
Ask HN: Reading recommendations for understanding food allergies? - sacul
The prevalence of food allergies is increasing in the USA, at least, if not around the world. In my case, I have two daughters with serious food allergies and sensitivities. I’d like to educate myself on this issue, and I’d be grateful for some recommendations about where to start. Thanks!
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killjoywashere
Pathologist here, I use FDA-approved antibodies in my daily practice. I'm
going to assume you're a hacker and you're looking for what I'll call "Haynes
Manual" understanding. Any textbook on molecular biology or immunology would
be a good start. Conversely, I would strongly advise avoiding anything from
any internet personality with an opinion on this stuff.

The medical part of the internet is extremely skewed because the subject
matter is rather complicated. There are experts trying desperately to stay in
their lanes and keep up high walls by only publishing in serious scientific
journals, and there's the YouTubers and bloggers inviting you into their pits
of crazy. Even if you're trying to understand a fairly simple system, like a
modern drive-by-wire Honda Accord, YouTube is likely to lead you astray before
you find the right answer. When it comes to biomedical systems, most social
media types are telling you to pour sugar in your gas tank, and the right
answer has never, and may never, be posted in that forum.

The compromise is to read a textbook. Sort of like a Haynes manual isn't
actually going to teach you the finer points of adiabatic expansion, but you
can get reliable information about how your car is put together.

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Nomentatus
To the extent that you mean IgE allergies, ordinary medical care is rather
sound; but where non-IgE sensitivities-you-can-still-die-from are concerned,
practitioner knowledge is much thinner on the ground,and the science far more
recent. You won't find much in textbooks, just journal articles. Look into
MCAS (mast cell activation syndrome) and Dr. Afrin's book "Never bet against
Occam" is the best starting point for that; although one point of view. Note
that some usually-missed-no-matter-how-many-doctors-you-see diagnoses (esp in
the young) such as Anylosing Spondylitis and Ehlers-Danlos Syndrome involve
such sensitivities. Whether you children have these are not, they'll almost
always be quick to reassure you they don't. Extraordinarily severe
underdiagnosis (90%) in both cases.

------
wslh
Not a doctor but same experience and took a scientific approach which at the
end was just about removing food and having a clean home. I wrote a short
comment about this before [1] but will expand here:

1/ You need to know the kind of reaction they have. Go to the allergist. If
they are gastrointestinal or if they are respiratory or of another kind. The
first type can be solved after one year, the second is more dangerous with
risk of anaphylactic shock.

2/ The allergist will do a blood study and patch tests. If it is respiratory
it will show specific immunoglobulin types. If it is gastrointestinal it is
probable there will not be immune system reactions then it is about trial and
error, incorporating one by one the top 8 allergenes within an interval of 15
days. Some reactions are delayed until 15 days. It is important in these cases
to 100% isolate traces of food with specific crockery for the child including
cleaning sponge, etc.

My first daughter was cured after the first year, the second one continue to
have issues with some cheeses and "dulce de leche" [2] and rice. These produce
hippus and some small behavior changes, nothing terrible.

[1]
[https://news.ycombinator.com/item?id=15082349](https://news.ycombinator.com/item?id=15082349)

[2]
[https://es.wikipedia.org/wiki/Dulce_de_leche?wprov=sfla1](https://es.wikipedia.org/wiki/Dulce_de_leche?wprov=sfla1)

~~~
Nomentatus
This is true for IgE allergies, but many (sometimes life-threatening) mast
cell reactions don't involve IgE and are very difficult to diagnose, since
tryptase levels are very hard to measure properly, and the specific variant
(alpha) of tryptase is relevant, and that pretty much requires a genetic study
only available from one source right now.

It is always good to find triggers - but these can be very numerous (often
secondary or transient) in MCAS (mast cell activation syndrome.) Tough job, if
MCAS is at work.

~~~
wslh
> and that pretty much requires a genetic study only available from one source
> right now.

What is the source?

