Ch. Assistant Dr. Ekaterina Ivanova: With asthma and arthritis, the cause may be food intolerance

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Ch. Assistant Dr. Ekaterina Ivanova: With asthma and arthritis, the cause may be food intolerance
Ch. Assistant Dr. Ekaterina Ivanova: With asthma and arthritis, the cause may be food intolerance
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Dr. Ekaterina Ivanova-Todorova is an immunologist at the Clinical Immunology Laboratory of the University Hospital "St. Ivan Rilski" in Sofia and chief assistant at the Department of Clinical Laboratory and Clinical Immunology of the Medical University in Sofia

We offer you the most important from Dr. Todorova's lecture during the discussion "Food intolerance in patients with systemic autoimmune diseases and other chronic inflammatory conditions", which was also attended by Prof. Dr. Malina Petkova, endocrinologist at "Lozenets" University Hospital, Assoc. Dr. Snezhina Mihailova from "Alexandrovska" UMBAL and representatives of patient organizations.

What is food intolerance, Dr. Todorova?

- Food intolerance is an adverse reaction to food with clinical symptoms that do not follow classical immune allergy mechanisms (not IgE mediated).

Initially this type of condition was wrongly called non-immune. In fact, it turns out that these are absolutely immune-mediated conditions, the mechanisms of which, however, proceed completely differently from those of allergies.

Food intolerance is caused by the body's inability to digest certain substances or parts of them.

This is practically an idiosyncratic immune response that occurs as a result of individual deficiencies that may be in metabolism, in absorption, or other abnormalities in the processes of digestion and resorption of food. This also includes some genetic defects that go hand in hand with some of the autoimmunity.

When do we talk about an allergy to certain foods and when do we talk about a food intolerance?

- Unlike food allergy, which is an IgE mediated process, food intolerance is usually associated with an immune response against low molecular weight chemical substances and biologically active food components.

Clinical symptoms are similar to those of many allergic conditions - such as abdominal swelling, pain and diarrhea, but are usually delayed in time.

Also, many of these food intolerance reactions are associated not only with gastrointestinal symptoms, but also with clinical conditions, such as asthma, urticaria, headaches, rashes, hyperactivity, joint pain.

The main difference between allergy and food intolerance is that when we talk about food allergy, we mean the formation of IgE antibodies and the symptoms after eating this food are immediate and can are life threatening.

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When we talk about intolerance to a certain food, we mean the formation of antibodies of the IgG class. The symptoms are delayed in time, they can appear from hours to weeks after the consumption of the provoking food, and what is very important - they are not life-threatening.

They cause a non-specific inflammation, which can also be systemic in nature with the appearance of symptoms from many organs and systems, and often lead to an amplification of the symptoms of the underlying disease, as is the case with systemic autoimmune diseases.

Which autoimmune diseases are associated with food intolerance?

- So far, only a few of the autoimmune diseases have been linked to food intolerance: celiac disease, inflammatory bowel disease, rheumatoid arthritis, some of the autoimmune thyroid diseases, and multiple sclerosis.

Are the causes of this intolerance known?

- They are divided into several groups. The first includes the so-called metabolic dysfunctions or the inability to properly break down lactose and fructose.

The second are the genetic defects. Some of the autoimmune conditions also belong to this group. These are defects in the genes for some of the vitamin D receptors. Many patients with autoimmune diseases are vitamin D deficient.

The third group is the pharmacological response to histamine and tyramine.

Histamine intolerance is generally divided into two types - genetic, when we have a defect in diamine oxidase, one of the two enzymes that break down histamine, and non-genetic, which is very common in the vast majority of patients with autoimmune and chronic inflammatory diseases states.

The fourth group are idiopathic, i.e. the information is yet to be obtained here. These are intolerances caused by toxins in some fish or by preservatives and enhancers of any kind.

What are the symptoms?

- The symptoms are non-specific and usually not only related to the digestive system, because very often they have a delayed nature.

This means that you may have eaten one food and it will cause a reddening of the skin for example, which will come after 48 hours and you will blame another food or some other cause for that reddening. That is why the diagnosis of food intolerance is quite complicated.

Very often, food intolerance in different groups mimics conditions related to food allergy as well as mimics the conditions of the underlying disease of the given patient.

For example, intolerances to lactose, m altose, sucrose and fructose cause symptoms only in the gastrointestinal tract: abnormal gas in the intestines, abdominal pain, diarrhea, nausea, vomiting.

The most common symptoms of histamine intolerance are itching and swelling of the skin, stomach and intestinal problems accompanied by headaches, hyperactivity, etc.

In tyramine intolerance there is migraine headache and urticaria.

It turns out that glutamate, which is put into a number of products of the mass industry, is actually the most dangerous because it has the most systemic manifestations, both from the side of the central nervous system - redness and numbness of the face, tingling and stiffness in the arms and legs, tightness in the chest, dizziness, blurred vision, psychological reactions, you name it from the gastrointestinal tract as well as the respiratory system.

How is food intolerance diagnosed?

- The main problem with food intolerance is that its symptoms are delayed, sometimes by as much as 48 hours. That is why it is very difficult to diagnose an intolerance.

An additional complicating factor is the fact that each person has an individual limit of intolerance to a given food, above which clinical symptoms appear.

Regarding making an accurate diagnosis of food allergy or intolerance, it cannot be done on the data of one test alone. This is also the mistake of many patients who tend to self-diagnose intolerance by seeing deviations in the indicators in one of the tests they have undergone.

However, the European Academy of Allergology and Clinical Immunology believes that food intolerance should be considered a combination of clinical symptoms supported by the results of several tests.

Only then is the so-called elimination diet applied - from 3 months to a year. Food is then introduced in small doses and the patient's response is monitored.

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