Lactose Intolerance

Food Allergies

Food Allergies

Peanuts can leave you breathless. Cat dander can lead to itchy eyes, a stuffy nose, coughing and sneezing. And most of us have suffered through those seasonal allergies with horrible pollen counts. Learn more...

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Treatment of Food Allergies and Intolerances

The major mode of treatment for food allergies and intolerances is for the person to avoid consuming the food or foods that seem to cause health problems. This involves a high degree of dietary awareness and careful food selection. When foods are eliminated from the diet, it is important to ensure the nutritional adequacy of the diet, and some individuals may need to take dietary supplements. There are some food intolerances, such as lactose intolerance, where individuals may be able to reduce the amount of the food consumed and not totally eliminate it from the diet. People with lactose intolerance do not have to completely eliminate milk products, though they must reduce their intake of lactose (milk sugar) to a manageable level. see also Additives and Preservatives. Koerner, Celide B., and Munoz-Furlong, Anne (1998). Food Allergies. Minneapolis, MN Chronimed. Metcalfe, Dean D. Sampson, Hugh A. and Simon, Richard A. (1997). Food Allergy Adverse Reactions to Foods and Food Additives....

Clinical aspects of food allergy and food intolerance 1431 Symptoms

In the case of food allergy, late reactions seldom occur. The clinical symptoms of allergic food reactions are listed in Table 14.2. The oropharynx and gastrointestinal tract are the initial sites of exposure to food antigens. Symptoms such as edema and itching of the mouth often occur. However, these reactions may be transient and are not necessarily followed by other symptoms. In some people, certain fruits, nuts, and vegetables cause oral symptoms only, while in others a more extensive reaction is seen. The quantity of the offending food also plays a role in the gravity and extent of the reaction, although in Table 14.2 Symptoms of food allergy principle a small amount of a certain food can readily cause a response. Sometimes the allergic reaction only develops if the food intake is followed by exercise. This is referred to as exercise-induced food allergy. Hypotension and shock are life-threatening consequences of a food-allergic reaction. Generally, the reaction is accompanied by...

Allergies Food What Are Food Allergies

Various types of food allergies or food sensitivities (characterized by symptoms, but not confirmed by laboratory tests) can maintain the body's inflammatory response at a high idle. These allergies can exacerbate symptoms of other inflammatory diseases, such as asthma and rheumatoid arthritis, or raise blood pressure and blood sugar levels. Occasionally they can completely mimic the symptoms of other diseases. There are several leading causes of food allergies, and they may intertwine. Physicians have traditionally recognized only acute allergic reactions, such as when a person develops a rash after eating shellfish or strawberries. However, most cases of food allergies may be more subtle and difficult to diagnose. As ironic as it might seem, some people actually become addicted to a food that causes an allergic reaction. This allergy addiction may develop as part of the body's response to a commonly consumed allergen. During these reactions, the body releases endorphins, substances...

Presenting complaint

The clinician takes a detailed account of the patient's presenting complaint, initially using open questions, and then using closed questions to obtain important details. The information gathered includes the timing and frequency of symptoms, any precipitants that the patient may suspect and any adjuvants such as alcohol or exercise. The clinician is looking for common or recognised patterns of symptoms. The focus of the questioning will differ depending on the age of the patient. The clinician concentrates upon symptoms that have been confirmed to occur as a result of food allergies. Symptoms are more easily dealt with if considered on a system-by-system approach. Common patterns of symptoms arising from food allergy occur within the gastrointestinal system, the skin, the respiratory system and the cardiovascular system.3 Patients commonly have symptoms in different systems. The common symptoms are listed in Table 3.1. Table 3.1 Common symptoms associated with food allergy Table 3.1...

Milk and Milk Products

Many people do not produce enough lac-tase to completely digest the lactose in milk. If lactose is poorly digested, it can cause cramps, gas, and diarrhea. This inherited condition is termed lactose intolerance and most often affects Asians, African-Americans, and other populations that traditionally consume few milk products. Although most infants and children can absorb lactose, lactase activity tends to decline with age. Lactose-intolerant people can often eat small amounts of yogurt, buttermilk, and some cheeses because most of the lactose in these foods has been fermented by bacteria. 2. Milk allergy can be a trigger of asthma, eczema, arthritis, and other symptoms.26 A milk allergy is almost always a reaction to the proteins in cow's milk, whereas lactose intolerance is a reaction to the lactose. Therefore, unlike lactose-intolerant individuals, people with a milk allergy must often avoid all milk products, including yogurt and cheese.

