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  • Scott Adams
    Scott Adams

    Allergy and Intolerance by Lydia S. Boeken M.D.

    Reviewed and edited by a celiac disease expert.


    Through his writings, we know that Hippocrates, the father of medicine, had already recognized the presence of allergic reactions in people as early as ancient times. However, the term allergy is a relatively new one, as compared to many other commonly used medical terms. In 1906, Viennese pediatrician Baron Clemens von Pirquet used the term for the first time to describe an altered response of his patients bodies. Von Pirquet believed that this altered reaction manifested itself in changes of the immune system, effected by external influences on the body, such as: food intake, the air breathed or direct skin contact. The term allergen (the substance responsible for the altered reaction) was born. At that point in time, however, von Pirquet had no means of scientifically proving that these immunological changes actually occurred in the body. It was not until the mid-1920s, that a second significant event occurred.

    Researchers found that, by injecting a minute quantity of purified allergen under the skin, certain individuals would develop a clear skin response; a welt, with or without itching and redness, could be provoked. This positive skin test for allergies would show itself most prominently in patients with hay fever, asthma, chronic rhinitis, hives and eczema. The prick test became a method of demonstrating the involvement of the immune system in allergic reactions. However, the precise biological reason for the reaction continued to remain a mystery.

    It was not until the Sixties, when an important discovery occurred which provided long-awaited scientific support for the classical allergy theory and removed any doubts about the relationship of the immune system with allergies. This breakthrough came about with the scientific discovery of immunoglobulin E (IgE) by a Japanese couple named Ishizaka.

    Classical Allergic Reaction

    The following are the chain of events which happen in allergic reactions:

    • An allergen must be present in the body. This allergen is the substance which causes us to have an abnormal immunological response. Allergens tend to be protein molecules. Interestingly enough, the immune system only detects particles of a certain size as potential troublemakers and protein molecules are just the right size. In a small number of cases, the body actually responds to molecules other than proteins. These molecules, which are generally much smaller, are called haptens. By combining with protein molecules, haptens form larger complexes which can then be detected by the immune system.
    • The allergen is detected by the B cells. These are specialized immune cells, capable of producing antibodies. Just like allergens, antibodies are protein molecules, which have the capacity to neutralize allergens.
    • Every B cell produces its own, specific antibody, depending on the type of intruder it needs to respond to. It is easy to understand why the body must have a ready pool of millions of antibodies, in order to combat these numerous offenders. There are five main categories of antibodies (IgG, IgA, IgM, IgD and IgE) which the body releases under different circumstances (for instance to fight off various infections, etc.). In the case of allergies, the body produces the antibody immunoglobulin E (IgE), first discovered by the Ishizakas.
    • Usually, antibodies will bind directly to the appropriate damaging substance and neutralize it. However, IgE deviates from this common path. It first attaches one of its legs to one of the bodys numerous mast cells. The other leg is used to hold on to the offending allergen. This action signals the mast cells to begin disintegrating, thereby releasing histamine.

    Histamine is a chemical substance responsible for a great number of complaints which may arise during allergic reactions. It causes muscle cramps and an inflammation-like process with redness and swelling of mucous membranes.

    Allergic reactions can occur under a variety of circumstances. For instance, inhaling certain substances, such as grass pollen, house dust, etc., may cause an allergic response. However, the consumption of certain foods may do the same. Allergies typically bring on complaints very rapidly upon contact with the allergen. Complaints may vary from a runny nose, sinusitis, earache or runny eyes to itching of the skin, eczema and shortness of breath.


    Conventional medicine can easily diagnose and treat allergies for foods or inhalants. Here, the so-called RAST test plays a very important role, because this test can demonstrate the presence of IgE.

    However, demonstrating the presence of intolerance is more difficult. In this situation, similar to the case of classical allergies, the body responds abnormally and, in addition, the immune system does not produce IgE. It quite often takes much longer for complaints to come on, thereby masking the possible link between the offensive substance and the complaints themselves.

    These are only a few of the reasons why food intolerance is considered a fairly controversial concept in conventional medicine. Intolerance can be responsible for a wide variety of complaints which, at first glance, seem to lack a plausible explanation. Intolerance can manifest themselves as the following:

    • Gastrointestinal complaints: stomach ache, irritable bowel, Crohns disease, ulcerative colitis
    • Skin complaints: itching, eczema, hives, acne (in adults)
    • Joint and muscle complaints: ranging from atypical pains to rheumatoid arthritis
    • Headache and migraine
    • Chronic fatigue
    • Asthma, chronic rhinitis or sinusitis
    • Pre-menstrual syndrome
    • Hypoglycemia
    • Depression, anxiety
    • Sleeping disorders

    Diagnosing Intolerance

    It is impossible to accurately demonstrate intolerance through conventional testing methods.

