This post is by regular contributor Naomi Cook.
Four weeks ago I left the Allergy Centre at our local hospital with my daughter. She had been newly diagnosed with multiple food chemical intolerances, but I was feeling lucky. As I paid the receptionist for our visit I overheard a doctor ask another mother, “Have you packed their epi-pens?” My heart went out to those families, those mothers living with their children’s life-threatening allergies on not even a daily, but hourly basis.
You may remember my previous post on Cow Milk Protein Intolerance. It is perhaps almost predictable, food allergy experts may say, that we are here at this crossroads once again. My daughter has spent recent months increasingly unsettled and unhappy. Screaming fits after eating and sleep difficulties have prompted us to investigate; and indeed there is more to our ‘food intolerance’ picture.
Allergy vs. Intolerance
These terms are sometimes used interchangeably for simplicity (it is also easier to describe food intolerance as an “allergy” to someone who has no knowledge about the subject) but they not synonymous and can be defined as the following:
Allergies involve the immune system where the body reacts to certain proteins in particular foods (4). Common allergenic foods include egg, milk, nuts and seafood. 3, 5
Physical Reaction: This is usually quick, the body releases histamine and IgE which can result in red itchy skin and hives. There may be gastro-intestinal symptoms such as nausea and vomiting. 3 In severe cases there may be respiratory symptoms such as bronchospasm (tightening of the airways) and difficulty breathing. Widespread swelling can result in a dramatic drop in blood pressure and this may lead to collapse. If anaphylaxis occurs, death is possible. 3
Diagnosis: Blood tests (RAST) and Skin Prick Tests. 3, 5
Treatment: Adrenaline (when life threatening), anti-histamine, and sometimes a lifetime avoidance of the problematic protein is necessary. Some allergies like dust mite allergy can be treated by a course of injections of allergen to bring about de-sensitization.
Intolerances do not involve the immune system. Instead certain food chemicals irritate the endings of nerves in different parts of the body. 4 These food chemicals are not unique to particular food stuffs but occur across multiple food groups. 4
Physical Reaction: This may be slower, occurring over hours or even days. Because there is an agitation of nerve endings all over the body resulting symptoms are diverse. This diversity means that symptoms are much harder to pick up upon as they may even be almost nondescript, seemingly unrelated to food. They may include sleep disturbance, hyperactivity – in children – aggravated ADHD, 1, 5 irritability, headaches, depression, lethargy, constipation/diarrhea (Irritable Bowel) and feeling ‘run down.’ 1, 2, 4
Diagnosis: Supervised elimination diet followed by food challenges
Treatment: As the symptoms are diverse so is treatment and will depend on the body area affected, someone who gets a migraine after eating chocolate may take paracetamol or something stronger. Someone who gets heartburn after eating tomato may take an antacid or need on-going medication for reflux. Avoidance of the problematic foods is key but it is thought that tolerance and personal thresholds to the problematic food chemicals can increase over time, especially in children. 3, 5
What are Natural Food Chemicals?
These are chemicals that occur naturally in all foods in varying degrees; low, moderate, high and very high. 5 Usually the tastier something is, the higher it is in natural food chemicals. 4
Salicylates: These are plant chemicals and occur in a multitude of food products including fruit and vegetables. They tend to be higher in unripe fruit and vegetables. They are present in natural flavourings and perfumed products, from toiletries to cleaning products. They are also found in high quantities in many herbal medications. 3, 5
Amines: These are produced in higher quantities in food after protein breakdown; they are in many ripe fruit and vegetables and fermented products such as yeast products. 3, 5 They increase in meat it ages, such as when it is frozen and consumed later.
Glutamates: These amino acid building blocks are found in most foods and are ultimately natural flavor enhancers. 5 Tasty foods such as soy sauce, cheese, vegemite and yeast extracts are naturally very high in glutamates and are often extracted and added to bland foods to increase their flavor. 3, 5 Monosodium glutamate or MSG is the best known example. 5 Hidden glutamates are often described as “yeast or vegetable extracts” on the products list of ingredients. 1
Someone who reacts to natural food chemicals will most likely react to artificial additives found in processed foods and medications. 5
Even before starting the elimination diet with my daughter we knew that she was sensitive to salicylates having had a screaming fit after eating soup with tomato in it (tomato is very high in salicylates). She cried whenever she was given fruit puree with berries and these are very high in salicylates. We also thought she was sensitive to the amines in chicken and fish as they always made her very constipated (she also gagged when eating the tiniest amounts of these meats which my mother’s intuition felt was her little body telling her that it was no good for her). Mealtimes where becoming increasingly stressful with much unexplained crying. Previously uninterrupted night sleep was becoming punctuated with crying fits and early morning awakening and she seemed to need higher and higher doses of reflux medication to settle her.
The elimination diet needs to be supervised by a dietician. In the “strict” diet foods will usually only be allowed from the “low” list, 3, 5 that is, foods low in salicylates, amines and glutamates. Some elimination diets such as the “simple” allow foods from other categories such as moderate or even high. 3, 5 Elimination can take 3-4 weeks and then once there has been a succession of ‘good days’ food challenges can begin. 5 Reactions to food challenges help then to determine what food chemicals are problematic and after some time hopefully it is possible to work out a personalized threshold level for the culprit chemicals.
We are just eating from the “low” list which includes swede, celery, leek, white potato, rice and pulses. For fruit, one very ripe, peeled pear is allowed a day. This is in addition to no dairy, soy, meat, wheat or gluten or any other vegetable that is flavoursome and higher in natural chemicals. Meals are simple, brown rice pasta with butter beans, leek and swede sauce, followed by rice pudding made with an amino acid based (non-allergic) formula.
I am presently on the elimination diet too as I am still breastfeeding. As you can imagine things are pretty limited, but every cloud has a silver lining: The little food I can eat, tastes great and I have really lost interest in most processed foodstuff.
My daughter is already beginning to improve, for the first time in five months she has slept through the night, she plays happily by herself and mealtimes have become less stressful. The next step for us will be food challenges but in the interim, I am tentatively hoping that she is beginning to enjoy her little life once again.
I’d love to hear from other mothers of allergic and intolerant children about your journey through diagnosis and treatment.
This link to Sue Dengate is the key to understanding more about food chemicals, and which preservatives and additives to avoid in processed food, I highly recommend it. Her two books: “Fed Up” and “Failsafe Cooking” are food intolerance bibles, 2 I would recommend reading them even if your children are not allergic or intolerant, the amount of information provided on artificial food additives is eye opening and for me, will change my shopping and food choice habits for life.
The Royal Prince Alfred Hospital has the following invaluable publication Friendly Food 5 and multiple informative pdfs on allergy.
These links provide access to a huge variety of food products suitable for the allergic and intolerant:
DISCLAIMER: The information contained in this article should NEVER be used as a substitute for the advice of a licensed physician. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please see a physician if you think you or your child are unwell. This author has no competing interests.
- Dengate S, “Fed Up” (2008) Random House, Australia
- Food Intolerance Network: Food Intolerance Factsheet
- Royal Prince Alfred Hospital “Elimination Diet Handbook” at www.allergy.net.au
- Royal Prince Alfred Hospital “Food Allergies and Intolerances“
- Swain A, Soutter V, and Loblay R, “Friendly Food” Murdoch Books, Australia