What would you think was the cause?

Posted on: Wed, 07/26/2006 - 10:38am
anonymous's picture
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Joined: 05/28/2009 - 16:42

This is concerning my nonFA son who has food sensitivities (bowel problems after eating too much of certain foods/dyes).

Today he ate some cheddar Goldfish crackers with his lunch, about a child's handful worth. This was at about 11am. If he eats too much, he can 'react' to the annatto in the crackers, so I was careful not to give him too much. (Although, sometimes it's hard to tell how much is too much until it's too late. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] )

Then, around 1:30pm, he asked me if he could have some candy. He had about half a serving size of Wild Berry Skittles. Skittles have Blue No. 1 in them (which causes him trouble), so, again, I made sure he didn't eat too much.

**Please note: He ate these same things yesterday with no trouble.

Now, at about 2-2:30pm, he went to the bathroom with diarrhea.

At 3pm, he threw up.

No fever, no sign of any illness before these things.

Would you think it was from the Skittles, or the Goldfish, or maybe both? Or something else entirely?

His 'reactions' can come on after a few days' build-up in his system. For example, he can't have chocolate too many days in a row.

Another question: Should I consider that his sensitivities may be growing into full-blown allergies? That was my first thought at 3:00 today, but there were no other signs of an allergic reaction.

Sorry this was soooo long!

Thanks for any opinions.

Posted on: Wed, 07/26/2006 - 1:26pm
luvmyboys's picture
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Joined: 05/25/2006 - 09:00

Lam, I am curious how you pinpointed the source of the problem? I go through various phases of various sensitivity to (I think) wheat. But for some reason I had a time during my last pregnancy where 1 goldfish, or 1 piece of pasta or 1 tyson chicken nugget would make me cramp up and give me a horrible stomach ache. You would think then that a piece of whole wheat bread would incapacitate me, but it seemed no worse than 1 goldfish! And yet it comes and goes...Right now I could probably eat a bowlful with little problem. Has this been going on for a while? Are there any headaches with the symptoms as often these things tend to go along with migraines.
Luvmyboys

Posted on: Wed, 07/26/2006 - 1:31pm
milosmom's picture
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Joined: 05/30/2006 - 09:00

You might have already done this but Have you had him tested by your allergist lately?
Also, I don't know where you live but I'm wondering if there isn't a bug going around here (Nor Cal) Monday night Miles threw up in the middle of the night and has been fussy and had diahrrea yesterday and today. (not related to the question I posted earlier regarding the bagel as that was a while ago). I thought it might be a delayed reaction to the MMR (as he has some spots right now that look like pimples) but last night his babysitter threw up as well so I wonder.... Are any of your son's friends sick?

Posted on: Thu, 07/27/2006 - 2:54am
anonymous's picture
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Joined: 05/28/2009 - 16:42

luvmyboys -
Process of elimination. We suspected different things, then went to our allergist. She tested for the things that COULD be tested for, but the rest were up to us.
All the things we've figured out are: chocolate, paprika, cinnamon, annatto, blue no. 1, whole wheat and soy. He has gotten better with soy.
There are no other symptoms that we're aware of. He's only 7, and has a very high pain tolerance. He may not realize he's having a headache.
Have you thought of the "build-up" effect as being an explanation for the coming and going?
milosmom -
Yes, we had him tested for the things we suspected that COULD be tested for. Unfortunately, most of them couldn't be tested, so we had to figure them out by process of elimination.
No, no one has been ill recently.
Lam [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
[This message has been edited by Lam (edited July 27, 2006).]

Posted on: Thu, 07/27/2006 - 7:09am
LisaM's picture
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Joined: 11/04/2005 - 09:00

