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?
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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
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(The diagram on the right helps understand
the process for these patients.)
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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
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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
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Infuse | June 2019