allergy avoidance diet

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Allergy Avoidance Diet

Introduction

Adverse food reactions, also called food allergies and food intolerances, affect millions ofpeople, and are believed to cause a variety of common health complaints and diseases. Many

nutritionists and physicians believe that the only definitive way to identify and manage adverse

food reactions is through an Allergy Avoidance Diet.

Some health care practitioners prescribe an Elimination Diet followed by food challenges. In an

Elimination Diet, any food that is suspected of causing an allergy or intolerance is eliminated for

a period of four days to three weeks, until symptoms are gone. Depending on the severity and

type of symptoms, an Elimination Diet may range from moderately to severely restrictive in the

amount of foods allowed.

However, Elimination Diets typically include a variety of hypoallergenic foods including lamb,pears, apples, rice, most vegetables, most beans and legumes (except peanuts) and the "non-

gluten" grains (for example, millet, quinoa, and amaranth). Once the body has adjusted to the

absence of suspected foods, these foods are systematically added back into the diet, and any

resulting symptoms are recorded.


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An alternative way to manage adverse food reactions is to follow a Rotation Diet, in which

problematic foods are eaten only once every four days. An Allergy Avoidance Diet may beespecially benecial for those suffering from irritable bowel syndrome, migraine, recurrent otitis

media, rheumatoid arthritis, and asthma.

History

Although the writings of Hippocrates dating back to 400 BC discuss the role of adverse foodreactions in the development of various health complaints, it wasn't until the 20th century that

formal research studies documenting food allergies began to appear in scientific journals.

Popularity

It is now believed that adverse food reactions are responsible for many undiagnosed health

complaints. As a result, a growing number of healthcare practitioners are using Allergy

Avoidance Diets to identify food allergies and food intolerances in their patients.

Principles

Although the term "food allergy" is sometimes used to describe all adverse reactions to food, the

term is more often used to refer specifically to food reactions that are mediated by the immune

system.


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To protect us from illness and disease, our immune systems are continuously trying to lessen the

danger represented by substances called antigens. Antigens are parts of proteins that our bodiesrecognize as dangerous and take steps to neutralize. Antigens can be found most anywhere there

is protein - in foods, of course, but also in microorganisms like bacteria.

When our immune cells identify a dangerous antigen, they act to neutralize it and prevent it from

causing harm in the body. When antigens from bacteria or viruses interact with our cells, we can

get the flu, or the common cold. We don't get the flu from food antigens, but we can get a wide

range of immune-related symptoms that range from sniffles to hives to anaphylactic shock.

Immediate versus Delayed Hypersensitivity

Allergic reactions to food, also called food hypersensitivities, are further classified as eitherimmediate or delayed. Immediate hypersensitivity reactions occur within hours or even a few

minutes after a food is eaten, typically causing very obvious physical symptoms such as a rash,

the hives, a running nose, or a headache.

In rare cases, immediate hypersensitivity reactions can cause anaphylactic shock, a life-

threatening condition in which the throat swells and blocks the passage of air. Immediate

hypersensitivities affect only a small percentage of the population.

Immediate Reactions to Food


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The foods that are most often implicated as the cause of immediate allergic responses include

milk, eggs, peanuts, tree nuts (walnuts), soy, strawberries, wheat, fish and shellfish. Manypeople with immediate food hypersensitivities must completely eliminate the offending food

from their diet to avoid the serious symptoms.

Delayed Reactions to Food

Many of the same foods that are known to cause immediate hypersensitivities in a small numberof people, have been implicated as a cause of delayed or "masked" food allergies in much larger

numbers of individuals. Delayed food hypersensitivity reactions are believed to affect millions

of people; some physicians have suggested that as many as 60% of all Americans suffer from

masked food allergies.

These reactions may be responsible for a variety of symptoms including dark circles or puffiness

under the eyes, fluid retention, dermatitis, sinus congestion, fatigue, abdominal pain or

discomfort, joint inflammation, mood swings, indigestion, headaches, chronic ear infections,

asthma, poor memory, anxiety and depression.

As the name suggests, delayed hypersensitivities do not appear immediately after consuming a

particular food. In fact, in most cases the immune response is so delayed that it is difficult to

determine which food is causing the symptoms, and many people are unaware that they are

sensitive to certain foods.