I've had very few reactions just involving the gut (have had one, though. I am anaphylactic to egg--usual response as a child to *small* amounts of egg...I mean, really small amounts was hives in the throat + projectile vomiting + my mom said that I would just look odd . . .my eyes would look a bit glassy.. she can't really explain it. in 1985 my mom fed me egg to see if I was still allergic (*not* a good idea, I know). I seemed fine so I kept on eating . . . until I had severe, severe stomach cramps that lasted the better part of the day. Haven't had *any* egg since 1985 so I really don't know how I would react. I do react severely on the scratch test---I consider myself to be anaphylactic to egg. My point here is just that GI reactions can mean a severe allergy rather than an intolerance . . . but then again, as you note, GI reactions could point to intolerance.
As for the issue of overloading the system with allergens . . . well, the official word on that is if you're allergic to something (as opposed to having an intolerance) you should avoid it 100%. But I react to so many things . . . when I was a kid I'd eat some things if I could sometimes tolerate a little. My tolerance levels would vary. I always thought of certain allergies as being in a different category than others . . . but I know that's not the way we're supposed to think of reactions to food involving the immune system.
In my personal opinion, following the selective avoidance route might be okay with some people . . . but it can be dangerous too. For instance, the first allergist I went to see when I moved to Toronto practically yelled at me when I reported having a reaction to banana (I wouldn't have even mentioned it except for he asked about recent reactions). He said he couldn't understand me. Why would I deliberately go and eat something that I was allergic to? That's how people like me end up dying, he said. But I really didn't know that I was *supposed* to avoid banana. I considered it a mild allergy (made my throat and mouth itchy . . but I could usually have up to 1/3 of a banana without reacting although it varied). We had never discussed how to manage food allergies . . . I guess he just assumed that I knew what I was doing. But people who are allergic to banana can go into anaphylactic shock . . .
So while it sounds like you have a good handle on the food intolerances . . . from my experience, I'd say that it might be good to err on the side of caution for awhile just in case and then reintroduce the offending foods gradually to see if there is a reaction. If you are certain that it is a food intolerance, there is probably less of a cause for concern, but if it is an allergy then I think caution is needed. (I've heard that people can be allergic to annato . . . I would guess that reactions to dyes are generally intolerances.)

Posted on: Thu, 07/27/2006 - 9:06pm
rebekahc's picture
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Joined: 12/02/1999 - 09:00

DD has a long list of food intolerances (there is a new blood test available for this including many additives/chemicals - e-mail me privately if you want more info). Her treatment was done in phases - basically like a highly specialized elimination diet. The maintenance part of the regimen is basically a rotation diet. She is able to have some things she is intolerant to, but only every third day.
I would guess your son was probably reacting to the build up in his system - hopefully it's not becoming a full blown allergy.
Rebekah

Posted on: Fri, 07/28/2006 - 3:50am
anonymous's picture
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Joined: 05/28/2009 - 16:42

Just to let you all know...
My son has shown no other signs of illness or allergic reaction since Wednesday.
Thank you for all your thoughts. I have decided it must have been an allergic-type reaction, brought on by too much of the offending substance (build-up). I plan to discuss this with our allergist next time we're in. If she says anything different, I'll try to post it here.
Thank you again for helping me with this.
Lam [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Tue, 09/19/2006 - 10:06pm
anonymous's picture
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Joined: 05/28/2009 - 16:42

Hi, Everyone!
Met with our allergist yesterday, asking her questions concerning the things I've posted in this thread.
She ordered a RAST and IgE test for most of the offending foods, but some are not "RASTable" (my word [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img] ).
Her opinion is that he is not having an allergic reaction. She's thinking more along the lines of intolerance, immature system, etc... I'm not sure I agree with her after reading the things that have been posted here about GI allergic reactions.
She ordered the RAST just to make sure it's not an allergy. If it turns out that it IS an allergy, it could get worse (as we all know), and we should start avoiding the foods.
I'll post the results if they show anything interesting.

Posted on: Tue, 09/19/2006 - 11:28pm
mommyofmatt's picture
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Joined: 03/12/2004 - 09:00

We're testing my ds (no known food allergies) throuh a GI at this point.
He seems to have food sensitivites which aggravate his reflux. Unfortunately, we're doing an endoscopy to look for any IGA mediated allergies (among other things)that do not show up on traditional allergy tests of RASTS and skin. His traditional tests were all negative.
From what I've read so far, if an allergic reaction is a delayed one, it could be IGA mediated, and would not show up through traditional testing. Some people also seem to do patch testing where the allergen is placed on skin and then taped over and left there for a few days to see if there's reaction.
I'm just sort of beginning my research in this fun-filled new area for me, so hopefully what I'm saying is correct. Feel free to jump in anyone if I've got this wrong...just thought I'd mention it in case it's something you want to look into.
Good luck! Meg
[This message has been edited by mommyofmatt (edited September 20, 2006).]

Posted on: Wed, 09/20/2006 - 12:17am
Greenlady's picture
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Joined: 06/30/2004 - 09:00

Thanks for sharing your experiences - it's one of the best things about these boards.
I remember reading in a transcript of Dr. Robert Woods' presentation to the FDA about "non-IgE mediated food allergies", which might just be another term for intolerances, but it sounded a lot like the symptoms you were describing. I'll see if I can find his discussion and post it here.

