Supporting and referring patients with food allergy and adverse food reactions
Leena Padhye, MD
Leena Padhye, MDAllergist

Supporting and referring patients with food allergy and adverse food reactions

Published on April 10, 2024

This article is intended to support your clinical encounters with food allergies as a PCP, dietitian or other non-allergy specialist.

By: Dr. Leena Padhye

Recent epidemiological estimates suggest up to 10% of the U.S. population has a food allergy. IgE-mediated food allergy is a serious, potentially life-threatening form of adverse food reaction that can lead to anaphylaxis. In addition to IgE-mediated food allergy, other types of food-related reactions include:  GI-mediated food allergy (e.g. FPIES), autoimmune food conditions (e.g. Celiac disease), food intolerances (e.g. lactose intolerance), and many other types of adverse food reactions and sensitivities.

Symptoms of various food-related allergies or intolerances can overlap and finding the etiology and subsequent treatment plan can be frustrating for both patients and their care teams. Dealing with a known or unknown food-related condition can have a tremendous impact on a patient’s wellbeing. Primary care physicians and providers are often the first and recurrent stop for patients who are looking for support and answers. 

As an allergist, I welcome the opportunity to help any patient suffering from a food-related health issue. However, given the often longer-than-ideal appointment wait times and uncertainty regarding the ideal action or referral plan, primary care physicians are often ideally situated to provide initial recommendations for patients.  

While patients are waiting to see a specialist or in the process of better understanding their symptoms, collecting information in a food journal can be particularly helpful. Important parameters to log include:  foods/ingredients eaten, time of food intake, adverse symptoms, and timing of adverse symptoms. When we look at these diaries over several months, helpful patterns or culprit foods may be identified. If a patient may suspect a specific food, removing that food from the diet and then reassessing symptoms can also provide important clues.

There are many tools to help with food journals and food avoidances, from handwritten notes to various online platforms. Of course, the hardest part can often be truly removing the food from the diet and avoiding hidden ingredients. The Fig app has been particularly helpful for many of my patients who are figuring out possible culprit ingredients and assessing their health off of certain foods. (Full disclosure, I am a Medical Advisor to Fig)

Many patients have been suffering for years and are desperate for answers that lead to improved health. Generally speaking, specific foods are tested (via skin or serum) or avoided based on hints in a detailed clinical history. However, we generally discourage the use of serum food panel testing due to both patient cost and its limited clinical utility. Further, serum component testing for IgE-mediated allergy is rapidly advancing and allergists may have to repeat or order different blood work, adding to discomfort and cost. Sometimes, the allergist may not be the last stop in a food health journey. We may recommend evaluation by our dietician, gastroenterology and/or rheumatology colleagues. Additionally, not all types of adverse food reactions have reliable clinical tests at this time – but we hope that continued innovation will make that possible in the years to come. 

Living with food allergies and sensitivities can be immensely challenging. With clinical care team support, diagnostic advances, and treatment innovations, we hope patients will live with less confusion and a better quality of life.

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