Certain diet-based comorbid conditions are more prevalent in food-allergic patients.
In most cases, patients with food allergies are presenting with more than just that condition. It’s critical to understand how diet therapy may affect comorbidities, and to understand the patient’s individual tolerance as well.
In an interview with MD Magazine® while at the American College of Allergy, Asthma & Immunology (ACAAI) 2019 Scientific Meeting in Houston, Carina Venter, PhD, RD, associate professor of Pediatric Allergy & Immunology at the University of Colorado School of Medicine, described the most common food allergy comorbidities, and what an individualized food allergy treatment plan could entail.
MD Mag: What diet-driven comorbidities often present in patients with food allergy?
Venter: In terms of diet treatment for food allergies, it’s of course the IgE-mediated food allergies. Then, a particular interest of mine is eosinophilic esophagitis, where if the patients opt not to use oral steroids and they’re not candidates for biologics, then the only other option of treatment is diet therapy.
I mean, the potential of diet therapy is huge. You can almost cure everybody's EoE or get rid of these symptoms, for that matter, by using an elemental diet. About 80% of children and adults will have resolution of their symptoms and eosinophil counts by going on a successful elimination diet.
Then we've got FPIES, as we say in short—or Food Protein Induced Enterocolitis Syndrome—in which the only treatment is just avoiding them the food allergen. And interestingly, with FPIES is these foods are very atypical allergens. So they’re oats, rice, sweet potato, and banana.
Of course we see FPIES in milk and soy as an IgE food allergy, but very much atypical foods as well. So I would say, in terms of dietary management of allergic disease, it's the IgE allergies we know, FPIES, and then in very young infants, we get proctocolitis, which tends to get better on milk exclusion. But that's normally outgrown by the time they're 1 year old.
MD Mag: What constitutes the best individualized food allergy treatment plan?
Venter: I think it's understanding that patient’s tolerance, and also how the tolerance level will change when they are exposed to co-factors such as sleep deprivation, exercise, alcohol use, hormonal changes.
I think in an ideal world, in all formats of food allergy which I've just explained, I would love to be able to say to a patient, ‘Normally you don't have to worry about trace amounts, and trace amounts in your case means so many milligrams of this particular protein. But if you do go and play soccer, then we need to reduce your tolerance level to X amount or milligrams, or grams of protein. And that will change when you go skiing, and you're at high altitude coming down the slopes.’
I think that that would be great. And also: know what the protein content is of commercially-available foods, because most manufacturers won't give us that information, because they say it's proprietary. So, first level we need to understand tolerance for each patient and how that changed, but second level is that industry would allow us to know what the protein content of of different foods is, so we can just open up patients’ diets.