I forgot to mention that both daughters had blood in the stools after eating
allergens. This is commonly connected with cow's milk protein intolerance but
can happen with other allergens.

~~~
Nomentatus
[https://www.genebygene.com/products/TPSAB1-Copy-Number---
Cli...](https://www.genebygene.com/products/TPSAB1-Copy-Number---Clinical)

This is the original study, the test may derive from its authors:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397297/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397297/)

------
throw345hn
From my perspective as someone who suffers from IBS I understand why there is
debate about seeing gastroenterologist & dietician vs a naturopath.

From what I have read, I think the reality is that gut based science including
microbiome research is an emerging field with a lot of research in flux and it
may be years before we fully understand everything. Because of this and just
like deep learning you see a number of papers coming out almost everyday about
diet, microbiome, brain-gut interaction, probiotics, prebiotics etc. Out of
these a lot of the research needs to be backed up and there is just not enough
yet to fully show a specific plan.

Unfortunately a number of gastroenterologists dont seem to keep up with
research and I have even had one doctor tell me that everything is in my head.
Things like these make you lose confidence in doctors and its understandable
why some people turn to naturopaths even though a lot of it is quackery. I
recommend working with a good gastroenterologist and a dietician to
personalize your diet.

For IBS related personally I recommend following research coming out of Monash
university.

I also recommend books Mind-Gut interaction by Emeran Mayer and The Good Gut
by the Sonnenburgs

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darpa_escapee
Be wary and skeptical of what you see on the internet regarding allergies.
There are a lot of people trying to push quackery to make a quick buck online.

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jjguy
I have an unusual food allergy to poultry. I had the same question - seeking
deeper understanding so I could better manage my life.

I searched online, had family in the medical research hunt for papers and
finally made an appointment with a renowned allergist in DC - I flew there
just for the appointment.

I left disappointed. My allergy is too unusual, there is no research
available. What I need does not exist. For the common allergies - like kids
and nuts - there are plenty.

The net/net from my experience is seek out an allergist, and be very specific
in your requests.

------
foobaw
My friend's mom started this
[http://www.foodallergybooks.com/](http://www.foodallergybooks.com/). My
friend has fatal food allergies (nuts and others) and has to carry around an
epi-pen and has an extremely limited diet. Not sure if this is the best
resource, but you can contact her to ask any questions you may have.

------
alacer
My recommendation is that you read this regarding food allergies.

What I do is (1) avoid the medical community like the plague (except for
dentists); (2) take other advice without immediate rejection, unless it is
plainly wrong, but skeptically nontheless; (3) over a long time gather
relevant information and always be on the lookout for it; (4) try some of this
information in practice with personal experiments to see if and how it works
and do not expect it to work forever if it works at first; (6) try to define
what exactly you mean by "food allergy" preferably before attempting to fix
it.

Generally what has helped me has been a balanced lifestyle with moderation in
all aspects including diet, sleep, exercise, work, play and spirit, since they
all interplay, but this balance may be highly individualized and can take some
trial, error and instrospection to determine and may vary with time. In USA
society work can typically be a big imbalance and has been so for me.

My experience is that much of what people commonly call food and other
"allergies" is due to cumulative negative emotional responses or stress often
coinciding with a lack of happiness in life. In such cases the cure is to find
and be that hapiness.

------
cs702
A good place to start is Food Allergy Research & Education (FARE), a non-
profit that sponsors and is connected with a good number of doctors and
researchers studying the subject:
[https://www.foodallergy.org/](https://www.foodallergy.org/)

------
DoreenMichele
I once talked to someone who suggested that allergies may be indicative of
undiagnosed parasitic infections. I didn't understand the medical stuff well
enough to remember it such that I could repeat it here. I'm just tossing that
out as a suggested angle to read up on.

Best.

~~~
spike021
When I was looking into my own food "hypersensitivities" this was actually
mentioned by the gastroenterologist, but I had an endoscopy and other tests,
which ruled out that theory.

So could be an issue, but may not.

------
dizzystar
pre-note: the allergies are examples, as I'm not sure the specifics here.

The money you'd spend on just going to a specialist will far outclass what you
are going to find online. They are able to isolate exactly what is causing the
allergy and intolerance.

Personally, I don't think that food allergies are increasing so much as there
is a wider understanding of allergies and intolerances (there is a
difference). Conditions that were unclassified 20 years ago are now
acknowledged as real conditions. Only a few years ago, people who would
complain of being allergic to "hypo-allergenic" foods like bananas, plums,
cherries, and so on were laughed out of the office and called hypochondriacs.
Dust, pollen, and peanuts, and similar were classed as allergens. Today, the
story is different. The relationship between seasonal allergies and food
allergies is better understood. For example, you can be allergic to a certain
tree, which only blooms in fall, and that tree will trigger a food allergy
that only expresses itself during the fall. This doesn't mean you should start
eating an allergen during the off-seasons (IMO).

I live with a lot of allergies and intolerances. My best advice is to simply
stay away from what can make your daughters sick. Unfortunately, they will end
up discovering allergies the hard way, and you can only support them by trying
to recognize what is going to make them ill. If you open an orange and they
are sneezing, stop buying and eating oranges. Everyone will have to make some
sacrifices for them, but at the same time, learn to differentiate between what
is okay and not okay to eat around them.

There is nothing more irritating than eating a piece of strawberry cake and
apologizing to them for eating that in front of them. To them, you are eating
poison, so it's no loss to them.

And FFS, please for all things lovely, don't ever ever ever sneak an allergen
into their food to see what happens. That's incredibly rude, and yep, their
friends and boyfriends are going to do this to them (ugh).