    The Amsterdam Clinic currently uses the following test, which is very reliable.

    • Another useful test is the IgG(4) antibody test. Here, the presence of IgG(4) antibodies is determined. These antibodies are the slowly occurring variety, which do not appear in the blood until 24 to 48 hours after exposure to an offending food or substance. The reliability of this test varies between 80 and 90%.



    In the treatment of inhalant allergies (such as asthma, hay fever) and food allergies and intolerance, avoidance (elimination) of allergens plays an extremely important role. In the case of food sensitivities, either the cytotoxic test or IgG(4) test can help determine reactions to specific foods. Based on the test results, an elimination/rotation diet can be specifically tailored.

    Foods causing strong reactions in these tests, should (temporarily) be excluded from the diet. More moderate reactions allow for rotation of certain food items in the diet. These may be eaten once every four days. Especially during the first week(s) of the diet, withdrawal symptoms, similar to complaints stemming from the cessation of coffee, tobacco or alcohol consumption, may occur. The body seems to crave offending food items. Generally, these withdrawal symptoms disappear after a couple of weeks. Concurrently, those complaints relating to food sensitivity also diminish.

    Using this dietary approach, the reaction to food allergens may decrease in the course of time. After a three month moratorium, reintroduction of forbidden food items can be attempted, one at a time. In this way, food items still causing reactions can be isolated more easily. Often, at least part of existing intolerance completely disappear after an elimination/rotation diet.

    With the treatment for inhalant allergies, elimination is also the first step. It is obvious that patients having an allergy for cats or dogs, should avoid any contact with these pets. The situation becomes more difficult when dealing with allergies to grass or tree pollen, since total elimination is basically impossible. The same goes for house dust mite allergy. The house dust mite lives in mattresses, pillows, carpeting, drapes, upholstery, etc. Through mite-killing pesticides, special mattress and pillow covers, non-carpeted floors, etc. reasonable results can be obtained.


    Medicines for inhalant allergies, such as antihistamines (Triludan), corticosteroids (Prednisone, Pulmicort, Becotide), cromoglycates (Lomudal, Lomusol), and airway dilating medication (Ventolin, Berotec, Atrovent) do suppress symptoms, however, they do not cure the allergy! In the realm of conventional medicine, effective medications for food allergy and intolerance do not exist at all.


    Enzyme-potentiated desensitisation (EPD) and the provocation/neutralization method are very effective treatments for food allergy/intolerance and inhalant allergy problems. These methods tackle allergy problems at the root.

    • During EPD treatment, a small quantity of a food or inhalant allergen mixture is injected intradermally into the skin, in conjunction with the enzyme beta-glucuronidase. This combination causes the body to gradually adjust its exaggerated responses to food and inhalant allergens. In this way, the immune system is readjusted and reset. Initially, the injections have to be given once every two months. Gradually, however, the intervals between injections become longer and the injections can often be discontinued after a time. According to conservative estimates, at least 80% of those patients treated with EPD show considerable improvement in the course of time.
    • Provocation/neutralization can be used both diagnostically and therapeutically. Here, separate extracts of food or inhalants, suspected as possibly offending, are injected intradermally. This causes a welt to appear in the skin. After 10 minutes, the size and nature (firmness, color, etc.) of the welt are evaluated. A positive welt will generally bring on symptoms (provocation). Depending on the size and nature of the welt, as well as, the presence of symptoms, varying concentrations are injected, until a dose is found which does not cause any welt changes or symptoms. This is the neutralizing dose. Injections with the proper neutralizing dose will bring on immediate protection against the symptoms caused by the offending food and/or inhalant.

    Copyright © 1996 the Amsterdam Klikiek

    For further information please contact:

    Amsterdam Kliniek
    Reigersbos 100
    1107 ES Amsterdam Z.O.
    Telephone 31 (0)20 697 53 61
    Telefax 31 (0)20 697 53 67
    Lydia S. Boeken M.D. London/Amsterdam

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    Recommended Comments

    I was diagnosed with celiac disease in February of 2006, and it has been very hard for me to explain to people the difference between an allergy and an intolerance, and after I referred them to this article, they finally understood!

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    I have been searching and reading for several years on the subject. Yes, celiac is a damaging thing, however, intolerance is pretty nasty too. The sickness and life alteration it causes is horrific. I have intolerance big time! It is so not worth it for me to try and live a life with wheat allergens. We are all different and let this be a help for ALL of us as it is! I enjoyed reading everyone's spin on it here.

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    Kelly, I believe you are mistaken. The endoscopy/biopsy was considered the gold standard 50 years ago, when today's sophisticated blood tests were not available. The biopsy has a surprisingly high false-negative rate, as villi damage is often patchy, not visible to the naked eye, and therefore easily missed; healthy areas taken for biopsy might be right next to a damaged area.


