The Curbsiders Internal Medicine Podcast #95 Food allergy, food intolerance and celiac disease
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May 14, 2018 Sheila Crow, gastroenterologist and researcher focused on food allergy, intolerance, and celiac disease. She explains how to tell immune-mediated allergy from nonimmune intolerance. Shortlists appropriate diagnostic testing and when to suspect celiac’s extraintestinal signs. Discusses FODMAPs, especially fructans, as a likely cause of many so-called gluten sensitivities and warns against unvalidated “voodoo” tests.
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Different Immune Mechanisms Matter
- Celiac disease is immune-mediated via T cells while classic food allergy is IgE/mast cell mediated.
- Intolerances like lactose are non-immune mechanisms with enzymatic or pharmacologic causes.
Test TTG IgA Early While On Gluten
- Test for celiac with a TTG IgA while the patient is still eating gluten; do it at the first visit.
- Consider checking total IgA or using IgG assays only if IgA deficiency is suspected.
Diagnose Lactose By History, Confirm By Breath Test
- Use history to narrow intolerances first: try a trial of skim milk to assess lactose intolerance.
- Use breath tests (lactose, fructose) if history is unclear or available in your practice setting.
