affordable. My friend Anne went last year for $1500. Outrageous!

I hope your back gets better, Lesley.

Monique