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Problems with Wheat

Wheat intolerance, wheat allergy, and wheat sensitivity are all terms frequently used to

described adverse reaction to this food. Wheat is somewhat unique when it comes to adverse

food reactions, particularly because it has long been classified as the primary "gluten grain" and

because its research history has been both complicated and controversial. Understanding allergy-

related issues associated with gluten is important for understanding problems connected to

wheat.

What Is Gluten?

In a scientific sense, there is not such thing as "gluten"if that word is being used to describe

any single substance or even category of substances. The term "gluten" comes from the world ofindustry, not science. In the world of industrial baked goods, gluten is a gummy, yellow-gray

material that is left over after dough (made from flour and water) has been washed. When the

dough is washed, many of the water-soluble substances and starches are washed off and what's

left is a complicated mixture that has traditionally been referred to gluten. The dough used to

produce gluten does not have to be made from wheat flour. Other cereal grains like oats can alsobe used to produce gluten. In industrial practice, however, wheat is almost always the food

source for producing gluten.


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If a gluten dough-ball is dried out and analyzed, it turns out to be about 80% protein by weight.

The other 20% of this weight is made up of fats, carbohydrates, and minerals. From a chemicalstandpoint, gluten is a diverse mixture of substances.

Gluten Proteins

There are 4 primary types of gluten proteins: (1) albumins, (2) globulins, (3) prolamins, and (4)

glutelins. (Glutelins have a more specific name when they are found in wheat. In this case, theyare called glutenins.) The prolamin proteins in gluten have been particularly implicated in the

process of protein-based wheat allergy. However, the role of prolamin protein in food allergy is

also complicated because prolamins are found in all cereal grains, not just wheat. The prolamin

proteins found in wheat are the gliadin proteins; in oats, they are avenins; in corn they are zeins;

in rye they are secalins; and in barley they are hordeins.

Protein-Based Wheat Allergy

With respect to wheat, and within the prolamin family of proteins found in gluten, it is the alpha-

gliadin polypeptides that have been most closely linked to food allergy. These alpha-gliadin

polypeptides include peptide A, peptide B, and peptide C. These small proteins appear particular

to wheat. If gluten is produced from sources other than wheat, the prolamin proteins in the gluten

change from gliadins to other types of prolamin proteins, like avenins in oats or secalins in rye.

In these non-wheat cases, the allergy-triggered events associated with the prolamin proteins

become less predictable, and sometimes fail to occur altogether.


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"Gluten Grains"

The differences in prolamin protein composition between wheat and other cereal grains have

prompted controversy in the area of allergy and in use of the term "gluten grains." Traditionally,

wheat, oats, barley, and rye have been referred to as the "gluten grains" and placed on a par with

wheat in terms of allergy. When a person has traditionally been advised to avoid wheat products

for allergy reasons, that person has also traditionally been advised to avoid oats, barley, and rye

as well. The recommendation in this traditional context has been to avoid all "gluten grains." The

differences in protein chemistry between wheat and all other cereal grains, however, has caused

some organizations to start thinking about wheat as a grain that falls into its own unique category

and to place restrictions only on wheat and wheat gluten when allergy is the issue. These

organizations have largely abandoned use the term "gluten grains," and have begun to think

exclusively about wheat and wheat gluten. These steps have had interesting and controversial

consequences with respect to health problems involving wheat allergy. For example, several

organizations formed to support individuals with celiac disease have altered their public health

recommendations to include acceptability of oats for persons diagnosed with celiac disease.

Previously, oats had been categorically avoided as gluten grains for all persons following dietary

restrictions related to the diagnosis of celiac disease.

Non-Gluten Sources of Wheat Allergy


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In addition to the wheat allergy problems associated with wheat's prolamin proteins, there are

other components of wheat that have been associated with allergy. These components includewheat germ agglutinin (WGA), a glycoprotein, and two very short amino acid strings called

tetrapeptides (PSSG and GGGP). These substances are present in significant amounts in wheat

but do not appear to be present in the same way in other grains.

Whole Grains versus Processed Grains

Some healthcare practitioners believe that wheat allergy-related problems are triggered in part by

the highly processed nature of wheat products in the marketplace. Commercially produced

breads are typically formulated to contain a specific amount of highly processed wheat flour

(stripped of the germ, the bran, and majority of fibers, vitamins, and minerals) and a specific

amount of equally processed wheat gluten. Manipulation of this flour-to-gluten ratio candramatically improve textures of highly processed breads and baked goods. Because the natural

balance of nutrients found in whole wheat is dramatically altered by these processing events,

some healthcare practitioners point to these processing impacts as the major underlying reason

for prevalence of wheat allergy. Because 100% whole grains are the only grains recommended

among the World's Healthiest Foods, these allergy-related considerations involving wheatprocessing are completely avoided with the World's Healthiest Foods approach.

