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food allergy

A food allergy is an immune response to a food protein that occurs soon after eating.  The response is usually immediate and can include hives, swollen airways and anaphylactic reaction.  This can happen while ingesting any food, including foods that you eat often and in very small amounts.  There are three common types of allergy testing: skin prick test, IgE blood test and food challenges.  Complete avoidance of the food is essential since the severity of the reaction can be life-threatening.

food intolerance

Food intolerance or food sensitivity is an abnormal response in the intestine to certain foods.   The result is irritation and inflammation every time that food is eaten.  Food intolerances are often a delayed sensitivity, and the reaction can vary from person to person.  Your body can mount an immune response which can last up to 6 weeks, depending on the type of food.  Because of this delayed response, food intolerances are often missed.  Symptoms vary from person to person, ranging from no symptoms to severe symptoms: diarrhea/constipation, gas/bloating, GERD, IBS, abdominal pain, mouth ulcers, nausea/vomiting, allergies/asthma, sinusitis, joint inflammation and pain, hives, eczema, rash, headache/migraine, fatigue, anemia, low mood/anxiety, hypothyroidism and osteoporosis.  The most common foods that cause food intolerances are gluten, cow’s milk, soy and eggs.  Food intolerances can be tested through blood, SIgA salivary testing and food elimination diets.

celiac disease

Celiac disease (CD) is a digestive disorder that damages the small intestine and blocks absorption of nutrients from food.  People who have CD cannot tolerate a protein called gluten, which is found in wheat, rye, barley and possibly oats.  When people with CD eat foods with gluten, their immune systems respond by damaging the fingerlike protrusions called villi on the lining of the small intestines.  Nutrients from food are absorbed into the blood stream through these villi, and without them a person becomes malnourished no matter how much food is eaten.  Symptoms vary from person to person, ranging from no symptoms to severe symptoms: gas, mouth sores, increased appetite, dry skin, night blindness, abdominal cramping/bloating/distention, constipation/diarrhea, weakness, back pain, body aches, loose/hard/small/large/floating/frothy/foul-smelling stools, weight loss and fatigue.  People with CD may have no symptoms, but can still develop complications of the disease over time.  Long-term complications include malnutrition—which can lead to anemia, osteoporosis, miscarriage, liver disease and cancers of the intestine.  Because the body’s own immune system causes the damage, CD is considered an autoimmune disease.  CD is also known as celiac sprue, nontropical sprue and gluten-sensitive enteropathy.  CD runs in the family.  If you have the genes for celiac disease you may have the tendency for a while without getting sick.  Then something like severe stress, physical injury, infection, childbirth or surgery can "turn on" celiac disease.  

celiac disease testing

Historically, the diagnosis relied on an invasive biopsy of the small intestine.  A normal biopsy, however, does not exclude the disease.  There are two different types of blood testing to determine if you have celiac disease.  One is a celiac disease panel.  This test is designed to detect the presence of several different antibodies.  Unfortunately, it is not 100% diagnostic since the celiac disease has to be “turned on” for the labs to show positive results.  The other blood test looks to see if you have the genetic markers that increase your probability of developing the disease.  Genes do not lie.  If you have the genes, you have a higher probability of developing the disease.  If there is a stressful event or pregnancy and you have the genetic markers, these can be turned on to then cause celiac disease.  In the active disease state, the celiac disease panel will come back positive.  
As you can see, the symptoms of both celiac disease and gluten intolerance are the same.  Lab testing is very important in the diagnosis and should be done prior to removing gluten from the diet because the lab testing, including intestinal biopsy, will not be accurate once gluten is out of your system.  Genetic testing, however, can be performed at any time.

treatment

The only treatment for celiac disease is a lifelong commitment to eating a gluten-free diet.  Although this may seem like an overwhelming lifestyle change at first, it is something that I am well-prepared to help you with, and you will leave my office with a multitude of recipes and ideas that will help smooth your dietary transition.  Improvements begin within days of starting the diet.  Eating any gluten, no matter how small an amount, can damage the intestines.  The treatment for gluten intolerance is the same, complete avoidance of gluten-containing foods.  People who have gluten intolerance and not celiac disease may be able to eat it in the future with repair and healing of the digestive system.  Because every individual has a different reaction and severity, the best plan is to completely avoid gluten for a specific period of time and then introduce it back into the diet with an eye to any reactions that may occur.  This is call food introduction.