Nutrition

What is the difference between IgE allergies and mast cell triggers? Can you have IgE allergies and mastocytosis? Are there tests to identify these triggers?

Some people have a genetic tendency to produce IgE (a type of antibody) to normally harmless substances, such as food, pollen, insect stings and medication. The body produces IgE directed against specific substances. For example, one person may produce IgE antibodies directed against peanut and birch pollen, while another person might produce IgE directed against egg white and dust mites. Once produced, IgE will attach to mast cells. If the IgE are exposed to the triggering substance, the mast cells can activate (degranulate). For example, a patient develops peanut IgE which attach to mast cells around the digestive system. When peanut is eaten, the IgE are exposed to the peanut, which causes the mast cells to activate, leading to anaphylactic symptoms. In most cases, IgE mediated food allergies are consistent. The allergic individual reacts every time the food is eaten. The symptoms also occur quickly after the food is eaten. As a result, IgE mediated food allergy is often called immediate food allergy.

It is possible to have both IgE food allergy and mast cell triggers?

Your physician may use skin tests and/or food specific IgE blood tests to determine if your body has produced IgE to a suspected item. Each food is tested individually. If the test to a specific food is negative, IgE mediated allergy to that food is very unlikely (although the food could still be a mast cell trigger). If the test is positive, an IgE mediated allergy to that food is possible. However, false positives are very common. In other words, IgE to a specific food, does not necessarily mean you are allergic to that food. If you have been consuming a positive food regularly without symptoms, it is unlikely that you have a true IgE mediated allergy to that food, even if you have a positive skin or blood. A good article on this topic can be found at www.foodallergy.org/diagnosis-and-testing . Read about false positives under the skin prick test and blood test sections. Please note, it is extremely important to speak with a knowledgeable allergist to sort this out. You should not introduce IgE positive foods without medical supervision and/or guidance.

Mast cell activation can also be triggered by other substances or events, including a variety of food, food additives, inhaled chemicals, medications/supplements, temperature changes, etc. These are commonly called mast cell triggers. The symptoms can be very similar to IgE mediated allergy. However, the reactions tend to be less consistent. A mast cell trigger may be problematic one day, but well tolerated on a different day. Unfortunately, there are no tests to determine mast cell triggers.

Is there a specific diet to be followed for mast cell disease? How can I figure out which foods I cannot tolerate?

There is no specific diet, however there are basic guidelines. Using an elimination diet can be helpful to determine food triggers. Mast cell disease patients often report symptom improvement with dietary changes; however, these changes vary from person to person. Identifying helpful changes takes some experimentation. There are foods that patients with mast cell disease seems to be more reactive to overall. These include but are not limited to: Monosodium Glutamate (MSG), alcohol, shellfish, artificial food dyes and flavorings, food preservatives, pineapples, tomatoes & tomato based products, and chocolate. While these foods commonly trigger a lot of patients, they may not be an issue for everyone. That is why an elimination diet is recommended. With the help of a registered dietitian, you can start off with a limited diet and then slowly introduce each food while keeping a written record of what foods you eat and any symptoms that occur. This can help you identify and eliminate food-based triggers from your diet. If you seem to be reacting to all foods, you might be reacting to the act of eating rather than specific foods. It would be best in this case to find a physician to help you with a plan of action to reduce overall mast cell reactions. Once you get your mast cells under control, you can re-evaluate your diet for potential triggers.

What is a low histamine diet?

