Infuse Issue 8 June 2019 - Page 22

Your clinic also works with patients with coeliac disease as well. Is there any overlap between allergies, food chemical sensitivities, and coeliac disease? • • • • • • • • It is important to understand that these are separate conditions with different mechanisms, tests and dietary treatments. However, in some patients there is overlap of the conditions which presents a real challenge with dietary investigation and management for them. Infants with eczema F/H asthma, eczema, hayfever Immediate reproducible reactions Egg, milk, nuts, seafood, wheat, soy Nuts & seafood often persist Airborne allergens SPT, specific IgE blood test Complete avoidance Adverse Reactions to Food Food Allergy IgE antibodies With these individuals there are separate investigations for food allergy, intolerance and coeliac disease and then a diet is developed to manage each of the conditions together. When taking a very careful history it is important to keep in mind the differences between these adverse reactions to food and understand how to drill down to identify the differences. Food Intolerance Irritation of nerve endings Coeliac Disease Inflammatory T-cells • • • • • (The diagram on the right helps understand the process for these patients.) • • • • • • Any age F/H Coeliac disease, diabetes, thyroid disease Chronic reproducible reactions to small amounts of gluten HLA gene association Blood test for antibodies to tissue transglutaminase Small bowel biopsy Strict gluten free diet Life-long immune reactivity • • • • • Any age F/H hives, headache, IBS, mouth ulcers Delayed variable reactions Dose dependent, cumulative Life-long susceptibility, variable tolerance Natural chemicals and additives Wheat, milk, soy Diagnostic elimination diet and challenges What’s the best part of your job? I would say that one of the most rewarding and satisfying parts is to help patients restore their health so that they can live normal lives symptom-free. To see patients restored to good health makes all the clinical work and research worthwhile. Another rewarding aspect of my job is the sharing of knowledge and experience with my colleagues in the profession to help their patients and to encourage, support and inspire the students and new graduate dietitians to pursue a successful and rewarding career in dietetics. LEARN MORE: https://www.slhd.nsw.gov.au/rpa/allergy/default.html © Dietitian Connection 22 Infuse | June 2019