What are allergies and food intolerances?
Foods provoke adverse reactions that we can divide into two large groups: allergic reactions mediated by the immune system that recognizes something as innocuous as innocuous as food, and non-allergic, non-immunological reactions, also identified as intolerances.. The first, in turn, are divided depending on the mechanism by which they occur in reactions mediated by immunoglobulin Ig, which is what is popularly known as food allergy. Other immunological reactions not mediated by this immunoglobulin, fundamentally the most important being the most known disease that is Celiac disease, and other more infrequent entities such as esophagitis or eosinophilic gastroenteritis.. Faced with all these processes of immunological origin, we have non-immunological, non-allergic processes, fundamentally associated with a metabolic cause, usually due to a deficiency or malfunction of certain enzymes that cause an incorrect absorption of certain sugars. Fundamentally we have in this regard to lactose intolerances and fructose intolerances. There are other tables of uncertain mechanism, especially problems of intolerance to marine foods, particularly bivalves. And then, finally some pictures of pharmacological mechanism by substances that the food releases directly or that include in its own composition, as it can be especially Histamine. Each of these entities has a different diagnostic and therapeutic approach.
How can they be diagnosed?
First of all, the most important thing in the diagnosis of an allergy or food intolerance is a correct medical history. Depending on the suspicion of that history the diagnostic study will be different in each case. Food allergies are diagnosed primarily with skin tests, if necessary also allergy analysis and in many patients the so-called provocation or exposure tests. Sometimes the exclusion and controlled reintroduction diets are also useful. In patients with suspected Celiac disease, we have an analysis and, in many cases, it is necessary to refer the gastroenterologist to make the diagnosis through an intestinal biopsy.. The non-allergic, enzymatic mechanism tables are mainly made by exhaled breath determinations, breath tests, which will give us a very accurate and reliable information. I want to warn that all these panels of analysis of alleged food intolerances, do not have any type of diagnostic validation, do not have any kind of real clinical use. No type of academy or scientific society, both allergology, digestive or endocrinology endorse them anywhere in the world.
What does your treatment consist of?
The treatment in general in all the processes of allergy or intolerance, once we have achieved a correct diagnosis, is fundamentally the avoidance of that food that causes us the clinical problem. Obviously this sometimes conditions very restricted diets where it is very important the adequate support by specialists, collaborators in our group, nutritionists, who can advise which are the most appropriate personalized diets taking into account these restrictions. It is also very important to avoid those food traces of those allergens, those foods that can create clinical problems and in that sense it is important to detect which are the brands or manufacturers that we can use for certain allergic or intolerance processes. When we have already established the clinical problem, allergic reactions that can cause food can be adequately controlled with treatments with corticosteroid antihistamines and in some cases of severe reactions autoinjectables adrenaline that the allergist will prescribe. In cases of intolerance, treatments with probiotics in lactose intolerances and even fructose intolerance can be of great clinical utility in support of avoidance measures, to exclusion diets.