Dr. Robert Pastore, PhD, CNS

Food Intolerances & Allergies

#070 - On Food Allergies

Dr. Pastore discusses the top 9 food allergies, and a new consumer study showing that these allergy diagnoses are on the rise. Topics covered include what a food allergy is, when and why food allergies appear, anaphylaxis and less severe symptoms of a food allergy, and what to discuss with your doctor to get a formal diagnosis.

2020-07-1710 min read

The Pastore Podcast
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SHOW NOTES NOTES

What is the difference between a food intolerance and food allergy? [0:20]

  • Intolerance in an inability to tolerate a specific food
  • Classic/common food intolerance is lactose intolerance
    • Lack enzyme called lactase to digest lactose
    • Can be lactose intolerant, or could be dairy intolerant (different)
  • Another example of an intolerance: gluten causes digestive stress
    • Bloating, gas, stomach distention, acne
  • Intolerance & food sensitivity definitions and languages are evolving
    • Patient is “sensitive immunologically” to [food]
  • Food intolerances are not life threatening
  • Food allergy = immunological reaction
    • Immunoglobulin IGE response
      • Immunoglobulin = immune system regulator, different types
      • IGE is an immediate reactive immunoglobulin that can bind to a food substance a person is allergic to
      • Forms an antigen-antibody complex that stimulates symptoms
        • Anaphylaxis can be life or death
    • A measurable/proven true immunoglobulin reaction
    • Happening more frequently than governing bodies report
  • Allergies do not always cause anaphylaxis
    • Large range from mild seasonal allergies & sinus congestion, all the way to severe anaphylaxis
    • Studies & research are still coming out


  • Dr. Pastore’s patient had very high blood pressure, underlying cause was true food allergies. Removed the food, no longer needed medication for blood pressure
  • Lexie’s client allergic to dairy
    • Removing dairy has eliminated all asthma symptoms
    • Accidentally exposed & gained 5lb of fluid retention
  • “The solution to pollution is dilution”
    • Consuming an allergen causes the body to take fluid from between cells & floods area to “put out an immunological fire”
    • Causes water retention (not fat gain)
    • Effort for the body to dilute the negative immune response


  • Consumer study showed that every 3 minutes, a food allergy sends someone to the emergency room [8:00]


What are the top 9 most common food allergies? [8:20]

  • 9 major foods for IGE allergy responses
  • Not limited to just these 9 things, could be any
  • Majority of people react to:
    • Milk
    • Eggs
    • Wheat
    • Fish
    • Shellfish
    • Peanuts
    • Tree Nuts
    • Soy
    • Sesame
  • Most processed foods have at least 2 of the most common allergens
  • Food labels aren’t disclosing enough information for those with true allergies


  • Dr. Pastore has yet to identify an individual who has anaphylaxis to one food and doesn’t react to another food
    • Will have more than one food allergy
    • Triggers & contributes to the anaphylaxis
    • Could cause an entirely different subset of symptoms


  • Allergy is typically a poly-phenomenon, meaning more than one food


How many people have food allergies? What age do these allergies appear? [10:45]

  • There is no set age for when a true food allergy transpires
    • Diagnosed in children or as an adult
    • Even if you never had symptoms or reacted before
  • Can come on at any day at any age


FARE (Food Allergy Research and Education Organization) study [12:15]

  • Approximately 32 million people in the US that have a true food allergen or allergies (meaning to more than one food) and are at risk for anaphylaxis
  • From 2007 and 2016, the rate of food allergies increased by 377%
    • Tripled in 9 years
  • 1 in 13 children have a true food allergy
    • Roughly 2 per classroom


Food allergy symptoms can mimic symptoms of other medical conditions [13:40]

  • Genetic risk factor - if someone related to you is allergic to a food, you’re at a greater risk of developing an allergy to it oo
    • 1st degree relative with a true food allergy means you likely have an allergy or sensitivity to foods (may not be the same foods)
  • Find the true cause of the symptoms, remove the allergen, symptoms go away
    • Elevated blood sugar due to food allergy due to inflammation, regardless of carbohydrate consumption
      • A pro-inflammatory response has been associated with the resistance of a cell’s ability to utilize insulin & glucose
        • Accelerates gluconeogenesis (making glucose from non-glucose sources in the body, driven by the liver)
        • Gluconeogenesis uses amino acid alanine to produce glucose, but body strips alanine from existing muscle tissue & causes decrease in muscle mass
        • Hyper-gluconeogenesis leads to visible muscle mass reduction in large muscle groups (quads, lats)


How do you get diagnosed with a true food allergy? [16:50]

  • Give your doctor a detailed health history - past and present (as a child & adult)
    • Symptoms and if possible any knowledge about foods you may have eaten that cause problems
      • Even if you “outgrew” it
      • Could be a component of the Allergy March (atopic march)
        • Refers to allergic diseases/reactions can manifest over one’s life time for example someone can have eczema, allergic rhinitis, asthma and food allergies in any order of progression
        • The progression of allergy based conditions that transpire over years in any order and lead up to the manifestation of a serious food allergy, including anaphylaxis
    • History of eczema or skin rashes
    • Asthma (as a child or adult)
    • Allergic rhinitis or sinusitis (sinus congestion & sneezing)
      • Food is often behind environmental allergies


  • Childhood allergy that you “grew out of”
    • Example: peanuts causes anaphylaxis as a child, but you “outgrew it” and now have asthma
    • Allergy is still there, just changed the way it manifested, have new symptoms when consuming peanuts (like asthma)
    • When we mature, immunology changes
      • Hyperpermeability of intestines (ability to absorb) is higher as a child, decreases as we age
      • Children absorb more & better with digestion than adults do


  • Include your family history
    • List all blood relatives with known or suspected food allergies and environmental allergies.