I will say that there are various reactions. For me, I know what I can and
cannot eat. If I get something on accident, I'll simply toss up in about 15
minutes, which is much better than the reactions I used to get.

Please just listen to your doctor. Get the allergy shots, and get the epi-pen
if needed.

I would also (lightly) advise that the issues with allergies is compounded
because a lot of people don't understand nutrition at all. Adkins is good,
bad, neutral? What? I'm nearing 40, have good general health, and look about
10 years younger than my age. I know of a few others with a similar range of
allergies who are in amazing general health. A friend's relative plays
professional sports and can eat maybe 10 things without getting ill. While it
emotionally hurts to see someone who can't eat all the "healthy" stuff, just
remember that it is poison to their body, and you just have to work with what
you have.

Hope that helps.

~~~
Nomentatus
But good luck finding a specialist highly conversant with MCAS if your
allergies are not IgE reactions.

------
bloopernova
I am not going to try to debate "gwn7".

Please do your own research while seeing a Gastroenterologist or registered
Dietitian. Specifically a specialist you are referred to from your primary
care doctor. Do not go looking for a Naturopath or GAPS practitioner!

Please also do look into blogs that have debunked the people mentioned in that
comment.

Please, please, please do not blindly follow the advice given by the comment
by "gwn7".

Some discussions that I feel you might find informative:

[https://medium.com/@ZDoggMD/naturopathy-is-99-9-bull-hit-
but...](https://medium.com/@ZDoggMD/naturopathy-is-99-9-bull-hit-but-heres-
what-that-0-1-can-teach-us-a99de55e1948)

[https://badsciencedebunked.com/2015/09/10/trick-or-tweet-
dr-...](https://badsciencedebunked.com/2015/09/10/trick-or-tweet-dr-mark-
hyman-exposed/)

[https://angry-chef.com/blog/want-to-see-something-really-
sca...](https://angry-chef.com/blog/want-to-see-something-really-scary)

[https://www.naturopathicdiaries.com/](https://www.naturopathicdiaries.com/)

[https://en.wikipedia.org/wiki/Joseph_Mercola](https://en.wikipedia.org/wiki/Joseph_Mercola)

[https://www.theringer.com/2017/1/5/16041098/dr-joseph-
mercol...](https://www.theringer.com/2017/1/5/16041098/dr-joseph-mercola-
natural-health-website-bc1ac5e6ebc)

[https://www.quackwatch.org/11Ind/mercola.html](https://www.quackwatch.org/11Ind/mercola.html)

[https://owndoc.com/diet/gaps-scam/](https://owndoc.com/diet/gaps-scam/)

I wish you luck in finding the correct medical treatments for your daughters'
conditions.

~~~
seagoat
It's very surprising how much diet affects health. Very few members of the
medical community have much knowledge of nutrition and a lot of the medical
journal information is flat out misleading.

For example, I've had two bowel resections (first at age 12) and have been
living with Crohn's and Colitis for over 20 years. Without those resources
you've listed, I'd be stuck on monthly cyanocobalamin injections due to a
terminal ileum resection. With those resources advice, I tried methylcobalamin
and was able to absorb B12 orally. One less monthly injection for me.

I've also discovered a link between copper and angular cheilitis and many
others. Most medical journals will point you in the direction of
pharmaceuticals, which definitely have their place but also don't always work.
I've been on many strong immunosuppressive medications most of my life and
they do work.

------
gwn7
Not reading recommendations, but here are a few keywords of topics that are
directly connected to food allergies:

\- leaky gut

\- gut flora / gut microbiota / intestinal bacteria

\- autoimmune disease - food allergy connection

\- scd, gaps, paleo, autoimmune diets

And some people whose online/offline content may be helpful regarding the
topics above:

\- Mark Hyman

\- Joe Mercola

\- Natasha Campbell Mc-Bride

While educating yourself is extremely important, finding the right
professional is priceless (which is really hard these days). I'd recommend to
look for a functional medicine practitioner, or a good naturopath, or maybe a
gaps practitioner.

Good luck with your daughters. Digestive disorders can breed all kinds of
other health issues; so I'd recommend trying to cure their allergies (it's
possible for many people if not all) before accepting to live with them.

~~~
snsr
As a parent of a child with multiple life-threatening food allergies, I cannot
stress enough the degree to which the references you've posted are actively
harmful.

The quackery promoted by some of the people you've mentioned can have real
consequences for people who have anaphylactic reactions to foods.

~~~
jMyles
Without knowing anything about the specifics of the subject or these
particular people, I think that if you are going to make such an argument, you
need to say more or provide compelling source of your own that convincingly
support this position.

Otherwise, this seems like an unsubstantiated ad hominem.