Who Needs a Nutritional Supplement

On the other hand, if his or her diet is consistently imbalanced then that person's average daily intake for one or more essential nutrients will probably end up below recommendations. For instance, if a person doesn't eat fish or other seafood regularly, then they might not be achieving recommended levels for an essential fatty acid. Or, if a person doesn't tolerate or like milk and certain dairy foods, they might not achieve his or her AI for calcium and vitamin D on a regular basis. Therefore, unrelenting food preferences, food intolerance, and allergies, or limited availability of certain foods can certainly necessitate the consideration of a nutrition supplement. In addition, reduced calorie intakes to lose weight can often lead to inadequate intakes of one or more essential nutrients by reducing the volume of food in general or limiting the intake of certain types of foods.

Dietary Changes and Nutrients That Can Help

It is best to avoid foods that trigger allergic reactions. In addition, a rotation diet, in which the same food families are eaten only once every four days, may reduce the chances of future allergies developing. Avoiding an allergenic food for six months to a year sometimes allows the immune system to recover and not react to the problem food, as long as it is not consumed too often.

TABLE 773 Treatment of Fulminant Colitis

Diarrhea can be controlled by the use of loperamide (Imodium), 4 to 16 mg day, diphenoxylate (Lomotil), 5 to 20 mg day, and, in some cases, cholestyramine (Questran), 4 g one to six times daily. The latter is particularly useful as an exchange resin in patients who have limited ileal disease or resection, no bowel obstruction, and mild steatorrhea. The mechanism of action is binding bile acids and eliminating their known cathartic action. The primary aim of dietary therapy is the maintenance of nutrition and the alleviation of diarrhea. Elimination of lactose from the diet is of benefit in patients with lactose intolerance. Reduction in dietary oxalate should be considered in every patient. In addition, supplementation of trace metals, fat-soluble vitamins, and medium-chain triglycerides should be considered in selected patients.

The Cascade of Inflammatory Signaling

A disturbed gastrointestinal terrain can serve as an unseen 'motor' of inflammation, leading to a cycle of inflammatory signaling. There is a complex balance that exists between the indigenous flora and the adjacent immune system of the gut mucosa and liver. Evidence supports that impairment of normal gut barrier function, through environmental stressors (such as heavy metals and chemical preservatives), poor dietary habits (such as high in refined sugars and fructose), food allergies, various drug therapies, and chronic stress, results in the loss of the counterinflammatory flora balance and

Differential diagnosis

In children with chronic abdominal pain, increased flatulence and bloating, the diagnosis of carbohydrate intolerance should be considered. The breath hydrogen test following a lactose or fructose load will confirm the diagnosis. Exclusion of these offending agents may improve the symptoms. On the other hand, lactose intolerance has a very high prevalence in the general population and free elimination diet resolved symptoms in a similar percentage of patients in the lactose absorbers and in the lactose malabsorbers. As a result of the high independent prevalence of both conditions in the general population, the presence of chronic abdominal pain and lactose intolerance in one patient may be merely coincidental. Thus, the recommendation of an exclusion diet should be made with reasonable expectations, as it may be helpful in the resolution of symptoms in only a limited number of patients. Cholelithiasis is considered uncommon in infancy, childhood and adolescence, with a prevalence...

Alternative delivery

Aloe vera A plant of the genus Aloe, a member of the lily family. There are at least 120 known species of aloe, many of which have been used as botanical medicines. The sap and rind portions of the aloe vera leaf contain analgesics, antiinflam-matory compounds, minerals, and beneficial fatty acids. Aloe vera is widely known as a skin moisturizer and healing agent, especially in treating cuts, burns, insect stings, bruises, acne, poison ivy, welts, ulcerated skin lesions, eczema, and sunburns. It has also been used to treat stomach disorders, ulcers, and many colon-related disorders, including colitis. Aloe juice may be used to treat food allergies, varicose veins, skin cancer, and arthritis as well. Aloe vera may help stop the spread of some viruses, such as herpes simplex I and II, varicella zoster virus, pseudorabies virus, and the influenza virus.

Supplements For The Undereating Phase

Many people suffer from food allergies and allergic reactions due to undigested food in the colon and blood. Undigested food creates inflammation, water retention, toxins, and slows down your whole system. Your body recognizes it as a foreign invader thus triggering an allergic reaction. Digestive enzymes may help combat these probsems.

Nonintestinal Complications

Individuals who have Crohn disease or ulcerative colitis and have been treated with corticosteroids such as prednisone are at higher risk for developing osteoporosis, because the steroids damage their ability to absorb calcium. This condition is known as secondary osteoporosis. However, evidence shows that all people with Crohn disease or ulcerative colitis are at higher risk for primary osteoporosis. The reasons are not clear, but the guess is that a diet low in calcium because of lactose intolerance, as well as general malabsorption of nutrients, plays a role in the situation. The disease process itself may also be partly to blame. Some bone loss may be caused by inflammatory mediators.

