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Gluten is a protein in cereals such as wheat, barley, and rye. A person with gluten intolerance or sensitivity may experience pain and bloating after eating foods that contain gluten. Research indicates that around 1% of people in the United States have celiac disease, 1% have a wheat allergy, and around 6% have gluten intolerance — also known as non-celiac gluten sensitivity. People with celiac disease must avoid gluten, as it can cause intestinal damage and prevent the body from absorbing essential nutrients. Those with a wheat allergy must avoid all wheat products, as consuming any could even be immediately life threatening. Gluten intolerance can lead to discomfort, but it is unlikely to cause severe symptoms that require emergency care. An individual with gluten intolerance will develop symptoms after consuming foods containing wheat, barley, or rye. The symptoms of gluten intolerance may include: tiredness bloating abdominal pain diarrhea nausea constipation a general feeling of being unwell The following symptoms though non-specific might be associated also: anxiety headaches brain fog confusion numbness joint or muscle pain skin rashes A person with a wheat allergy within minutes to a few hours of consuming wheat can develop: hives/urticaria swelling/angioedema breathing difficulties, including wheezing & in severe cases, anaphylaxis may develop. Evaluating for Gluten Intolerance requires careful history taking, asking about symptoms and carrying out a physical exam. Then we will perform laboratory tests or a biopsy to rule out celiac disease and other gastrointestinal conditions. We then recommend a plan that allows them to monitor the person’s diet, elimination diets and any ill effects of various foods. Researchers have yet to find any specific biomarker of a gluten intolerance. At present, before diagnosing gluten intolerance, we will need to rule out other gluten associated disorders.

X-linked agammaglobulinemia or Bruton agammaglobulinemia, is an inherited immunodeficiency disease caused by mutations in the gene coding for Bruton tyrosine kinase (BTK). The disease was first elucidated by Bruton in 1952, for whom the gene is named. X-Linked Agammaglobulinemia (XLA) is an inherited immunodeficiency in which the body is unable to produce the antibodies needed to defend against bacteria and viruses. A genetic mistake in the BTK gene, prevents B cells from developing normally. B cells are responsible for producing the antibodies that the immune system relies on to fight off infection. The most common bacteria causing infection in XLA are Streptococcus, Staphylococcus and Haemophilus. XLA often becomes apparent in infancy once the maternal antibodies wane off, due to recurrent and severe bacterial infections including: • Ear infections • Sinusitis • Pneumonia • Diarrhea due to a parasite called Giardia Diagnosis of XLA can be made through screening tests that measure immunoglobulin levels or the number of B cells in the blood. There is no cure for XLA, but the condition can be successfully treated. Immunoglobulin replacement therapy under the watchful monitoring & guidance of an Allergist-Immunologist is a life-long and life-saving treatment that restores some of the missing antibodies. In addition, some people benefit from courses of oral antibiotics to prevent or treat infections.

Perennial allergies or Year Round Allergies may occur at any time of year—unrelated to the season—or may last year-round. Perennial allergies are often a reaction to allergens in household dust. House dust may contain mold and fungal spores, fibers of fabric, animal dander, dust mite droppings, and bits of insects. Substances in and on cockroaches are also the cause of allergic symptoms in some individuals. These substances are present in houses year-round but may cause more severe symptoms during the cold months when more time is spent indoors. (Substances that trigger an allergic reaction are called allergens) Usually, perennial allergies cause nasal symptoms (allergic rhinitis) but not eye symptoms (allergic conjunctivitis). However, allergic conjunctivitis can result when allergens are inadvertently rubbed into the eyes due to itching.   Symptoms of Perennial Allergies The most obvious symptom of perennial allergies is a chronically stuffy nose. The nose runs, producing a clear watery discharge. The nose, roof of the mouth, and back of the throat may itch. Itching may start gradually or abruptly. Sneezing is common. The eustachian tube, which connects the middle ear and the back of the nose, may become swollen. As a result, hearing can be impaired, especially in children. Some may also develop chronic ear infections. Some people have recurring sinus infections (chronic sinusitis) and growths inside the nose (nasal polyps). When affected, the eyes water and itch. The whites of the eyes may become red, and the eyelids may become red and swollen. The skin under the eyes can become dark (allergic shiners). Many people who have a perennial allergy also have asthma, possibly caused by the same allergy triggers.   Diagnosis Besides a careful history and thorough examination we need to conduct allergy skin testing which can help confirm the diagnosis and identify the trigger for symptoms (such as house dust mites or cockroaches). For these tests, the allergen extracts are placed into the uppermost layers of our skin. We then watch to see if there is a wheal and flare reaction (a pale, slightly elevated swelling surrounded by a red area). An allergen-specific immunoglobulin (IgE) blood test is done if results of the skin test are unclear or need confirmation. Then Avoiding or removing the allergen, if possible, is recommended, thus preventing the development of symptoms. Antihistamines, Anti- inflammatories, topical Corticosteroids & occassionally decongesants make up the medical therapy for perennial allergies. Ultimately Allergen Immunotherapy could potentially help resolve these chronic diseases.

