Recently, NICE issued some new evidence-based guidelines for testing children for allergies and, actually, I thought they were pretty sensible.
The media of course hyped up the fact that we shouldn’t be using unproven ‘alternative’ tests. Whilst I have a problem with the fact that much in use in the NHS remains unproven, I actually agree in this instance that we desperately need to stop people spending money on tests that won’t give the answers looked for, and that make people give up lists of foods they probably don’t have to.
Many times, people have come to see me clutching their ‘allergy lists’ in desperation for me to tell them they don’t have to follow such a restricted diet. Most of the time I tell them to ditch the information and get them to follow an elimination diet for the two primary allergens: wheat and dairy. Once those are truly out, things invariably improve and what I term ‘secondary allergens’ generally solve themselves with time and gut/liver repair. If they don’t then we’re into delving a bit deeper.
Elimination and challenge is still really the only way to identify allergies and intolerances. I wish it weren’t, but it is. Why? Because we simply don’t understand the body mechanisms at play enough yet to know how to look for them.
For example, here is a response I sent to a patient recently who went ahead and did a York test and was then confused about what to do:
“Food sensitivity testing is a complete minefield and I do not advocate it very often. Why? Simply because there are so many identified and as yet unidentified reactions, both immune and non-immune, that are involved.
We know how to test for certain reactions but not others which means that any food test is going to give truthful and useful info but also false positives, false negatives and not be able to pick up other reactions they don’t know about or know how to test for yet. With the greatest will in the world, any test is only going to give partial information.
For example, the York test is looking for one type of immune reaction to one antibody, IgG, which is known to be involved in a lot of intolerance issues, but that is just one type of immune reaction and one antibody. It may be the one at play with SOME foods, but it may not.
The Genova Fact test, for example, does something completely different and is looking for any type of change in the blood, involving an antibody or not.
The genetic gluten test, for another example, looks for a genetic pattern, which may or may not have been triggered yet, but is the only definitive answer for if you are gluten sensitive or not as your genes don’t change.
I could make a fortune just doing allergy tests as I get asked all the time. I choose not to because of the likelihood of them being wrong. They do occasionally show useful stuff and the only way for you to know is to cut out the ones that have come up on your test results and see how you feel. Some may be false positives or you may not have developed symptoms yet, but you just don’t know.
That is why so-called ‘elimination and challenge’ is the real gold standard for identifying food intolerances. A pain, but the only way is to remove the foods and challenge the body with them again. The only other definitive test, as I say, is a genetic gluten one, because your gene patterns cannot change. It is just a question of whether the gene problem has been triggered yet – a question of when, not if, though.”
I could indeed make a fortune just saying yes to everyone who asks me to do an allergy test, but I refuse to. It isn’t good enough yet and there are sadly no short cuts to be had, apart from the new genetic gluten one which is really good news for all those people normally forced to be ill whilst they eat gluten for 6-12 weeks to have the (not 100% either) coeliac test.
So, back to the NICE guidelines for children. They recommend that health professionals first attempt to recognise allergy (IgE) and, thank heaven, non IgE mediated allergies that are not acute (as in anaphylactic) and can have a delayed onset. Er, I think that’s what we have been terming ‘intolerances’ for a long while. But, it’s nice to see them officially in the mix.
Health professionals are then directed:
“Correct diagnosis of food allergy, followed by counselling and advice based on valid test results, is important because it will help to reduce the incidence of adverse reactions resulting from true food allergies, and will also help to reduce the unnecessary dietary exclusion of foods that are safe and should be eaten as part of a normal, healthy diet.”
I agree with that but can’t help gritting my teeth at the fact that we so-called ‘alternative’ nutritionists have been doing this for eons. Well done for catching up. We aren’t all in it to make a quick buck and many nutritionists I know will advocate elimination and challenge. We do have to offer alternative tests though and I always think of it a bit like when someone demands an antibiotic from a GP. Sometimes, a piece of paper is all that is going to satisfy, so I go ahead and make sure I give all the caveats. If the test helps, that’s great. If not, I start the elimination and challenge. I would LOVE to be able to make it easier!
One thing I will add is that I notice NICE picked out a few specific alternative tests for comment. They advised against IgG tests like York, for example, but also said:
” Do not use the following alternative diagnostic tests in the diagnosis of food allergy:
- vega test
- applied kinesiology
- hair analysis.”
Two things occur here. First, if we don’t know the physiological allergy mechanisms yet, how can we judge whether a test works or not? They might be great at picking up some stuff for all we know. Not all allergy symptoms show on the surface. We suspect, for example, that gluten can do damage for 20 years or more hidden and then you suddenly find you have an auto-immune disease like alopecia or something.
The other thing is that I have personally used and seen energetic diagnostics (like kinesiology and vega) at work and, in the right hands, it can be very illuminating. Haven’t a clue how it works, but then neither does NICE. Not that I recommend them particularly as a modality, but I don’t rule them out in future.
So, all in all, I agree with the new guidelines but I would like NICE to recommend the use of us experienced health professionals alongside the NHS framework that exists, who are well-versed in this area instead of trying to reinvent the wheel. As they admit in their report, the provision in the NHS for allergy sufferers is woefully inadequate. HELLO – WE ARE HERE!!! Use us!