Muscle Joint and Soft Tissue Complications of Diabetes

Several studies have shown that total fasting improves the symptoms of rheumatoid arthritis (RA) in some patients, but the effects are temporary. Because it was possible that food allergy aggravated arthritis, researchers have studied the effects of elemental and exclusion diets. Elemental diets contain minerals and amino acids rather than complex proteins and have resulted in a modest improvement in symptoms in some patients but

Wob Pulmonary Physical Examination

The answer is b. (Fauci, 14 e, pp 1115-1116.) Influenza A is a potentially lethal disease in the elderly and chronically debilitated patient. In institutional settings such as nursing homes, outbreaks are likely to be particularly severe. Hence, prophylaxis is extremely important in this setting. All residents should receive the vaccine unless they have known egg allergy (patients can choose to decline the vaccine). Since protective antibodies to the vaccine will not develop for 2 wk, amantadine can be used for protection against influenza A during the interim 2-wk period. A reduced dose is given to elderly patients.

Probiotics and the control of immune dysfunctions

In human studies of allergic disease, there is longitudinal evidence that consumption of probiotic-supplemented yoghurt over a period of 1 year can lower the circulating levels of IgE and reduce nasal allergies in elderly subjects (Halpern et al., 1991 Trapp et al., 1993 Table 13.2). Wheeler et al. (1997) have shown that shorter-term consumption of probiotics (i.e. 1 month) by adult allergy sufferers can generate a trend towards reduced peripheral blood eosinophil counts and increased IFN-7-secreting activity of lymphocytes, suggesting that probiotic-induced anti-allergy immune regulation may be effective in humans also. A report by Pelto et al. (1998) demonstrated an alternative mechanism for the ability of L. rhamnosus GG to limit hypersensitivity responses in subjects with cows'-milk allergy, namely, that the probiotic can prevent the up-regulation of pro-inflammatory receptors on leucocytes (a response that normally precedes GI tract inflammation in milk-sensitive subjects). Other...

Nonneoplastic Conditions

Coeliac disease traditionally investigated by Crosby capsule biopsy of the proximal jejunum, it is now assessed by a combination of coeliac serology and distal duodenal biopsies taken at flexible OGD. Cardinal features are an excess of surface intra-epithelial lymphocytes, villous atrophy and crypt hyperplasia. Proof is by clinical improvement on a gluten-free diet and deterioration on subsequent rechallenge. It is present thoughout the small intestine and can be complicated by malignant lymphoma or adenocarcinoma. Other conditions can produce similar mucosal changes, e.g., Giardia lamblia infestation, lactose intolerance or post-infective enteritis, but are usually not gluten responsive. Giardia is a kite-shaped flagellate protozoon present in the intervillous mucus causing diarrhoea with or without mucosal inflammation - it typically affects children or the elderly.

Demographic Transitions and Genetic Disease

Similarly, among the many examples of malabsorption diseases with a genetic component, and that are significant contributors to the prevalence of diarrhea, worldwide, are disaccharide intolerance (including lactose intolerance), familial Mediterranean fever, fructose intolerance, galactosemia, glucose-galactose malabsorption, glycogen storage disease, and inflammatory bowel disease.

Lupus Systemic Lupus Erythematosus SLE

The type of fat in the diet is important saturated fats and polyunsaturated fats including sunflower, corn, and safflower oils are inflammatory and can exacerbate the condition. In studies, improvement has been shown when omega-3 fatty acids are included in the diet. Alfalfa seeds and sprouts aggravate the disease and food allergies may precipitate an inflammation.

Dairy wW S Up with That

Robert Hatherill, a research scientist at the University of California at Santa Barbara, indicates that we can set ourselves up for serious disease by exposing the body to dairy products. Infants with milk allergies make antibodies to fight milk proteins that are linked to destroying cells in the pancreas. In the case of cataracts, milk sugar can build up in the lens of the eye, causing irreversible clouding or cataract. Dr. Hatherill, whose field is environmental toxicology, also points out that cow's milk enhances the uptake of lead, cadmium, mercury, and other metals.


(rheumatoid arthritis and lupus), diabetes, food allergies, gastritis, Graves disease, hepatitis, pernicious anemia, osteoporosis, and psoriasis. Several enzymes inside the wall of the intestine further digest oligosaccharides and proteins. These special cells also control absorption of nutrients to prevent large molecules of undigested foods from entering the blood stream. If this occurs, food allergies may result. Drugs, food additives, and inflammatory bowel diseases all can damage these delicate cells. Frequent use of nonsteroidal anti-inflammatory medications, such as ibuprofen, is a common culprit when these cells are damaged. Diseases such as sprue, Whipple's disease, Crohn's disease, Giardiasis, cryptosporidiosis, lactose intolerance, and eosinophilic gastroenteritis all impair proper digestion and absorption of nutrients. But it should be appreciated that nutrient absorption utilizes different pathways in the intestine, so that isolated nutritional deficiencies can occur. For...

