Hi there, my name is Dr. Chet Tharpe and I’m a board certified allergist in South Carolina. Today I was on the Facebook group, Parents of Children with Multiple Food Allergies and I came across a post by a mother, who reports that her son has been complaining of stomach aches every so often. So after discussing these stomachaches with their pediatrician, a blood allergy test was done and he was told that there were many things that he was “slightly allergic” to and that he should stop eating these foods immediately. The mother reports that she’s just puzzled because a lot of these foods he eats without any symptoms at all but now she’s being told by the medical provider to stop these foods altogether. So she’s wondering if anyone from the group has a similar experience.
Unfortunately, this is an extremely common scenario that I encounter in my clinic where a patient or the parent of a patient will come in with allergy tests that they had done for symptoms such as stomach aches or rashes. As a result of the test results, they were told that they need to stop foods that showed an elevated level. Or if they weren’t told to stop them, they stopped them on their own for concerns that they were allergic and possibly doing more harm than good.
And in many of these instances, they start avoiding several foods and come to the clinic frustrated, upset and fearful. They just don’t know what to eat or what to feed their child and are very scared of this newly diagnosed allergy. Some parents are very remorseful that they’ve been feeding their kids food they’ve been allergic to for years and are concerned they’ve harmed their immune system. It’s altogether a really unfortunate situation that as an allergist is all too common. I see it regularly.
So what does this mean? Well, let’s first talk about the testing. We’ve talked about this before on my video blogs where an positive allergy test by itself without any knowledge of a reaction to the positive allergen and in this case food, tells you no more than the fact that you are “sensitized” and is called “sensitization.” Sensitization just tells you the test is positive. It does not tell you that you are allergic.
So then, what defines an allergy? Well, the true definition of an allergy is history of a reaction to a food or foods confirmed by testing which is usually a positive blood test or a positive skin test. Positive testing or sensitization alone does not mean that your child is allergic. The problem with allergy testing is that there are a lot of false positives results. This basically means that you are sensitized but you do not have any symptoms when you consume the food and are thus not allergic. Food allergy tests are really accurate if they’re negative although, not 100%. But for the most part, if the test is negative, your child is not allergic. However, if the test is positive without a known history of symptoms, the chances that you are truly allergic is closer to a coin flip in most cases.
So in this situation, we have a child with intermittent stomach aches but are not made aware of any other symptoms. We don’t hear about any of the typical allergy symptoms like itching, swelling, rash, wheezing, shortness of breath, or vomiting that should occur within minutes to a few hours after a food you are allergic to is ingested.
Now, the typical allergy testing that is done is what’s called an IgE test and I’m guessing that’s what this child had done. What’s interesting, is that stomach aches by themselves are typically not the result of an IgE or allergic reaction.. Again, an IgE or allergic symptoms are going to typically include symptoms such as itching, rash, swelling, wheezing, or vomiting that should occur within minutes to maybe a few hours of consumption of the food. And, it’s going to occur every single time that you consume that food.
So that would be a food allergy. But stomach aches by themselves are not explained by IgE testing. So what does that mean? Does that mean you have to avoid the food? Well, in this case no as these symptoms are not life threatening and again do not match up with the tests being done.
So are these test results worthless? Actually some allergists would say that they are and they are not helpful.
However, I wouldn’t go as far as to say that they are not helpful. But, I would use the results with caution and go back to the history of symptoms to see if we can make a little more sense of the results. I would definitely not tell you to start avoiding these foods immediately as we have already declared that you are not feeding your child something that they are allergic to and that IgE blood results are often falsely positive. Furthermore, the common idea that you have harmed or damaged your immune system by feeding your child these foods is just not so. We are now learning that lack of exposure is problematic and can cause the development of allergy, so consuming these foods if your child does not have symptoms is a good thing.
So, how can these test results help us? They can again open an informative discussion about the history of symptoms, especially as it relates to the foods tested.
If this were my patient, I’d first go through the negative test results with you. I’d confirm any history of symptoms (in this case stomachaches) with any of these foods that you can recall. Again, they should occur every time they are consumed. If there is no history of symptoms, the negative results can be ruled out as food allergy issues and your child can freely eat them.
Now, what if there is a negative food result but you still highly suspect that this food may be the culprit? We would likely discuss an avoidance strategy and further investigation into this food.
Remember, the child had symptoms of stomach aches only and IgE testing which does not typically explain stomachaches. So, we must acknowledge that even if the IgE testing is negative it may be falsely negative since IgE testing is likely not diagnostic for stomachaches in the first place.
Now onto the positive test results. Are there any positive results that you are almost certain are not causing the stomachaches. If so, you can continue to freely eat these foods as again, the positive IgE result does not explain the stomachaches and we know the potential for false positives. Are there foods that we know cause symptoms and now we have positive IgE testing? If so, I’d likely avoid these foods for now and observe. Consider a 2 week trial of avoidance with a food journal to see if the incidence of stomachaches improve. How about positive results where we are just not sure if these foods are causing an issue? In this case, I’d give a few possible options:
- If there are not a lot of positive foods in which avoidance would be very restrictive, I may say avoid them for now and discuss a reintroduction and a food journaling plan. For example, you would avoid all positive foods for 2 weeks and document the frequency of stomach aches. After 2 weeks, you’d add 1 food at a time back in 2 week intervals and see if there is an increase in stomachache frequency. If not, that food can be continued. If so, avoidance should resume along with journaling and re-introduction of other foods.
- If there are a lot of positive foods or just key foods where avoiding all is restrictive, I would avoid 1 at a time at 2 weeks intervals while diligently food journaling. In this instance, the 2 week time period of avoiding a culprit food should lead to a decrease in stomach ache frequency. If this is not observed, that food can be continued in the diet.
So these are just a few of many possible options to further investigate food as a possible cause of the stomach aches based upon blood testing. The key is the correct interpretation of these tests and definitely not telling you that you need to immediately avoid all these foods in this situation.
Again, far too much anxiety is likely being created in this case with food avoidance and we do have to acknowledge the fact that prolonged avoidance could increase the risk of developing a food allergy to a previously tolerated food.
So, as always, I hope this has helped you in your respective situation and also hope it will stimulate a productive discussion with your physician. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!