The Specifics of Celiac Disease


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Celiac disease is a health condition that some people associate with simple gluten intolerance.

However, celiac disease is in fact a multi-system autoimmune disease in which changes in liverfunction, digestive tract function, and the function of other organ systems comes into play. The

role of a specific enzyme, called tissue transglutaminase, or tTG, appears to be especially

important in celiac disease. Short strands of protein (polypeptides) found in gliadin (one family

of wheat proteins) are acted on by this enzyme, and many resulting problems associated with

Celiac disease may result. For some, but not all individuals, a blood test measuring antibodies totTG can be an effective screening test for Celiac disease.

Adverse Reaction to Food Additives

Many people are also unable to "tolerate" natural and synthetic chemicals, such as sulfites, that

appear in abundance in our food supply. These sulfur-containing preservatives are used in driedfruits, wines, and many other processed foods. Between 1980 and 1999, the United States Food

and Drug Administration received more than 1,000 reports of adverse reactions, some fatal, to

sulfites. It has been estimated that at least 1% of all people with asthma are sensitive to sulfites.

Synthetic food colorings, including Food Dye and Color Yellow No. 5 (tartrazine), areproblematic for many people. Monosodium glutamate (MSG) is one further example of an

additive used to increase flavor, particularly in Asian foods. After eating at restaurants that use

MSG, many people become bloated or experience severe headaches.

Adverse Reaction to Salicylates


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Salicylates and amines are examples of naturally-occurring food substances found in many

vegetables, herbs, spices, fruits, and chocolate. These naturally-occurring components of foodhave been associated with a variety of symptoms including mental confusion, depression, and

migraine headaches.

The Role of an Elimination Diet

Food allergies and food intolerances are a major source of undesirable symptoms that negativelyimpact the quality of life of many people. Many healthcare practitioners believe that the only

definitive way to identify and manage adverse food reactions is through the use of an

Elimination Diet followed by carefully organized food challenges.

This process is quite arduous and must be done carefully if adverse food reactions are to beidentified. As a result, it is best to perform an Elimination Diet with the support of a

knowledgeable health practitioner.

In an Elimination Diet, any food that is suspected to cause an allergy or intolerance is

eliminated. Depending on the severity and type of symptoms, the Elimination Diet may range

from moderately restrictive to severely restrictive in the amount of foods allowed.

Food Excluded on an Elimination Diet


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Standard elimination diets eliminate the most common allergens, such as wheat, soy, corn, dairy,

eggs, gluten, nuts, citrus, fish, chocolate, and shellfish, caffeine, alcohol, and artificial foodadditives. More restrictive Elimination Diets remove all of the foods previously listed plus those

foods that contain salicylates and amines.

The Challenge Phase of an Elimination Diet

The purpose of the Elimination Diet is to avoid all problematic foods for a minimum of fourdays, or until a person experiences some relief from his/her symptoms. For some people, it takes

up to three weeks before improvement is seen. Once the body is cleansed, the foods that were

eliminated are systematically added back into the diet, one food at a time.

This re-addition of foods is called the "challenge" phase of the diet. On the first day of foodchallenges, a food is eaten one to three times during the day. Over the next few days, the dieter

returns to the Elimination Diet, and watches for the return of any symptoms.

If any symptoms develop, it is possible that the dieter is "allergic" to the recently reintroduced

food. If no symptoms develop, it is likely that the reintroduced food is not a problem for the

dieter, and he/she can move on to the next food challenge. To more accurately determine food

allergies and food intolerances, it is extremely helpful during the challenge phase to keep a diary

of foods eaten and any emotional, mental or physical reactions.


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It can take several months to complete an Elimination and Challenge Diet. If a person does not

have the time or desire to undertake such a process, a Rotation Diet may be a more appropriateoption for managing the symptoms associated with food allergies.

In a Rotation Diet, foods are rotated so that a person eats a food (or food family) only once every

four days. For example, if you suspect a sensitivity to wheat, you would rotate wheat-containing

foods into your diet every fourth day. It is believed that by decreasing the consumption of

problematic foods by rotating them, the symptoms associated with these foods can be reduced.