Posted on: Wed, 09/20/2006 - 12:42am
Greenlady's picture
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From Dr. Woods' lecture (page 34 - 41). Not much practical help, but it may give some more background and terms to search on:
DR. WOOD: Now, the last category that I want to mention is something that we will lump together as gastrointestinal food hypersensitivity.
There are a variety of conditions that fall under this umbrella.
There are some that are in the immediate
hypersensitivity category. This would be part, say, of an anaphylactic reaction where someone ate food, broke out in hives, had vomiting, diarrhea, abdominal pain, or other gastrointestinal symptoms.
There is another condition called "oral
allergy syndrome" where patients have reactions that are confined to their mouth or throat or lips, particularly related to fresh fruits and vegetables.
There is another group of conditions that
are lumped under a category of eosinophilic disorders of the GI tract. There is a specific condition, eosinophilic esophagitis, where only the esophagus is involved. As most people in the audience know, the eosinophil is a type of white blood cell that is most affiliated with allergic reactions.
If you take someone who is having a bad hay fever day outside today and look at their nasal secretions, their nasal secretions will be loaded with eosinophils. If you take someone that is having difficult asthma, their bronchial mucosa will be loaded with eosinophils.
By the same token, if you have allergic eosinophilic esophagitis, the lining of your
esophagus is loaded with eosinophils. It may be isolated to the stomach, it may be more diffuse where we would call it "allergic eosinophilic gastroenteritis." This is somebody who may have disease anywhere in their GI tract, and oftentimes very diffusely.
There are some other conditions, enterocolitis syndrome and dietary protein
proctitis, that are much more common in very young babies.
The importance of presenting these different syndromes here is that some of these syndromes are IgE mediated and some of them are not IgE mediated, some of them are very acute and some of them are very chronic.
It turns out that those syndromes that are more chronic and low-grade that don't present with any acute symptoms, don't present with any clear cause and effect of eating the food and having increased gastrointestinal symptoms are going to be, potentially, the most difficult for this Committee to grasp. That is because these patients are often reacting to remarkably small exposures.
I will come back at the end to sort of
give a couple of examples of the dilemma that kind of patient is going to present to us as we really try to figure out what is safe and what is not safe.
It also turns out in the same vein that the non-IgE conditions in general are probably going to be most difficult to deal with, both because they often don't have the acute IgE-type symptoms, and because they are predominantly mediated by a different part of your immune system that can recognize even smaller degrees of these food proteins that identifying thresholds are going to be much more difficult.
(Slide.)
DR. WOOD: Now, when we are trying to approach a patient with a food allergy, one of the real difficulties is making an accurate diagnosis.
The diagnosis, as in most everything we do, begins with a history, talking about the foods they suspect are causing problems, whether we think the symptoms are consistent with food allergy, whether
this is something that may not be food allergy at all, or whether it may be a food intolerance rather than an allergy. We are going to be interested in the timing of the symptoms and the reproducibility of reactions.
It turns out that when you do a very careful history, most of the time it is wrong. It will be correct in the acute reactions, where you have a patient who comes in and says, "I fed him scrambled had hives all over." "She took her first bite of peanut butter, and developed hives within 2 minutes."
It is very likely that the history will be
born out when you do further testing. However, when you look at the bulk of patients with food allergies, many of them will have these more chronic conditions like eczema or the gastrointestinal disorders. When you are looking at those patients, you will only verify the history when you do further testing about a third of the time.
(Slide.)
DR. WOOD: The next set of tests we do after taking a history would typically either be skin testing or serologic testing. A RAST test, "radioallergosorbent test," is the most common serologic test that is used.
These tests have some value and they also have some problems. The problems they have is that there is a relatively high rate of false-positive tests. They do not have a terribly good positivepredictive accuracy.
They are generally accurate when they are
negative. Although, they will only be active when they are negative when you are convinced this patient has an IgE-mediated condition, because both of these tests rely on the presence of IgE antibodies to identify the specific food allergy.
An example would be if a patient develops
hives or anaphylaxis, which typically are
IgE-mediated, and they suspect that it is a certain food. If you get a positive test back, it is verylikely that they have that allergy. If you get a negative test back, then you need to keep looking.
It was not likely that food that caused that
reaction.
However, if you have a patient with something like the allergic eosinophilic gastroenteritis where there may not always be IgE antibodies, you cannot stop with a negative test and say, "We've proven you don't have food allergy." That is something that happens all the time, but it is often going to lead to a misdiagnosis and mismanagement of that patient.
The bottom line is that we need to carefully interpret our tests in the context of the overall clinical picture, and that we need to rely on oral challenge tests as the more accurate tests, so that we will say that they are not completely definitive. They are more definitive but not completely definitive.
Again, they are going to be less definitive in the patients that have more delayed type reactions or more chronic conditions where they won't react in that four-hour observation period of your food challenge.
Here's the link to the whole transcript:
[url="http://www.fda.gov/ohrms/dockets/ac/05/transcripts/2005-4160t1.doc"]http://www.fda.gov/ohrms/dockets/ac/05/transcripts/2005-4160t1.doc[/url]

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