Inability to Predict Outcome

In many situations (e.g., atopic disease), the subject wants to know whether there will be any benefit from food avoidance (e.g., not drinking cows' milk or not eating apples). Even if there were valid tests for the diagnosis of food intolerance, the outcome of avoidance measures depends on a number of other variables. Allergen avoidance may succeed for the following reasons:

1. the patient was intolerant to the item;

2. coincidental improvement; and

3. placebo response.

The reasons why a trial of food avoidance may fail to help can be summarized as:

1. The subject is not allergic to the food.

2. The period of elimination was too short. For example, where a child has an enteropathy (damage to the small intestine) due to food allergy, it may take a week or more for improvement in symptoms to occur.

3. The food has been incompletely avoided. This may happen in a subject supposedly on a cows' milk protein-free diet who still continues to receive food that contains cows' milk proteins such as casein or whey.

4. The subject is allergic to other items, which have not been avoided. For example, a child with an allergy to cows' milk protein who fails to improve when given a soy-based milk to which they also have an allergy.

5. Coexisting or intercurrent disease, for example, gastroenteritis in a child with loose stools who is trying a cows' milk-free diet.

6. The patient's symptoms are trivial and have been exaggerated or do not exist at all and have either been imagined or made up by the parents.

It is unrealistic to expect there to be a simple test that can overcome all these problems.

Food Allergies

Food Allergies

Peanuts can leave you breathless. Cat dander can lead to itchy eyes, a stuffy nose, coughing and sneezing. And most of us have suffered through those seasonal allergies with horrible pollen counts. Learn more...

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