Module 3: Adverse Reactions to Food

10.00: Opening of meeting

10.05: The Classification of, and evidence for, the ways in which foods contribute of to ill-health.

• Different classifications, establishing the reality of adverse reactions, establishing mechanisms, specificity versus sensitivity of different forms of challenge.
• Types A and B reactions and their characteristics.
• Metabolic and pharmacological mechanisms.

11.00: Coffee

11.20: Elimination Diets

• Historical development of the different forms of elimination diet; their advantages and disadvantages.
• History - Rowe's diets, McEwen's diets, Lamb and pears, and Few foods diets (and why not to use them without desensitisation back-up), Addenbrooke's diet and its origin, Stone Age diet (Mackarness), and variations Airedale version with rotation.
• Also just guessing from history, diet diary, addictions, chipping away.
• Likelihoods of particular foods being the culprit based on results of trials, such as Egger's.
• Mention of diets for disaccharide problems, dysbiosis etc (to be covered later).

12.20: Panel Discussion

1.00: Lunch

2.00: Establishing sensitivity to foods

• Methods of challenge and limited role of laboratory and other tests.
• Oral challenge after appropriate period of avoidance as current gold standard for clinical investigation.
• Negative results cannot be relied on unless food investigation was in an ultra-clean environment, with appropriate timing, size of portion, and contact of food with the mouth.

2.40: What to do first

• Recognition: typical history and symptoms, addictions and cravings.
• Clearing the way: environment, hyperventilaters, obvious non-starters, obvious bad diet.
• The importance of a good history and of the clues that can be derived from it.
• Problems that are better dealt with first, or simultaneously.
• Recognising patients who could not manage an elimination diet.
• Adapting methods to the patient.

3.20: Tea

3.40: The Stone Age diet

• How to chose your patients, when to do it and when not to do it.
• How to reintroduce foods.
• Do these patients need supplements?
• Good general nutritional content of this diet, but patients must also avoid any foods they are aware of reacting to.
• Advantages of asking the patients to reduce exposure to pollutant chemicals at the same time, and to rotate between two food lists.
• Details about the management of patients during and after the diet.

4.30-5.30: Panel discussion

Second Day Session

9.00: Gut dysbiosis

• Diagnosis and management
• Recognition, diagnosis and management of bacterial and fungal types of gut dysbiosis.
• Aetiology and mechanisms.
• Abdominal and distant symptoms.
• Role of diet and medication.
• Blood group antigens shared with microorganisms and their role in disease.

10.00: Non-allergic adverse food reactions

• Idiosyncracies, biochemical, physiological and pharmacological reactions to foods, gut enzyme failures, hypochlorhydria, enzyme polymorphisms, gut permeability etc.

11.00: Coffee

11.20: Management of allergic children in general practice

• Recognition of children affected by adverse reactions to foods.
• Syndromes special to children.
• Modifications of elimination diets for children.
• Fungal type gut dysbiosis and its management in children.

12.20-1.00: Panel discussion

1.00: Lunch

2.00: Brittle patients and their management

• Recognition of patients who might have severe reactions on challenge, worsening patients with Type A allergy, patients with moderate or severe asthma etc.
• Precautions - arranging challenge under supervision, rubbing food on intact skin, or touching lips, delaying challenges for 2 months, dangers of accidental challenge.

2.30: Problem Cases - longer term management

• The tightrope between sufficient precautions to improve and a satisfactory lifestyle.
• Possible contributions of rotating foods, of Nalcrom and of desensitisation.

3.10: Tea

3.30: Problem Cases - The role of the environmentally controlled unit

• Fasting in an ultraclean environment as the only way to exclude a contribution of adverse reactions to foods as a cause of medically-unexplained conditions which have failed to respond to other managements.
• Regime and findings.

4.00-5.00: Panel discussion