A low histamine diet restricts foods that are potentially high in histamine and/or may lead to histamine release. Histamine is one of several inflammatory chemicals released from mast cells (and other immune cells) and is responsible for many of the troubling mast cell disease symptoms. Histamine can be absorbed into the body from food. Food with very high levels of histamine can lead histamine poisoning (a type of food poisoning that is common with improperly handled fish). Some people may have lower levels of the enzymes which break down food histamine, and may be more likely to absorb histamine from food (histamine intolerance). Histamine forms during fermentation and spoilage. It may also be present in certain fruits and vegetables. However, there has been very little research to accurately measure the amount of histamine in food. A second part to the theory is that certain foods may trigger mast cells to release histamine. There are long lists of histamine releasing foods on the internet, but these lists are based on anecdotal reports. Since there is so much individual variation, and very little concrete information, the low histamine diet is a general guideline that requires experimentation, rather than a diet that should be followed exactly. With the help of a registered dietitian, an elimination diet based on your personal experience with symptoms is a good course of action.

Will dietary changes completely control my symptoms?

While improving your diet by eliminating triggers and eating wholesome, balanced meals can help to decrease your symptoms, there is no cure-all for mast cell disease.

Should I take nutrition supplements?

A multivitamin and mineral supplement is a good idea. Some people report benefit of specific supplements, but there have not been any studies to confirm this. Vitamin C is the most common one to report. Quercetin, an antioxidant, has been shown in some studies to inhibit mast cell activity. Before taking any supplement, talk to your physician or dietitian. Be sure to check all ingredients for potential triggers. If you decide to try specific nutrient supplements, do so systematically, and only continue if it makes a significant difference.

How do I introduce solid foods safely for my child with Mast Cell disease?

The American Academy of Pediatrics recommends solid food introduction when a baby has met ALL of the following basic milestones: 1) Able to hold his/her head up unassisted, 2)Opens his/her mouth and seems eager to eat when watching others eating, 3) Has doubled his/her birth weight. These milestones usually occur between 4-6 months of age. Introduce foods one at a time. This will help you to know what foods might be triggering your child. For instance, if you would like to start with rice cereal, do not mix the rice cereal with anything other than water or formula/breastmilk that the baby has previously consumed and is known to tolerate well. With mast cell diseases, it is important to wait at least 3 days between new foods. Monitor your baby for any signs of intolerance. Mast cell reactions to foods usually include a rash around mouth, diarrhea, vomiting, flushing , coughing or drooling, wheezing or stridor, diaper rash, or hives. Rarely, anaphylaxis can occur. Know the symptoms of anaphylaxis and have an anaphylaxis action plan signed by your physician. AAAAI Anaphylaxis Action Plan. Keep a food and symptom log, noting the time and amount of food given. Usually 1-2 tablespoons of a new food per meal is appropriate. Discuss any possible reactions with your physician. If you think a reaction occurred, discontinue that food and observe the child closely to be sure that the symptoms do not progress to anaphylaxis. Wait at least 3 days or as long as it takes for the reaction to resolve before introducing another new food. Questionable foods can be reintroduced at a later date after talking with your physician. It is important to note that infants/children with mastocytosis should have an Epi-pen Jr available at all times in case of anaphylaxis, and all caregivers should be trained in using it.

What do I do when I am sending my child to a playdate or birthday party?

Call the child’s parents in advance to find out what they will be serving. You can then send a packed meal similar to what is being offered from your home. Keep safe cupcakes in your freezer and defrost them the day of any party your child will be going to. You can try to match the colors of the birthday party cake by using all natural food dyes which are becoming more available these days. Explain to the parent who will be in charge that your child has what is comparable to allergic reactions. It is helpful to have a printed paper with the information on it. Always give the parent in charge all rescue medications your child may need, including antihistamines and epinephrine auto injector. For more help in dealing with children and food issues, go to www.foodallergy.org or www.allergyhome.org.

How do I eat in a restaurant?

Choose restaurants that are allergy-friendly. Call the restaurant in the middle of the afternoon, when the chefs are not busy and can speak on the phone. Explain that you have severe allergic reactions to certain foods. Even though you may not be truly IgE allergic, using the words “severe allergy” gets people to pay attention and realize the risk involved. Ask about cross-contamination prevention. Go over the menu with the chef and figure out which foods are safe for you. This eliminates the need for the server to ask detailed questions while the chefs are busy at mealtimes.

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