ZAP-70 (zeta-associated protein 70) deficiency is an immunodeficiency involving impaired T-cell activation caused by a signaling defect. It is a primary immunodeficiency disorder that involves cellular immunity deficiencies. Inheritance is autosomal recessive. ZAP-70 is important in T-cell signaling and in T-cell selection in the thymus. This deficiency causes T-cell activation defects. They generally present during infancy or early childhood with recurrent infections similar to those in severe combined immunodeficiency (SCID); however, they live longer, and the deficiency may not be diagnosed until they are several years old. Blood Testing necessary includes Complete blood count, including absolute WBC count and differential, is done; immunoglobulin levels are measured. Responses to mitogens and to standard vaccine antigens are determined to evaluate WBC and antibody function. Patients have normal, low, or elevated serum immunoglobulin levels and normal or elevated numbers of circulating CD4 T cells but essentially no CD8 T cells. Management Treatment of ZAP-70 deficiency generally involves preventing infection, managing acute infection, and replacing missing immune globulins. The ZAP-70 deficiency is fatal unless treated by hematopoietic stem cell transplantation.

When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. “Ketogenic” is a term for a low-carb, high fat diet. The idea is for you to get more calories from protein and fat and less from carbohydrates. You cut back most on the carbs that are easy to digest, like sugar, soda, pastries, and white bread. You eat more raw fruits and vegetable for the 10-15 % calories you need from carbohydrates. The ketogenic diet is popular for weight loss these days. Keto isn’t exactly a new diet — a ketogenic diet has been around nearly a century for epilepsy management — and recent research is exploring possible benefits ranging from Parkinson’s Disease to certain cancers. Yet suppose you don’t have a weight control problem or any of those medical conditions; instead you have food allergies, then is the Keto diet safe for you? The danger of nutritional deficiencies from unnecessarily restrictive diets is a real possibility when done without medical or expert supervision. OAS is a form of a contact allergic reaction that occurs upon contact of the mouth and throat with raw fruits or vegetables. The most frequent symptoms of OAS include itchiness or swelling of the mouth, face, lip, tongue and throat. Symptoms usually appear immediately after eating raw fruits or vegetables, although in rare cases, the reaction can occur more than an hour later. OAS is generally considered to be a mild form of food allergy. Rarely, OAS can cause severe throat swelling leading to difficulty swallowing or breathing. People who have Oral Allergy Syndrome run a 1 in 60 chance of developing life threatening anaphylaxis. You should see an Allergist Immunologist if: Your OAS symptoms are causing significant throat discomfort; Your OAS symptoms are getting progressively worse; Your OAS symptoms are caused by cooked fruits and vegetables; Your OAS symptoms are caused by nuts; You develop systemic reactions after eating raw fruits or vegetables such as hives, vomiting or difficulty breathing. You wish to find out what pollen or foods you are allergic to so you can avoid them. As expected more fruits and veggies can aggravate OAS symptoms and needs proper Allergy guidance in some individuals.