There are loads of different allergy-related conditions officially and unofficially-recognised! In this section, I will try and put any I come across for you in case you need help identifying something unusual – apart from the usual allergy (IgE) and food intolerance (non IgE) types.
Histamine Intolerance
By rights, this should really be termed histamine excess as that’s what it actually is. I have come across this more and more recently. In many, it is caused by not having enough of the required enzymes like DAO (diamine oxidase) to break histamine down in the body, but it can be a lot more complex than that.
I have written a Histamine factsheet for you which will take you through what HIT is, how to test and I’ve given treatment protocols for you too.
You can test for histamine blood levels and DAO enzyme levels if you need to here.
Histamine testing is far from perfect yet but we can at least see what level of histamine you have in your system and if you have enough of the DAO enzyme needed to break it down.
MCAS (Mast Cell Activation Syndrome)
This is where the body is simply producing far too many mast cell responses to things that should be safe. It’s complex. One of the best resources I have seen on it is is from Dr Myhill here. She gives you a good overview of treatment options – the things you need to start investigating to break the cycle. Personally, I would always start with the gut (check the DD CSAP3 and SIBO) and lowering histamine mediators (see my page here).
FPIES – Food Protein Induced Enterocolitis Syndrome
Affects babies and under 3s mostly.
Symptoms include vomiting and sometimes diarrhoea after food starting usually under 6 months and/or floppyness, lethargy and failure to thrive as toddlers.
Often misdiagnosed as not food-related because nothing shows up on IgE allergy testing. Sometimes wrongly thought to be an infection of some kind.
No official diagnostic tests available so food elimination is done if suspected. Most commonly dairy and soya (from formula usually), then rice and oat solids, although other foods involved.
Usually ‘grow out of it’ by three.
More information:
A more recent FM article from a Mum describing what happened to her child
Oral Allergy Syndrome
More accurately termed ‘pollen-food syndrome’ by some experts. The body becomes sensitised to pollen and then develops an allergy to foods that have a similar protein structure. Often starts with hayfever development in chidren and teens.
Most common symptom is a tingling or itchy feeling in the mouth after eating raw fruit and veg. Also include itching, swelling or redness of the mouth, lips, gums, tongue or throat, itchy ears, rhinitis, conjunctivitis and hoarseness. The uvula, the dangly bit at the back of your throat, can swell, as can your oesophagus, pharynx or windpipe.
They can come on immediately after eating or, for the most sensitive, touching or inhaling usually raw fruit and vegetables, spices, herbs, nuts and seeds. Worse in pollen seasons, all year round.
Confirmed by diet analysis (related pollen families) and possible skin prick testing.
More information:
An article I wrote about it: Oral Allergy Syndrome
Eosinophilic Disorders
There are several eosinophilic disorders, all of which relate to raised eosinophils and inflammation in the body site where they are found. It can occur in babies right into adulthood, most children being diagnosed by about five.
Effectively, you can get high eosinophils in the digestive tract or system-wide. Wherever they are high, you are likley to get inflammation, pain and/or swelling plus the usual gamut of allergic reactions. It is basically an inflammatory delayed hypersensitivity food reaction it seems.
Gastrointestinally-speaking, you can have raised eosinophils in:
the oesophagus (eosinophilic oesophagitis)
the stomach – (eosinophilic gastritis)
the small intestine (eosinophilic gastroenteritis)
the colon (eosinophilic colitis)
Plus, you can have more systemic problems where eosinophils are raised in the blood generally (the most advanced is hyper-eosinophilic disorder) which can then cause inflammation anywhere in the body and, from the way I interpret it, so far the following disorders have been identified and named:
Churg Strauss Syndrome which appears to be high eosinophils in the blood causing problems mainly in the lungs (asthma), sinuses and nerves.
Eosinophilic fasciitis a thickening, swelling, hardening and pitting of the connective tissue under the skin leaving it looking orange-peely – and possibly joint/nerve pain.
Eosinophilic Pneumonia which affects the breathing, lungs, apparently can be acute and sudden or can come on over a few months with a cough, low grade fevers, progressive shortness of breath, weight loss, wheezing, fatigue and night sweats.
Eosinophilic Cystitis inflammation in the bladder, frequent bladder ‘infections’, needing to go etc.
Testing includes biopsy findings and case history, possible trial of steroid therapy. The path lab looks for a high number of eosinophils, where they are (are they in the wrong places?), changes in the tissue layers (damage done, infiltration of them into tissue layers), and degranulation (spilling of the contents of the eosinophils which suggests they are active).
Apparently, not all labs really understand the process so it is worth finding a consultant/path lab who have dealt with EGIDs before. It’s important to note that, from what I read, high eosinophil counts don’t always happen; it is more about what they are up to than how many there are and I read some reports of people being given a negative result simply based on eosinophil numbers.
Treatment is the same as any food sensitivity disorder. It is an inflammatory reaction to an allergen that has to be identified, removed and/or suppressed (steroids, anti-histamines etc as per). My own view is that is probably has some auto-immune component too so treatment should also be looking at that and I believe immuno-suppressant therapy is becoming quite common now.
More information…
Apfed in the US
FoodsMatter has some goods stuff on it too – the latest about helminth therapy for EGIDs – just put eosinophil in the search box.
Here is the International consensus on diagnosis and treatment document which is really useful too.
New treatment guidelines for eosinophilic oesophagitis (EE)
Nice overview from a Mum with EGID diagnosed children and who runs a very useful blog to help you.
Food-Dependent Exercise-Induced Anaphylaxis
FDEIA is quite rare but it does happen. It basically means someone who reacts when they have eaten a food they are sensitive to and then exercises within 3-4 hours after eating it. If the person eats the food and doesn’t exercise, in this condition at least, the reaction doesn’t occur.
It’s a variation on normal exercise-induced anaphylaxis and it can occur in some people after eating any meal rather than a specific food. It is an IgE type allergy so is often diagnosed with skin prick and igE antibody tests.
It seems to be more prevalent in women than men and in the 25-35 age group, especially amongst those with asthma or other allergies already.
More information…
There’s a good article here from Dr Joneja to start you off.