Research

A growing body of scientific literature points to hidden food allergies and food intolerances as a

cause of many medical conditions including migraine headache, arthritis, irritable bowelsyndrome, asthma, attention-deficit hyperactivity disorder, and recurrent otitis media. Common

health complaints such as fatigue and eczema are also attributed to adverse food reactions.

Clinicians and researchers believe that the number of people suffering from adverse food

reactions is constantly increasing. They cite several reasons for this:

Repeated consumption of a limited number of foods: Many people eat arelatively small number of foods several times during the day. Forexample, wheat, a common food allergen, is found in breakfast cereals,the bread used to make a sandwich at lunch time, and the spaghetti


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eaten at dinner time. Also, wheat is a thickening agent used in food

processing, so it is a common "hidden" ingredient in many processedfoods.

Or consider the number of times you can eat corn in one day: in yourcorn flakes at breakfast, in your corn tortilla at lunchtime, and your

corn-on-the-cob at dinnertime. Other commonly eaten foods such asmilk and eggs are also a frequent cause of allergic symptoms. Therepeated exposure to these foods taxes the immune system.

Improper digestion and poor integrity of the intestinal barrier: The

digestive tract plays a vital role in preventing illness and disease byproviding an impenetrable barrier. When the integrity of the intestinalbarrier is compromised, a condition coined "leaky gut syndrome"develops. With leaky gut syndrome, partially digested dietary protein

can cross the intestinal barrier and be absorbed into the bloodstream.

These large molecules can cause an allergic response, producingsymptoms directly in the intestines or throughout the body.

One of the causes of leaky gut is an absence of "friendly" bacteria in theintestines. The "friendly" bacteria help maintain the health of the


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and legumes (except peanuts) and the non-gluten grains (for example, millet, quinoa, and

amaranth).

Typically the only sweeteners allowed are maple syrup or brown rice syrup. Acceptable

beverages include rice milk, pear nectar, chamomile tea, and sparkling water (without any added

sweeteners).

However, the foods that are included in an Allergy Avoidance Diet must be carefully selectedfor each individual, so that all problematic foods are eliminated. See the Principles section above

for more details.

Foods Avoided

Any food that is known, or suspected, to cause an adverse reaction is either completely

eliminated from the diet, or eaten on a rotation basis. Wheat, corn, cow's milk, eggs, dairy

products, peanuts, and soy foods are among the most common food allergens. Many people also

react to artificial food additives, such as monosodium glutamate, sulfites, and food colorings;

foods containing these ingredients must be eliminated.

If you are simply trying to avoid wheat, dairy, or corn, you can include a wide variety of fruits

and vegetables in your Allergy Avoidance Diet. However, if you suspect that you are sensitive to

amines and/or salicylates (see Principles section above for more information), you must avoid all

foods containing these naturally occurring chemicals. Unfortunately these chemicals are


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widespred in many commonly eaten fruits and vegetables, as well as many other foods.

Examples of foods that contain salicylates and/are amines are tomatoes, broccoli, olives,spinach, mushrooms, avocado, all dried fruit, smoked meats, canned fish, hard cheeses, soy

sauce, miso, chocolate, cocoa, beer, cola drinks, vinegars, and yeast extract.

When following an Elimination or Rotation diet, be aware that many processed foods contain at

least one of the most common food allergens. Milk, soy, wheat, peanuts, and eggs are staples in

the food industry, and often appear in foods as "natural flavors," which means that the food label

may not list the ingredient.

Additional Information about Allergy-Related Meal Planning

If you decide to experiment with some of the allergy avoidance methods listed above, you willdiscover that some allergy-related meal planning is really quite simple. If you decide, for

example, that wheat is a food you want to avoid, you automatically know that wheat bread is off

your grocery list.

But when it comes to highly processed foods, or sauces and condiments, you will find that

allergy avoidance becomes more difficult, because wheat is not always so easy to spot. Soy

sauce, for example, often contains wheat as a key ingredient. So do teriyaki sauce and food

starch.


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Because the recipes on our website are prepared from minimally processed whole foods, you'll

find very few "hidden ingredients" when meal planning from our recipes - regardless of whetheryou are planning for wheat-free, soy-free, or other allergy-avoidance meals. But when you

venture out into the grocery store and are selecting from highly processed foods, hidden

ingredients are common.

If you decide to try allergy-related meal planning in any of the following five areas, you may

find the information below helpful in selecting foods for yourself or your family.

