Is gluten evil?

November 23rd, 2011

The answer is clearly NOT the same for everyone!
First, what is gluten? This naturally-occurring protein is abundant in wheat, oats, rye, barley and a few other grains that most Americans consume regularly. As such, “gluten sensitivity” is a distinct phenomenon from wheat allergy. True food allergy has an immunologic basis and yields demonstrable food-specific allergic antibodies (IgE) via skin prick or APPROPRIATE blood tests (not all blood tests are equal–talk with your doctor before you decide how to proceed). In contrast, gluten sensitivity or celiac disease does not involve allergic antibodies. Typical manifestations of celiac disease include abdominal pain, cramping, diarrhea, failure to thrive in children, unintended weight loss in adults, and sometimes a distinct rash called dermatitis herpetiformis. Gluten sensitivity (not a true allergy) does NOT produce hives, respiratory symptoms, or systemic reactions (anaphylaxis). It is true that many symptoms of gluten sensitivity and food allergy overlap, i.e. nausea, abdominal pain, cramping, diarrhea, and bloating. For this reason, allergy testing to wheat, oats and other grains is sometimes useful. The gold standard test used to diagnose celiac disease is a small bowel biopsy (not easy to get), though serologies (blood test for anti-tissue transglutaminase and anti-endomysial antibodies) can also be suggestive of presence or absence of the disease.
Many patients have negative testing for celiac disease and food allergy but clearly feel better when they avoid large amounts of gluten. To what can we attribute this frequent observation? Well, food intolerance or “sensitivity” exists in many other forms as well, and we are certainly allowed to have gluten sensitivity without true celiac disease. I have also observed that individuals who are vigilant enough to limit or exclude gluten from their diet tend to observe other healthy habits that may impact their well being: better dietary choices, increase level of activity, and avoidance of other environmental exposures that may negatively impact their health (i.e. tobacco, allergens, irritants, and infections).
If you are concerned about gluten sensitivity or celiac disease, start with talking to your physician to decide whether additional testing is appropriate.
Kevin Parks MD

Egg allergy and influenza vaccine

November 23rd, 2011

New data have emerged regarding egg allergy and the flu shot. The influenza vaccine contains a small amount of ovalbumin (egg protein), which has always been the basis for concern in administering the flu vaccine to egg-allergic individuals. However, recent assays (lab tests) have been more precise in quantifying the actual amount of egg protein in each of the currently available vaccines, which is very small. As such, the risk of an allergic reaction for a person with egg allergy is smaller than previously estimated. The revised vaccine guidelines now recommend that, if a person experienced hives ONLY with egg exposures (i.e. eating eggs), the flu shot can appropriately be administered in the primary care setting (pediatrician, family doctor, etc.). If the reaction was anaphylaxis, the vaccine should be administered in an allergist’s office. We no longer recommend skin testing to the vaccine in most cases.
Kevin Parks MD

Medication Allergies

November 18th, 2011

Many patients and referring providers have questions about reactions to medications… a rash, a headache, a twitchy eyebrow–what is an allergic reaction to a medication??
The term “allergy” is used colloquially to describe an adverse reaction. Such a reaction may, in fact, be predictable based on the pharmacologic action of the drug (i.e. lightheadedness if a blood pressure medication is lowering blood pressure too much);may be a known possible side effect (i.e. constipation due to a narcotic pain medication); or may be idiosyncratic (i.e. a headache due to an allergy nose spray). However, true allergic reactions to medications have an immunologic basis and cause symptoms that are consistent with an immunologic process. The classic example is penicillin allergy causing hives, though many other forms of allergic drug reactions can occur–possibly involving every organ system from skin to lungs to nephritis or pancreatitis.
Most drug reactions/allergies are diagnosed based on history–the course of events that occurs after taking the medication. Sometimes blood tests or other diagnostic information surrounding the reaction are helpful in making the diagnosis. We are able to test for a LIMITED number of medications via skin/blood tests for true immunologically-mediated reactions. We sometimes employ other diagnostic or treatment procedures to better determine whether a medication is safe to take. These procedures include GRADED DRUG CHALLENGES or DRUG DESENSITIZATION. We can only determine whether testing is necessary or possible after reviewing the history, medical records, and need for possible future treatment with the drug in question.

Kevin Parks MD