Case Studies

 Case 4.9 Is this food allergy?

A 38-year-old woman presented with a 2-year history of abdominal bloating, cramping abdominal pains and loose stools. Attacks occurred every 7-10 days but lasted only 2-3h. One attack occurred about 8h after a meal of pasta in a local restaurant and led her to believe her symptoms were food-related. She initially eliminated wheat-based products from her diet and then, because the attacks continued, dairy products as well. She was referred to a gastroenterologist and investigated extensively: gastroduodenal endoscopy, duodenal biopsy, barium meal, colonoscopy and pancreatic function tests were all normal.

She continued to believe her symptoms were food related: vague muscular pains, headaches, poor concentration and fatigue were attributed to other foods which were also eliminated from her diet. She was referred to an allergy clinic for further assessment.

Physical examination showed an undernourished woman with no other abnormal findings. As this was a second opinion, a wide range of tests were done. Her haemoglobin and erythrocyte sedimentation rate were normal. Her serum immunoglobulins were normal and her serum IgE was only 8iu/ml. She had no detectable antibodies to endomysium or gliadin (see Chapter 19). While waiting for her outpatient appointment, she had responded to a newspaper advertisement and sent hair clippings (and money) for analysis of her 'food allergy'. The report listed 24 foods to which she was allergic, as well as water and North Sea gas. Listed were foods she had felt able to tolerate previously. Her diet had become increasingly restricted: expert dietetic assessment showed her diet to be nutritionally unsound, with deficient intake of protein, fat, fat-soluble vitamins and trace elements. The diagnosis was that of psychological food aversion and irritable bowel syndrome. She was reluctant to accept this diagnosis and asked her GP for referral to another specialist.