Non-IgE Mediated Food "Allergies": or “Why can’t your daughter have tortilla chips if she can have Go-Gurt?”

The intersection of a healthy immune response and idiopathological autoimmunity in an environment as complex as the gastrointestinal (GI) tract remains a wild, new frontier for immunologists, clinicians, and patients alike. I’d like to share a brief overview of my foray into atypical food allergies.

Briefly, my daughter, Indigo, was “colicky” as a newborn and infant, only sleeping for 2-3hrs at a time. After a hive-inducing administration of yogurt at 9mo of age, she was tested for a dairy allergy. The lab assayed her blood for IgE against the top eight allergies¹; the result was a positive test for six of those eight allergens. An extended panel testing for IgE to 67 foods returned a positive result for 17 potentially problematic foods, though the test has a high rate of false positives.  


The foods that I ate were broken down and passed to her in breastmilk which is what she was fed exclusively until ~ 5months when solids were introduced.² Baby formula is manufactured from soy and/or dairy components---to which she had significant levels of circulating IgE. There are a handful of “hypoallergenic” elemental formulas that are composed of single amino acids--such as Elecare. These formulas would have cost us ~$1/liquid ounce--~$30/day.

Since breastmilk was her clearly her best option, suddenly an Elimination Diet was the only choice for her—and for me. This is how I found myself eating only turkey, rice, pears, apples, squash, and potatoes for six months³. We were desperate for a solution and desperate for sleep⁴; it was a drastic measure, but it worked. She weaned at 14 months and my diet returned to normal.

In severely allergic children, there is a tendency towards malnutrition and diminished growth due to incomplete absorption in the gut. This was never the case with us; Indigo was always a chunky baby, visibly healthy and sharp. She had some eczema on her cheeks, but it was subtle and transient. From time to time there was traces of blood in her stool, but this didn’t bother the gastroenterologist, because she was “thriving”.

Indigo is now almost five years old and annual tests have shown her IgE titers to have fallen dramatically over time. After a negative blood test for a previously offensive food, we used skin testing, another standard method for detecting IgE-mediated allergies. However, even after these came up negative she would exhibit “Screaming Tummy” (as I’ve dubbed it) when food challenged. This is a delayed reaction (4-5hrs post-exposure) evidenced by stomach pain, crying, and most especially night-waking with hysterical writhing and obvious cramping. The lingering effects include blood in her stool and render her more prone to reactions in subsequent days. 

Skin testing, 18months.

Skin testing, 3 years. Negative control on left shoulder, histamine positive control on right shoulder. These foods all tested negative. 

Allergenic foods no longer elicit hives and edema in Indigo; her symptoms have become strictly GI in nature. She has never tested positive via blood or skin test to corn, but ingestion of corn proteins prevent her from sleeping soundly at this point. It is only these proteins and sesame that are now avoided---miraculously easy compared to where we started.

As we have discussed in class, the body produces allergic reactions to proteins preferentially over sugars. I’ve spent many hours just this month trying to explain this phenomenon to her preschool. Corn is in everything⁵---but thankfully we just need to avoid the protein. As for the Go-Gurt? It contains high fructose corn syrup, modified corn starch, and “natural and artificial flavors”. It likely should not be fed to any children although it is mysteriously found in our fridge. 

As for a diagnosis, her symptoms mostly closely resemble eosinophilic gastritis—abnormally high numbers of eosinophils and excessive mast cell degranulation causes histamine, enzymes, and heparin to be released en masse along the lining of the GI tract resulting in localized cell damage, chronic inflammation, and recruitment of additional eosinophils that continue the cycle. (**Note that this is technically Type I Immunopathology and not true "allergy"!) We’re fortunate enough to have access to the extraordinary Gastrointestinal Eosinophilic Diseases Program –a joint venture between The Children’s Hospital and National Jewish Hospital. In a few weeks we will meet with her specialist again to discuss potential new therapies besides simple avoidance of the foods. 

First chocolate cake, age 4. 

We know that IgE is the usual suspect in allergic reactions. Clearly Indigo was an atopic child with high levels of circulating IgE---a genetic predisposition to this type of reaction. We also know that the composition of lymphocytes in the blood differs from early childhood to adulthood—the neutrophil to lymphocyte and the Th1 to Th2 ratios, for example. Her CBC at 18mo shows her lymphocyte levels below normal, but I have to wonder whether the reference ranges take into account the patient’s age—perhaps someone out there knows…? 

Are there other observations/thoughts/explanations you might have? Do you recall that food allergies are most common in surburban, Caucasian, singlets with microbiologist mothers? 
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1) These “top eight allergens”—peanut, tree nut, milk, egg, wheat, soy, fish, and shellfish--account for ~90% of food allergic reactions and are part of required labeling by the FDA on ingredient lists. You’ll see other iterations of this list (“Top 10” includes sesame and gluten as separate from wheat or include coconut; “Top 7” will lump together fish and shellfish, etc. etc.) http://www.foodallergy.org/section/allergens

2) This is supposed to help protect from food allergies---bathing her intestines in mother’s IgA confers natural, passive immunity. 

3) I eventually added olive oil, sunflower, and Chipotle Tabasco sauce for variety.

4) She did not sleep through the night once until 11 mo. old, intermittently from 1 to 2yrs and then less than a dozen times between age 2 years and 3 years. During that interim period of 1-2yrs, it seems she developed a completely new allergy to corn that was undetected until age 3.

5) The usual suspects include “...Whole corn or maize, popcorn, corn flour, corn starch, corn meal, corn alcohol, corn gluten, corn sweetener, corn sugar, corn syrup and corn oil…Derivatives of corn include: dextrose, dextrin, dextrate, maltodextrin, caramel, malt syrup…Corn starch is added to most confectioner’s sugar and baking powder to keep them from caking or clumping...modified food starch, vegetable gum, or vegetable starch may or may not be derived from corn…(and) other foods that might contain corn (include): distilled white vinegar, bleached white flour, (and) iodized table salt.” 

We’re not through yet: “Corn oil might be used in emollient creams and toothpastes. Corn syrup is often used as a texturizer and carrying agent in cosmetics. Corn may be present in adhesives for envelopes, stamps, and stickers. Plastic wrap, paper cup, and paper plates can be coated with corn oil...Some of the most commonly encountered corn-contain medications include the following: aspirin, throat lozenges, ointments, suppositories, vitamins, laxatives, (and) bath powders contain corn starch. “--summariezed from Joneja, Janice Vickerstaff et al. “Dealing With Food Allergies in Babies and Children”. Bull Publishing Company. Boulder, CO. 2007. ISBN 978-1-633503-05-9