  • Have a detailed physical exam covering head to toe


To be diagnosed, request your doctor to run [20:00]


  • A skin prick test
    • Stimulates to see if there is a histamine response


  • A total IgE
    • To ensure you have enough IgE to test for
    • If your body is not producing enough IgE, can lead to false negatives
    • Total IgE = how much IgE you produce at any given time, you should be producing some
    • Cutoff is 187, if less than 5 means you may be IgE deficient


  • IgE food allergy blood test against specific foods
    • IgE panel should be aggressive as possible, as many foods & environmental allergens as possible
    • Definitely run for the top 9 & any other suspected foods


  • If something was flagged, practice an elimination diet for at least two weeks
    • Then, if symptoms are not as severe as anaphylaxis, in the presence of your physician attempt an oral food challenging
      • Eating the suspected allergen to see if it causes a direct response
    • NOT appropriate for everyone, but is definitely helpful in revealing cause and effect


What are the signs, symptoms & risk of having a food allergy? [25:15]

  • Genetics/family members
  • Itching in your mouth that passes when the food is swallowed
    • Histamine release occurred
  • Gastrointestinal upset - could be more than a food intolerance
  • Hives or skin rashes
  • Anaphylaxis


Anaphylaxis  [26:30]

  • Life threatening reaction to an allergen
  • Negatively impact breathing and circulation
  • Classically this transpires minutes after eating the offending allergen


  • Rare form called biphasic anaphylaxis
    • Anaphylaxis that transpire hours or even DAYS after eating the offending food


  • The pathophysiology of anaphylaxis:
    • An antigen (substance body perceives as harmful) binds to IgE
    • The antigen-antibody response stimulates immune system in negative way
      • Causes the release of cytokines Interleukin 4 (IL4), Interleukin 13 (IL13) causing a pro-inflammatory responses
      • Which stimulates other inflammatory mediators that communicate with cells to activate a type of white blood cell called a basophil
      • This causes a histamine release
      • Which increases bronchial muscle contraction and causes heart to slow - heart muscle depression


  • Because of this, the symptoms of anaphylaxis include
    • Difficulty breathing
    • Reduced blood pressure leading to loss of consciousness
    • A weak pulse
    • Skin rashes, swollen lips, vomiting, diarrhea, severe intestinal pain or cramping due to histamine reaction


What is the treatment for anaphylaxis? [29:00]

  • Epinephrine pen
    • Improves cardiovascular rhythm and circulation
    • Bring heart back to normal rhythm
    • Help you breathe better
    • Can counteract chemical effects of an allergic reaction
    • Does not shut off allergic reaction, but can save a life
    • EpiPen, Teva’s, Auvi-Q, Symjepi brands
  • Antihistamine and/or steroid medication
  • Strict food-allergy elimination diet
    • Peanuts are the ONLY one of nine major allergens to have a treatment
      • Microdosed peanuts to ignore immune response
      • Done in physician/allergist office ONLY
    • For the other 8, strict allergen avoidance is the only treatment


Can you outgrow a food allergy? [32:45]

  • Very rare
  • In thousands of patients, Dr. Pastore has seen 3 people “outgrew” their allergy
    • No longer testing positive for a true IGE reaction
  • Most times allergy will manifest in a different way
  • Symptoms will change
    • Less severe, but still have mild symptoms similar to a food intolerance
  • Research shows 1 out of 4 people have an immunological reaction to food
    • Much higher for Dr. Pastore - only had 1 case of NOT reacting to a food
    • More than half of Lexie’s clients react to a food
  • FARE study showed 300x increase in the past 9 years
    • Will continue to increase exponentially



What did we learn from this new consumer study? [40:45]

  • FARE (Food Allergy Research and Education Organization) in collaboration with
    • Northwestern University Feinberg School of Medicine
    • Ann & Robert H. Lurie Children's Hospital of Chicago
  • Assessed food allergies & food allergy labelling
  • Need more strict allergy-friendly packaged foods (especially for picky eater children & those with limited financial resources)
  • McKinsey & co
  • Consumer study showed that...
    • 85 million Americans (roughly 20%)
      • Avoid purchasing food with the top 9 allergens
      • Spend 19 billion annually on foods that clearly avoid these top 9 foods
    • 71% check food labels every time they shop and spend up to 5 minutes examining an ingredient list
      • Labelling regulations not strict, allow loopholes & trickery
    • 68% trust allergy friendly brands
      • Still be cautious & look for “certified” allergy-friendly products
      • May still be at risk for cross-contamination
    • 53% desire clearer easier to understand food allergen labeling
      • Less technical terms
      • Large pronounced wording that it contains allergens
      • Example: won’t have “milk” printed on the label but has milk ingredients
      • “Natural and artificial flavours” can contain common allergens


  • Hopefully this study will catch the attention of agribusiness companies to change their labelling


  • Bet on the farm, not pharma


Wrap Up [56:00]



Speak to your doctor regarding:


  • A skin prick test
    • Stimulates to see if there is a histamine response


  • A total IgE
    • To ensure you have enough IgE to test for
    • If your body is not producing enough IgE, can lead to false negatives
    • Total IgE = how much IgE you produce at any given time, you should be producing some
    • Cutoff is 187, if less than 5 means you may be IgE deficient


  • IgE food allergy blood test against specific foods
    • IgE panel should be aggressive as possible, as many foods & environmental allergens as possible
    • Definitely run for the top 9 & any other suspected foods


  • If something was flagged, practice an elimination diet for at least two weeks
    • Then, if symptoms are not as severe as anaphylaxis, in the presence of your physician attempt an oral food challenging
      • Eating the suspected allergen to see if it causes a direct response
    • NOT appropriate for everyone, but is definitely helpful in revealing cause and effect