    People with dermatitis herpetiformis don't always have villi damage, so it is evident that the autoimmune reaction of celiac can bypass the intestines and not cause villi damage.


    In addition, with adult-onset celiac, many people with 'gluten intolerance' might actually have early-stage celiac. They would be having the same dangerous autoimmune reactions as anyone with biopsy-diagnosed celiac, and would need to be every bit as careful with their diet.


    If you go onto the forum of this site, you will find several members who were severely ill, some nearly dying, but all tests for celiac were negative. Yet, they were only able to recover their lives by removing gluten from their diet; these people were eventually diagnosed as celiac, as their immune systems were obviously involved in a way consistent with celiac, but they should never had to practically lose their lives because of such narrow diagnostic criteria. Their symptoms and dietary responses should have been caught long before, and weren't because of doctors stubbornly clinging to that narrow diagnostic criteria from half a century ago.

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    After 6 years of my Doctor telling me I had everything from IBS to Celiac to Diver, last year I had my GALLBLADDER removed and now I am back to normal. DONT STOP ASKING QUESTIONS AND PURSUING, my doctor robbed 6 years of my life because of his incompetence.

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    Guest Marion Donald


    I've read the comments. I've come to the conclusion that personal food testing and experimenting is about the best way to find out if one has Celiac Sprue. I'm so much better since eating mostly fresh, steamed veggies and very little non-breaded lean meat/fish.

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    After 6 years of my Doctor telling me I had everything from IBS to Celiac to Diver, last year I had my GALLBLADDER removed and now I am back to normal. DONT STOP ASKING QUESTIONS AND PURSUING, my doctor robbed 6 years of my life because of his incompetence.

    John: Actually, celiac disease has sickened many a gallbladder, mine included. I was very sick for a long time and was discovered to have gallstones. My gallbladder had to come out. I felt better, but had trouble regaining weight. I also happened to have a mysterious skin problem on one arm. While my digestive symptoms improved for a while, eventually they got worse again and my surgeon suggested I had celiac disease. He's not a fan of people consuming wheat anyway, not if they want to stay young and healthy. After about 5 weeks on the diet, I'm much, much better. My twin sister started the diet too, and she's doing well also. I think you should have the blood tests now, before your health goes downhill again and you want to quit eating gluten immediately.

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    After suffering from intestinal pain since a I was a child now at 41 a dear friend of mine nagged me to go off gluten for 3 years. I tried everything to avoid it, I went to multiple doctors, gastro doctor and had a Colonoscopy and still they found nothing except for a lazy colon, which I kind of figured since I only go about once a week, ouch. I fit the bill for Asthma, Fybromyalgia, migraines, and have had depression my entire life. So finally I decided to take my friends advise and stopped eating gluten. Now a year later I am still gluten free and feel great. I find the website as my bible to all the information I need. Recipes, updates, read other peoples ideas and comments, it is just wonderful. Thank you for having such a clean easy flow site that is up to date.

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    I accepted my internal medicine doctor's diagnosis of IBS, but have always tried to be careful not to eat too much wheat/gluten. Nonetheless, the symptoms listed in your article are creeping up on me again, so I think I will see a Naturopath that has been recommended to me. I am very grateful for your information on the presence/non-presence of igE being indicative of whether one has an allergy or an intolerance.

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    From the responses to this article, it seems that it has been misleading for some people. This article, although a fine summary of food intolerances, does not describe Celiac disease. Gluten intolerance is not Celiac disease. In a world full of medical unknowns, we DO know the exact mechanism of Celiac disease. The body produces an antibody response (IgA) to a protein called gliadin (a small, indigestible part of gluten) as it comes through the small bowel. This creates a hostile inflammatory environment in the wall of the small bowel which destroys the absorptive surface. At the same time, the antibody responding to gliadin, recognizes an enzyme (tTG) because gliadin is bound to it. tTG is found in a lot of different tissues, including the skin. This is why Celiac disease can be called an autoimmune disease. If you eliminate gluten from your diet, the antibody response is eliminated and all returns to normal. Antibodies to tTG can be measured from the blood giving the diagnosis of Celiac disease. This test picks up 90-100% of people with Celiac disease. But the gold standard of diagnosis is endoscopy with small bowel biopsy. If you haven't had this, then you can't exclude Celiac disease. It is true that you can be gluten intolerant, and it is true that you can have an IgE mediated allergy to wheat, but these are not Celiac disease.

    I don't think this article claimed to be a definitive guide to coeliac disease. I have allergies, including wheat, and I found it very informative and helpful.

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  • About Me

    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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