Chapter Summary

Type I hypersensitivity (anaphylactic type) reactions are characterized by IgE-related release of chemical mediators from mast cells and basophils following exposure to an antigen. Examples of type I hypersensitivity reactions include systemic anaphylaxis following bee stings and drugs. Localized forms of anaphylactic reaction include food allergies, atopy, and asthma.

Subject Index

Heart-related diseases, 160 herpes simplex, 161 hookworm infection, 166-167 infectious hepatitis, 172 infectious mononucleosis, 174 influenza, 180 lactose intolerance, 183 Lassa fever, 184-185 atrial fibrillation, 104 Australia and New Zealand AIDS, 1 beriberi, 46 bubonic plague, 63 cirrhosis, 79 dengue, 86 echinococcosis, 110 encephalitides, 36 filariasis, 127 gout, 155-156 heart-related diseases, 160 hookworm infection, 167 infectious hepatitis, 173 inflammatory bowel disease, 176 influenza, 180 lactose intolerance, 183 lead poisoning, 188 leprosy, 193 leptospirosis, 196 Lyme disease, 201 measles, 213 meningitis, 216 multiple sclerosis, 221-222 ophthalmia, 230 osteoporosis, 238 Paget's disease of bone, 238 poliomyelitis, 260 Q fever, 267, 269-270 in Argentine hemorrhagic fever, 39 ascariasis and, 42 in bacillary dysentery, 44 in cholera, 74-75 in clonorchiasis, 81 Cochin-China, 306 in colchicum, 154 in cystic fibrosis, 83 enteric, 340 in fasciolopsiasis, 123 in giardiasis, 93, 144...


Emotions linked to food experiences, not the food itself, can even cause a reaction. Just the appearance, smell, or taste of food might trigger an emotional reaction resulting in symptoms that mimic a food allergy or food intolerance. Or someone might get these symptoms by believing the food is harmful. Even if you suspect that emotions are at the root of an adverse reaction to food, check with your physician. Symptoms may stem from a more serious physical condition. To date there's no known scientific link between food allergies and arthritis, migraine headaches, behavioral problems, ear infections, and urinary tract infections, although research in these areas is under way. Recent studies are showing a link between food allergies and severe asthma in children. Food Allergies The Dangerous Side For most people with food allergies, the reactions are more uncomfortable than dangerous. In rare cases, however, an anaphylactic reaction can occur. When many different body systems react at...

Dr Steven Langer

Now, obviously she was bitter and angry that she had been suffering for all that time. But the organic feeling that she had of the overwhelming fatigue totally disappeared within a three-month period of time, and I've seen that in thousands of patients over the years. A small dose of thyroid, combined with things like nutritional support and eliminating food allergies, can really turn a person's life around. Moreover, I have seen teenagers and children who are acting out, who are written off as hyperactive, when they may be suffering from a thyroid disorder. Very young children or teenagers express their emotions differently from adults. Sometimes they get written off as being mentally retarded or having minimal brain dysfunction. Then they're given any one of a number of different drugs and placed in special classes. Many times, these young people have thyroid disorders that can be easily treated. But because thyroid dysfunction often leads to frequent infections, these kids are...


Some have suggested that food reactions may contribute to the inflammatory processes in rheumatoid arthritis, and advocate elimination diets as part of a treatment regimen. Most studies, however, have been done on very small groups of patients, many studies being controlled inadequately. Food hypersensitivity appears to be a factor in a small minority of patients at most. Evidence is insufficient to recommend elimination diets for treatment of inflammatory arthritis.34

Infectious Disease

The answer is b. (Braunwald, 15 e, pp 1125-1131.) Influenza A is a potentially lethal disease in the elderly and chronically debilitated patient. In institutional settings such as nursing homes, outbreaks are likely to be particularly severe. Thus prophylaxis is extremely important in this setting. All residents should receive the vaccine unless they have known egg allergy (patients can choose to decline the vaccine). Since protective antibodies to the vaccine will not develop for 2 weeks, amantadine can be used for protection against influenza A during the interim 2-week period. A reduced dose is given to elderly patients.

Gut Ecology

Yeast can also enter the small bowel, resulting in numerous microscopic perforations of the wall of the bowel. This can lead to food allergies, since large molecules of food products will be able to enter the blood stream. Interestingly, food allergies may subside when the yeast invasion is cured.