"But I could be allergic!" Food Allergies and Eating Disorders a Dangerous Duo.

Abstract

For many patients with eating disorders (ED) a diagnosis of food allergies can complicate treatment and allow the patients to avoid appropriate nutrition. Food allergy testing is cost intensive, often does not contribute to changing the plan of care for a patient, and can even lead to misdiagnosis. A thorough history is indispensable in assessing a patient for food allergies and ultimately an oral food challenge is the gold standard for the diagnosis. There may be psychological benefit to knowing the outcome of a food allergy test if this is having a significant impact on the patient’s quality of life. This comprehensive clinical assessment by a physician may bypass some of the added stress and financial burden brought on by formalized food allergy testing. A 35 yo woman with anorexia nervosa (AN) presents with concerns about bloating, inflammation and the influence of food allergies on her overall health. She has had AN for 3 years and her lowest Body Mass Index (BMI) was 13. With treatment it has improved to 17. However, she has been reading about how food allergies can affect her body and is asking for food allergy testing. A key role of healthcare is to provide accurate diagnoses with the combination of clinical reasoning and diagnostic testing. The US healthcare system is often an expensive model for patients and the financial burden of food allergy testing must be considered with the impact on the treatment plan. It is imperative that the healthcare model continue to assess the necessity of food allergy testing in order to provide the best care to patients while still being mindful of the financial cost and how results can complicate care, especially in patients with ED. Patients with ED frequently have multiple rules about how and what to eat, and the ED can use the results of allergy testing to further limit their intake. This can lead to disastrous effects. Patients with eating disorders do not need another reason not to eat.