“Our daughter, who was diagnosed with PDD-NOS, has no apparent allergy symptoms. However, a recent food panel shows she has mild (class II) allergy to egg white, peanut, soybean and wheat. Could you please provide guidance on the pros and cons of putting an autistic child with this type of allergy classification on a diet that eliminates these foods?”
Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional.
This week’s Food for Thought answer is by nutritionist Kelly Barnhill, director of clinical care at the Johnson Center for Child Health & Development, in Austin, Texas.
We know from clinical experience that elimination diets can help address health concerns. However, without appropriate guidance, the nutritional and other risks associated with these diets can outweigh their benefits. So they should not be implemented lightly or without professional guidance.
In regards to your daughter, it would help to know more before offering specific guidance on a potential allergy elimination diet. For instance, you mention there were “no apparent allergy symptoms.” Were there other symptoms that prompted her testing? Did the testing produce positive results for nonfood allergens such as cat or dog dander, dust or mold? It would also help to know her overall immune status and function.
Given the limited information in your question, I believe you’re referring to a histamine-related immune response. This would be a true allergy that unfolds as a strong, typically immediate immune system response to a perceived insult, or allergen.
The allergen can be something ingested or inhaled, or even touched. The inflammatory response typically involves multiple body systems and a specific antibody – immunoglobulin type E (IgE).
When this occurs, a domino effect follows: The immune system releases histamine and other inflammatory molecules to address what it sees as a foreign invader. We’re all familiar with this classic reaction: sneezing, watery eyes, runny nose, coughing and sometimes more. For some individuals, an IgE-mediated allergy response can include life-threatening anaphylaxis.
Allergy and Autism
In 2010, pediatric immunologist Harumi Jyonouchi, of the University of Medicine and Dentistry of New Jersey, published a comprehensive paper describing the need for greater attention to allergic responses in children with autism. She noted that true allergies in children with autism are likely underdiagnosed and undertreated, in part, due to their communication challenges. What’s more, he explained, allergies can cause or worsen behavioral symptoms such as irritability and hyperactivity.
Consider further allergy testing
Based on your reference to “class II” allergies, your daughter’s testing probably involved either an ELISA (enzyme-linked immunosorbent assay) or RAST (radioallergosorbent assay) blood test.
These widely used tests assess true allergic response to specific allergens. However, they frequently produce false positives or false negatives. In other words, they may miss an allergy (false negative) or incorrectly indicate one (false positive).
Consequently, many allergists and immunologists prefer to use skin-prick testing to identify allergies. While these tests can be uncomfortable, they’re relatively inexpensive, produce immediate results and are usually covered by health insurance.
So I suggest you discuss additional allergy testing with your daughter’s healthcare provider. Ideally this might include a IgE and IgG immune panels, total IgE and a celiac panel. Each of these tests can give you and the physician more information regarding your daughter’s immune status and food sensitivities. This is the information that I believe you need to create an appropriate elimination diet.
That said, perhaps there’s more to your daughter’s history that already points to food allergies. For instance, does she have a history of related symptoms? These could include frequent upper respiratory infections or hypersensitivity conditions such as eczema. If this is the cases, an elimination diet might be a reasonable approach at this time.
The importance of professional dietary guidance
In either case, I strongly recommend that you work with a knowledgeable professional to craft any elimination diet in the most healthful way possible. This is particularly important if you are considering eliminating important nutrition sources such as eggs, peanuts, soybeans and wheat. Without appropriate substitutes, eliminating these foods could lead to nutritional deficiencies or otherwise affect your daughter’s overall health status.
A diet or nutrition professional can guide you on a number of levels, including an analysis of your daughter’s current diet to offer sound nutrient replacement options, menu planning and strategies for both eliminating problematic foods and reintroducing new ones with success.
Increasing recognition of the gut-autism connection
The good news is that our research and medical communities have made great progress in understanding and appreciating the role that food can play in many health and behavioral conditions – including autism. This includes greater attention to food allergies, food sensitivities and gastrointestinal (GI) issues.
Read more about Autism Speaks' Gut-Brain Research Initiative here.
Today, more parents and professionals recognize the effect that food and GI issues can have on the overall health and well-being of all children. This is particularly true of children with complex health and behavioral conditions such as autism.
Bottom line: An elimination diet can produce benefits that outweigh the risks when applied safely with the guidance of accurate allergy testing and health professionals. I encourage you to explore this option further with your daughter’s healthcare providers.
Thank you again for your question. Please let us know how you and your daughter are doing in the comment section below or by emailing us again at email@example.com.