FCAAIA Notes: There is still a great deal of debate about the best way to treat eosinophilic esophagitis (EoE). I believe that debate will continue because one size does not fit all.
When an individual food or a limited number of foods are identified as triggers, the avoidance diet might be sufficient. For others, nothing but extreme dietary intervention (few or no solids and an amino acid based formula) is very useful. That is an unpleasant and impractical alternative. Topical esophageal steroids (e.g., steroid inhalers or nebulizer medications that are swallowed, not inhaled) are the first choice of medications for EoE.
So what foods to eliminate when trying? I think there are several reasonable approaches Continue reading “FOOD ELIMINATION DIETS ARE EFFECTIVE FOR LONG-TERM TREATMENT OF ADULTS WITH EOSINOPHILIC OESOPHAGITIS”
FCAAIA Notes: So here’s that “is it gluten or something else” discussion again. We have discussed that many people who label themselves gluten sensitive are in fact not. Of course, some people have Celiac Disease and I (but not everyone) believe that some patients have an actual non-celiac gluten enteropathy (abdominal symptoms with gluten, but not Celiac Disease).
This report raises the possibility that some of those patients don’t have an issue with gluten but with another component of wheat, fructan.
Fructan is a fermentable sugar and one of the foods eliminated in a FODMAP Continue reading “FRUCTAN, NOT GLUTEN, MAY BE THE REAL CULPRIT FOR MANY AN UPSET STOMACH”
FCAAIA Notes: It is quite clear that for infants who tolerate peanut products, early and regular introduction (before 1 year old) decreases the likelihood of peanut allergy by 80%. When the LEAP study data were published a few years ago, it caused a 180º reversal of our previous recommendations.
Old habits die hard, however. Some pediatricians are still hesitant to recommend early introduction even to their healthy 4-6 month old patients. Patients with moderate to severe atopic dermatitis and/or egg allergy are considered “high risk” for developing peanut allergy (based on the entry criteria of the study) and should be evaluated by an allergist before Continue reading “PEDIATRICIANS NOT EMBRACING NEW PEANUT GUIDELINES”
FCAAIA Notes: Well, it becomes clear that nothing is necessarily 100% safe. Four food groups (peanut, tree nuts, fish, and shellfish) account for most new-onset immediate-type food allergies. It is increasingly clear however that other plant foods are becoming more common allergens. Many patients with allergic reactions to fruits or vegetables are also allergic to pollens that have immunologic cross-reactivity to botanically related foods. Most of those (but not all!) can tolerate the fruits and veggies only if they are cooked. Continue reading “THE RISE OF ANAPHYLAXIS TO PLANT FOODS”