Most allergists are, to put it politely, "diagnostically challenged" when they see anything other than a runny nose or a wheezer.  Heaven forbid if they need to deal with a patient with multiple symptoms involving multiple body organs.  Most of us don't know where to even begin to unravel the mystery of a patient who says they react to multiple foods, inhalants, and chemicals.  And no wonder.  Our professional societies give us absolutely no guidance in giving us algorithms to use to approach these types of patients.  So I'll give it a try....after all, what have I got to lose when nobody else has had the guts to approach this taboo subject? 

I promised in earlier blog entries that I would present "patterns" I've seen over 27 years in treating allergies.  One pattern I've seen is the patient who presents with a prior history of "simple allergies" in earlier life, who then presents to my office with multiple food sensitivities.  It is the increase in food sensitivities and loss of tolerance to multiple foods that usually brings the patient in for testing and treatment.  Where to begin?  The following outline is designed to help with the process: 

Over the next few journal entries, I'll be using this skeletal template to superimpose the multiple permutations of it that can occur.   The key in this diagram is to focus on  the  cause  of the intestinal permeability  increase, since this is really the cause of the patients  spreading sensitivity to multiple foods. 

An increase in  intestinal permeability can result in increased egress of food antigenic fragments into the circulation, with subsequent rapid sensitivity.  What can cause intestinal permeability increase?  More about that later.  Let me point out one other important thing first.  As this slide indicates, patients can have a shift in their initial "target organ" to other target organs as their sensitivities multiply.  First, they may have simple targeting of the respiratory tract, manifesting as hayfever or chronic sinusitis, and later they may present with multiple sensitivities AND other target organ involvement--myalgias, arthralgias, headaches, gastrointestinal complaints, etc.  In short, it is a characteristic of this patient type that as their sensitivities multiply, they have a simultaneous recruitment of other body organ systems involved in the process. And please note:  specific antigens may specifically trigger different target organs.  In one patient, milk may trigger sinus congestion, and wheat may trigger myalgias and fatigue! 

Over the next few journal entries, I'll be using this skeletal template to "drape" on it the the multiple permutations that can occur with it on clinical presentation.

Later, dude.