In part one, we covered the pros and cons of skin prick testing (it only picks up wheat allergy) and the differences between wheat allergy, celiac disease, and non-celiac gluten sensitivity (NCGS).
But there’s even more to the story.
If you suspect you’re allergic to gluten, keep reading!
In this blog, we’ll cover all things gluten, including why skin prick testing might be detrimental (yikes), other foods to (maybe) be aware of if gluten is causing problems, and how our emotions can get tied up with the breadbasket.
Am I allergic to gluten because of skin prick testing?
Skin prick testing is a common and popular way to identify food allergies. Maybe you have considered getting one yourself to get to the bottom of the bothersome symptoms that plague you every time you eat.
Skin prick testing is quick and relatively simple—your doctor places a small amount of the suspected allergens on your arm and then pricks your skin with a needle, allowing the food to cross your protective skin barrier and come face to face with your immune cells. If you have a skin reaction, it suggests a food allergy.
While this sounds pretty straightforward, there is actually a possibility that skin prick testing could make food allergies worse, especially in those with dermatitis and eczema. How is this possible?
First, let’s differentiate between allergy, sensitivity, and tolerance.
When someone has a food allergy or sensitivity, their immune system sounds the alarm when a food is eaten, as it mistakes the food for a pathogen. This creates inflammation and a cascade of symptoms ranging from digestive distress to anaphylaxis.
In contrast, tolerance is what happens when your body has no reaction to food. No alarm, no symptoms, all is good. As infants, when we first begin eating foods, our immune system works hard to develop oral tolerance to all new foods.
Tolerance isn’t talked about often, but it’s imperative. In fact, it is essential to survival. Think about this: the EpiPen has only been around since the 1980s, and anti-histamines and corticosteroids were invented in the 1930s. Before that, an allergic reaction could become life-threatening in a matter of seconds.
Both tolerance and sensitivity share the common denominator of the digestive system—healthy and robust digestion paired with our semi-permeable intestinal barrier support the development of tolerance. But impaired digestion and extreme intestinal permeability predispose to the development of sensitivity and allergy. However, other pathways may contribute to food allergy, and that is where the skin comes in.
Like the complex immune system housed within the gut, your skin contains important immune cells that provide the first line of defense against invaders. As soon as the skin is damaged, irritated, or inflamed, immune cells spring to action.
The dual allergen hypothesis suggests that exposure to food antigens via a disrupted skin barrier is more likely to lead to allergy than exposure via the gut (1). This may be what’s happening when infants and children immediately react to a new food they have never consumed before.
For instance, in children, peanut allergy is strongly associated with the use of a lotion that contains peanut oil within the first year of life (OR: 6.8; 95 percent confidence interval, 1.4 to 32.9), particularly in those with rash or other skin barrier disruption (2).
In these cases, when damaged and inflamed skin is exposed to a food antigen, like peanut, the immune system marks that food as a pathogen that is not welcome and needs to be eliminated. Then, when the food is eaten, the immune system reacts, resulting in an allergic response.
So the question is, could this happen with skin prick testing? In theory, yes.
However, it is important to emphasize that this specific scenario has not been studied. The dual allergen hypothesis is based on exposure to a new food via the skin, or even the lungs, instead of the gut. This situation is most likely to happen in infants or children and less likely for an adult who has already been exposed to and developed oral tolerance to many foods.
But as we know, the immune system is complicated. New sensitivities and even allergies can occur at any age, especially when gut health is compromised.
And those with celiac disease and non-celiac gluten sensitivity may have an immune response that puts them at greater risk for other food sensitivities.
Celiac disease, instant coffee, and cross-reactivity
There is limited evidence that people with celiac disease might also need to avoid a litany of non-glutinous foods. It may be that these foods trigger a response similar to gluten. So, even on a gluten-free diet, those with diagnosed celiac disease still experience symptoms such as diarrhea, fatigue, weight loss, and bloating.
The list includes:
- cow’s milk
- milk chocolate
- milk butyrophilin
- whey protein
- instant coffee
However, we should closely examine the data backing this information.
