Check out the program below featuring Dr. Philip Arnone, DC, DABCI and Dr. Daniel Dantini, MD as they discuss delayed food allergies.

Food Allergies and the Immune System

A food allergy develops when the immune system reacts in an attempt to reject a food in your diet. This is called an autoimmune reaction. An autoimmune reaction is an event where the immune system is reacting and attacking substances that it should normally recognize as harmless. There are four different types of autoimmune reactions: Types 1, 2, 3, and 4. More than one type of reaction can occur at the same time in the same individual. These reactions are well documented in medical literature and can be labeled according to the Gell-Coombs classifications.

Type 1 Autoimmune Disorders (Immediate Onset)

The best known and well-studied form of food allergies is called a Type 1 immune reaction. Type 1 food allergies occur in less than 5% of the population and are most common in children. These reactions are also called immediate-onset, IgE-mediated, and/or atopic food allergies. Usually occurring in the genetically predisposed individual, this type of allergy occurs when the immune system begins creating a specific type of antibody called IgE (immunoglobulin IgE) in response to certain foods. One side of the IgE antibody will recognize and tenaciously bind to the allergic food. The other side of the antibody is attached to a specialized immune cell packed with histamine, called the mast cell.

Primed for action, the IgE antibodies now wait for re-exposure to the food allergen. When the specific food is consumed again, IgE antibodies immediately latch onto it. Histamine and other allergy-related chemicals -- called chemical mediators -- are released from the mast cell, causing symptoms such as stomach cramping, diarrhea, skin rashes, hives, swelling, wheezing or, in extreme cases, anaphylaxis. Since this allergy pathway occurs immediately, it is easy to recognize the problem after an individual is exposed to the irritant. This is also the immunological pathway behind seasonal allergies. The most common test for this type of reaction is the Scratch Test which is performed by most allergists.

Dr working with patient

Type 2 & 3 Autoimmune Disorders (Delayed-Onset)

Type 2 & 3 immune reactions are much more commonly involved in food allergies than Type 1 reactions. Type 2 and 3 food allergies also involve the immune system. They occur when the immune system creates an overabundance of IgG, IgA, and IgM antibodies in response to a particular food. Instead of attaching to mast cells like the antibodies in Type 1 allergies, Type 2 & 3 antibodies bind directly to the food as it enters the bloodstream. This creates a variety of "immune complexes" (food allergens bound to antibodies) that circulate through the bloodstream.

The antibodies will then target connective tissue. Since connective tissue is present in all muscles, joints, organs, and arteries, these attacks can lead to inflammation and damage to any system in the body. The allergic symptoms for Type 2 & 3 autoimmune reactions are delayed in onset, appearing anywhere from two hours up to several days after consuming allergic foods. For example, migraine headaches characteristically appear 48 hours after allergic foods are consumed. Delayed food reactions may emanate from any organ or tissue in the body and can contribute to over 100 allergic symptoms and well over 150 different medical diseases. An estimated 60 to 80 million Americans suffer from clinically significant food allergies, most all of whom suffer delayed symptoms.


Immediate vs. Delayed Food Allergy

There are many factors to consider when comparing Type 1 autoimmune reactions to Types 2 & 3 autoimmune reactions:

*Recent research seems to support that the delayed pathways may be a more common problem in children than the immediate reactions.

* Allergic symptoms of immediate reactions occur within two hours of eating. Allergic symptoms of delayed reactions do not appear for at least 2 hours, not infrequently showing up 24 to 48 hours later (there are even reports of delayed symptoms appearing 3 to 7 days after eating.) This makes certain allergies very difficult to identify through dietary observation. Because a small amount of a single food is involved, and the allergic symptoms appear immediately, immediate food allergies are usually self-diagnosable. Due to a combination of delayed symptoms, multiple foods consumed, and food cravings, Type 2 & 3 delayed-onset food allergies are rarely self-diagnosed. Blood testing is required to correctly identify Type 2 & 3 reactions.

* Immediate food allergies involve foods that are rarely eaten. Unfortunately, delayed food allergies often involve commonly eaten foods, and foods that someone may even crave.

* Immediate food allergies primarily affect the skin, airway, and digestive tract. However, virtually any tissue, organ, or system of the body can be affected by delayed food allergies. This includes the brain, joints, muscles, hormone-producing glands, lungs, kidneys, and nervous system. In fact, delayed-onset autoimmune reactions are linked to over 100 medical conditions involving every single part of the body, and some 100 different allergic symptoms as well.

* Immediate-onset food allergies are frequently permanent and fixed allergies. Once you develop an allergy to peanuts or shellfish, for example, it's for life. Delayed-onset food allergies are commonly reversible. If you strictly eliminate the allergic foods for 3 to 6 months, you can bring most of them back into your diet and remain symptom-free. Because delayed-onset food allergies are so often undetected and untreated, they are the culprits behind many chronic medical conditions with otherwise unknown causes. These allergic patients may suffer for years without ever suspecting that their health problems are rooted in what they eat.

* Delayed autoimmune reactions frequently change over the course of the years. Individuals can develop new autoimmune reaction pathways to foods that are eaten frequently. This is usually due to gastrointestinal permeability problems (also known as Leaky Gut Syndrome). This complication requires that in addition to the elimination of offending foods, a rotation diet must be established to properly correct the problem.

* Immediate-onset food allergy is often a skin-test positive allergy. The doctor can diagnose it with a simple scratch test. Delayed food allergies are skin-test negative. This means that traditional skin tests are poor assessments for detecting delayed food allergies. Instead, delayed reaction allergens often require blood tests in order to be detected. These tests detect serum levels of IgG antibodies to foods--IgA antibody as well as IgG in gluten sensitivity and celiac disease.


Treatment in our office begins with a complete exam and history to determine if an individual has the indicators of an autoimmune disorder. Frequently, general blood studies are ordered prior to food testing to evaluate for other health conditions and to help establish the diagnosis of food allergies. Once it is determined that food allergies are possibly responsible for a patient's condition, Delayed Food Allergy Tests are ordered. Our office utilizes the most advanced blood studies available for this testing.

A typical treatment program includes a 6 week elimination and rotation diet followed by an introduction phase. Symptomatic recovery is usually experienced within the 6 week elimination. However, dietary modification may continue for 12 to 24 weeks. Once recovery is complete, a patient can expect to get a lot of foods back in their diet. However, there are usually a number of foods that should always be avoided.

Some Conditions Associated with Food Allergies