339: How Sensitive Are You?: Best Test For Food Allergy (IgE) Sensitivity w/ Dr. David Fitzhugh

The Healthy Skin Show

If you’ve ever wondered the best way to test for food allergy sensitivity, this episode is for you!
What do I mean by food allergy sensitivity?
Many people think that you’re either allergic (and thus highly reactive) to specific foods or you’re not. And that’s not actually true as there’s a scale of reactivity or sensitivity that you could be on for IgE food allergies.
Making this even more complex is that your level of reactivity can change with time (this is especially true for children) which is why today’s episode is so important!
Food allergy testing isn’t perfect and can sometimes show false positives. Unfortunately, many practitioners (including many in the functional or integrative space) may recommend unnecessary elimination of foods that came back as a positive IgE reaction yet lacked any real-life reactivity.
Though it might seem harmless, it deserves to be repeated that unnecessary food eliminations can potentially lead to IgE food allergy reactivity if left out of your diet for too long.
Throw in chronic skin rashes like eczema, which increase the risk of food allergy (especially in children), and the question of what food is safe becomes increasingly confusing.
That’s why I wanted to bring in a food allergy immunotherapy specialist to talk about this important topic.
So if you’re wondering if skin tests are the gold standard, whether blood tests are accurate, and what the pros and cons are when trying oral food challenges or subcutaneous allergy shots, tune in to this fascinating episode with my guest, Dr. David Fitzhugh.
Dr. Fitzhugh is an allergist/immunologist in private practice in Chapel Hill, North Carolina.
He specializes in food immunotherapy for children and adults with severe food allergies but treats a wide variety of allergic and immunologic conditions, including allergic rhinitis, asthma, atopic dermatitis, mast cell disorders, and anaphylaxis.
In This Episode:

• Options that test for food allergy
• Can positive serum IgE blood tests be wrong?
• Food sensitivity vs food allergy
• Benefits of doing oral food challenges
• What is more likely to trigger a reaction like food allergy hives: subcutaneous allergy shots or oral food challenges?
• Is it possible to tolerate (to some degree) something you’re allergic to?
• Oral food challenges dos and don’ts
• How to reduce your food allergy reactivity
• Sublingual versus oral immunotherapy
• Thoughts on elimination diets and food allergies

Quotes

“In our field, we consider someone sensitized who's test-positive to an IgE test. That could be a skin test or a blood test. So you are sensitized. But if you're test-positive and you eat the food routinely with no issue, you're not allergic, right? Allergic means a clinical syndrome of having an allergic reaction. And where we see this most commonly is the eczema kids.”
“...every allergist in North America is doing subcutaneous allergy shots. These are the typical allergy shots to desensitize people against hay fever, grass pollen, dust mite, et cetera. And we see a decent rate of really serious reactions that occur with those. And so every allergist needs to be prepared to manage an allergy shot reaction, sometimes requiring multiple rounds of epinephrine, IV fluid. Those don't happen commonly, but they do happen. But yet the dichotomy is, there's in many ways a reluctance to do oral food challenge because parents and/or providers are worried about the possibility of reaction. And the thing is with carefully selected food challenges, we have the luxury of knowing where most kids will tolerate, following the blood test to the skin test.”
Links
Find Dr. Fitzhugh online