1.Dairy-free meal planning2.Wheat-free meal planning

3.Egg-free meal planning

4.Soy-free meal planning5.Yeast-free meal planning

Dairy-free meal planning

In addition to cow's milk itself, products made from cow's milk including yogurt, ice cream, sourcream, half and half, cottage cheese, hard and soft cheeses, butter, and puddings can be made

from cow's milk.

One of the most common allergenic proteins in cow's milk is called casein, and all variations of

this word appearing on an ingredient list signify the presence of cow's milk as a food source:


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casein, caseinate, calcium caseinate, ammonia caseinate, magnesium caseinate, potassium

caseinate, and sodium caseinate.

Casein can be used in food processing as an extender, tenderizer, and protein fortifier, and can

be found in unexpected places, including chewing gum, luncheon meats, and imitation sausage.

The words "non-dairy" do not necessarily mean that a product does not contain casein, and many

non-dairy products on the market, including soy cheeses, almond cheeses, and rice cheeses use

casein as a primary protein-boosting ingredient.

Wheat-free meal planning

All of wheat's components, including wheat bran, wheat germ, wheat starch, wheat nuts, and

wheat berries would be excluded from a wheat-free meal plan. Similarly, any type of wheat,including bulgar, durum, and graham would be excluded. Semolina, seitan, triticale, couscous,

and tabouleh would also be avoided, along with any product containing the word "gluten" (or a

variation of this word) in its ingredient list. These include high-gluten flour, vital gluten, and

wheat gluten.

Much more hidden are the food additives that may or may not be made from wheat. Theseadditives include:

Dextrin, an incompletely hydrolyzed starch that may be derived from thedry heating of corn, potato, rice, tapioca, arrowroot, or wheat


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Caramel color, which can be made from heat treatment of many food-

grade carbohydrates, including molasses, corn sugar, invert sugar, milksugar, barley malt syrup, or wheat starch hydrolysates

Extracts, including vanillin extract, which often use grain alcohol inpreparation of the extract and contain wheat protein residues

Egg-free meal planningThe desert sections of the grocery store contain the most egg-based products, including

puddings, custards, ice creams, cakes, cookies, meringues, cream-filled or fondant-filled

chocolates, fudge, icings and frostings, doughnuts, and muffins.

Baked goods and baking mixes also frequently contain egg. The list here includes waffles andwaffle mixes, pancakes and pancake mixes, and french toast. Egg noodles, breaded meats,

breaded fish, breaded poultry, souffles, hollandaise sauce, most mayonnaise, meat loaf, some

sausages, many fried rice dishes, egg drop soups, egg noodle-containing soups, and egg

substitutes can also contain egg.

On an ingredient list, any of the following words would also indicate the presence of egg:

albumin, egg white, egg yolk, dried egg, egg powder, egg solids, ovalbumin, ovomucin,

ovomucoid, ovovitellin, and livetin. The fat substitute Simplesse (TM) also contains

microparticulated egg protein.


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Soy-free meal planning

An ever-increasing number of ingredient-listed items can include some soybean-derived

component. Items that indicate or may indicate the presence of soy include: hydrolyzed soy

protein, hydrolyzed plant protein, hydrolyzed vegetable protein, texturized vegetable protein

(TVP), soy flour, soy grits, soy nuts, soy milk, soy sprouts, isolated vegetable protein, vegetable

gum, vegetable broth, or natural flavoring. Soy sauce, shoyu, tamari, miso, tofu, tempeh, soy

curd, and soy granules would all be avoided on a soy-free meal plan.

Yeast-free meal planning

A yeast-free meal plan is one of the most confusing to implement because of the controversies

surrounding residual amounts of yeast in many commercially-prepared, processed foods. Forexample, small amounts of yeast many become present during the drying of tea, coffee, and

spices.

The culturing of yeast is also used a starting point for commercial production of fermented

products, including vinegars and ciders. Citric acid, a food additive, is also derived from yeast-

culturing and yeast-fermenting processes.

Many cow's milk-containing products also contain yeast, since yeasts thrive on milk sugar

(lactose). This list of products typically includes sour cream, buttermilk, cream cheese, ricotta

cheese, and powdered milk. Because yeasts also thrive on concentrated sugars, many canned and


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frozen fruit juices, and particular fruit juice concentrates, can contain yeast. Since the mid

1970's, several dozen research studies on this topic have appeared in food science journals.