The findings of only one paper (3), a 2012 in vitro study (a study conducted in a Petri dish versus an in vivo study, one performed on animals or humans) by Aristo Vojdani, Ph.D. and Igal Tarash, claim that those with celiac disease should avoid these non-glutinous foods.
In this study, rabbits were injected with purified gliadin proteins, the major protein present in gluten. After four weeks, their blood was drawn, and antibodies were isolated and used to create anti-gliadin antibodies. These antibodies were then combined with one of multiple food proteins, including the list of foods above.
Unsurprisingly, the antibodies were most active when combined with gliadin, i.e., gluten. Some activity was also observed when the antibodies were combined with proteins in dairy, yeast, oats, corn, millet, milk chocolate, instant coffee, and rice.
This study was then used to back the creation of a now popular (and expensive) test offered by Cyrex Labs (where Aristo Vojdani works as Chief Scientific Advisor) called Array 4: Gluten Associated Cross-Reactive Foods & Food Sensitivity.
The test, however, monitors for cross-reactivity between every food in the Vojdani and Tarash study—over 20 different foods—versus the ones that were found to be possibly problematic in the study’s results.
Why is this critical information for people with celiac disease?
The diagnosis of celiac disease and the implementation of a life-long gluten-free diet can be psychologically challenging for some folks and is the main reason I developed Easy Peasy Gluten Freezy.
People with celiac disease must avoid even the slightest bit of gluten in order to heal their bodies and regain a functional quality of life.
So, if they are to avoid glutinous foods and a list of other foods, research and anecdotal evidence need to be crystal clear.
Unfortunately, we don’t have that clarity from the research. What we do have, however, is anecdotal evidence that a strict gluten-free diet combined with targeted gut healing works amazingly well for the large majority of celiac patients. Yes, some people with celiac do experience reactions to other foods. But it is the exception, not the rule.
Emotional aspects of dealing with gluten reactions
Dealing with food reactions can be emotionally draining.
The problem is only made worse when you can’t figure out which food is causing a reaction. This turns fun gatherings and social dinners into a private anxiety party where yours is the only name on the guest list.
Will the cheese in the dip send you running to the bathroom? Were those crackers really gluten-free? You thought you ate perfectly yesterday, but you feel like crap this morning. Why is this happening?!
First off—you are not crazy! You know your body better than anyone, and if you are feeling these symptoms, they are real. Something that can mess with your head when pinpointing your trigger food(s) is that your immune system may respond to the same food differently.
The immune system is highly complex and very specific. Let’s use eggs as an example.
Perhaps you notice symptoms after eating soft scrambled eggs, but you seem to be okay after eating a hardboiled egg. This suggests that your immune system has formed antibodies to the protein structure present when eggs are scrambled but not to the protein structure that is present when they are hardboiled.
This situation can be extremely confusing and frustrating, and it often leads to continuing to eat problematic foods or eating an unnecessarily restrictive diet.
So how can you figure out which food is causing a reaction?
Food sensitivity panels can be helpful in some cases, but they only look at general foods versus specifics, like scrambled vs. hardboiled eggs. The results can feel overwhelming and may lead to food fear and unwarranted food restriction. But if you do decide to go this route, have a nutrition professional help guide you through your dietary changes and create a gut-healing protocol for you. This will save you a lot of pain, stress, and suffering. (This is exactly what we do in The Good Poopers Club btw!)
The gold standard for identifying food sensitivities is to eliminate and reintroduce the suspected foods. And the first step is keeping a log of the foods you eat and the symptoms you experience. I help clients do this all the time!
Elimination of foods is hard. It often means you can’t eat your favorite foods with your friends or family. This sucks, but don’t allow it to put your health on the backburner. Begin by building your support network: let your friends and family know that you will be doing an elimination trial of X, Y, and Z foods. Communicate why it is important to you and how it impacts your health. Remember that, for many foods, elimination is not forever. The exception is that for celiac disease and non-celiac gluten sensitivity, you must be gluten-free for life.