Nutrient Excesses/Deficiencies

An Allergy Avoidance Diet, when carefully planned, provides sufficient amounts of all essential

nutrients. Care must be taken with children and pregnant women to ensure adequate caloric and

protein intake.

Who Benefits

Because adverse food reactions are implicated as a contributing factor in the development of

several medical conditions, identifying and eliminating the foods that cause reactions can be

helpful for many people. Specifically, an allergy avoidance diet is beneficial for those suffering

from irritable bowel syndrome, migraine, recurrent otitis media, rheumatoid arthritis, and

asthma.

Who is Harmed

Individuals following an Allergy Avoidance Diet may experience uncomfortable symptoms

caused by detoxification, including headache, muscle pains, or fatigue. These symptoms

typically appear 2-3 days into the diet, and disappear within seven days.


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When offending foods are reintroduced into the diet, individuals experience mild to severe

reactions to food. It is advisable, therefore, to follow an Allergy Avoidance Diet, especially astrict Elimination/Challenge Diet, only under the advice and supervision of a health care

practitioner.

Menu Ideas

The following daily menu is representative of the types of foods that would be included in astrict Allergy Avoidance Diet:

Breakfast:

Hot rice cereal with maple syrup, sliced pears, and chopped cashews Rice milk

Lunch:

Rice pasta topped with garlic

Dinner:

Lamb stew with lentils, cabbage, garlic and parsley

Resources


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For more information about food allergies, food intolerances, and allergy avoidance diets, check

out the following web sites:

The Food Allergy and Anaphylaxis Network (FAAN) atwww.foodallergy.org

National Institute of Allergy and Infections Diseases (NIAID), thedivision of the National Institutes for Health that supports research onallergies, infections diseases, and immunology at www.niaid.nih.gov

The Bastyr University Natural Health Clinic at www.bastyr.edu.

References

Bischoff SC, Herrmann A, Manns MP. Prevalence of adverse reactions tofood in patients with gastrointestinal disease. Allergy (Copenhagen); 51(11). 1996. 811-818. PMID:7030.

Bischoff SC, Mayer JH, Manns MP. Allergy and the gut. Int Arch AllergyImmunol 2000 Apr;121(4):270-83. PMID:7180.

Boris M, Mandel FS. Foods and additives are common causes of theattention deficit hyperactive disorder in children. Ann Allergy 1994May;72(5):462-8. PMID:7130.


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Candy S, Borok G, Wright JP, et al. The value of an elimination diet in the

management of patients with ulcerative colitis. S Afr Med J 1995Nov;85(11):1176-9. PMID:7190. Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in

attention deficit disorder. Arch Dis Child 1993 Nov;69(5):564-8.PMID:7140.

Cavagni G, Piscopo E, Rigoli E, et al. "Food allergy in children: an attemptto improve the effects of the elimination diet with an immunomodulatingagent (thymomodulin). A double-blind clinical trial". ImmunopharmacolImmunotoxicol 1989;11(1):131-42. PMID:7170.

Cavataio F, Iacono G, Montalto G, et al. Gastroesophageal reflux associatedwith cow's milk allergy in infants: which diagnostic examinations areuseful. Am J Gastroenterol 1996 Jun;91(6):1215-20. PMID:7110.

Edwards AM. Food-allergic disease. Clin Exp Allergy 1995 Jul;25 Suppl1:16-9. PMID:2990.

Felder M, De Blecourt AC, Wuthrich B. Food allergy in patients withrheumatoid arthritis. Clin Rheumatol 1987 Jun;6(2):181-4. PMID:6960.

Finn R. Food allergy--fact or fiction: a review. J R Soc Med 1992Sep;85(9):560-4. PMID:3040.


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Gaby, Alan R. The role of hidden food allergy/intolerance in chronic

disease. Alternative Medicine Review 1998; 3(2): 90-100. Gamlin L, Brostoff J. Food sensitivity and rheumatoid arthritis.

Environmental Toxicology and Pharmacology; 4 (1-2). 1997. 43-49.PMID:7040.

Pizzorno J, Murray M. The Textbook of Natural Medicine. The Textbook ofNatural Medicine 1998.

Vatn MH, Grimstad IA, Thorsen L, et al. Adverse reaction to food:assessment by double-blind placebo-controlled food challenge and clinical,psychosomatic and immunologic analysis. Digestion 1995;56(5):421-8.PMID:7120.

Woods RK, Abramson M, Raven JM, et al. Reported food intolerance andrespiratory symptoms in young adults [see comments]. PMID:7070.

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