The Four Levels of Food He… Allergies. I Meant Allergies.

food allergy

I recently had an appointment with Dr N to go over the results of my food allergy testing. There are four reaction levels (allergy levels) for the skin test (well, five I suppose if you decide to count “no reaction” as a level): +1, +2, +3, +4. Levels 1 and 2 are not allergies yet, but are definitely sensitivities and are accumulating in your system, while levels 3 and 4 are allergies. All of the allergens are treated similarly: rotation diets. In the discussion that follows, A designates a day where you can have as much of the food as you want, L designates a day where the intake of the food is limited, and X designates a day in which the food needs to be completely eliminated.

caution plate

Level +1

A level 1 food is a food that could eventually turn into an allergen if it was allowed to build up in your system, but it takes significantly longer to build up than the other levels. Managing a level 1 is actually pretty easy, because you can have it every other day (AXAXAXAX). By leaving one day in between the days you consume the offending food, you are giving your body time to fully process the food and eliminate it from your body. Unfortunately, I do not have any level 1 allergens.

Level +2

The level 2 foods are very similar to the level 1, but they build up in the system a bit faster. Because you are more sensitive to the food, it takes longer for your body to effectively process and eliminate it from the body. The rotation diet for level 2 foods allows the foods to be consumed, in unlimited amounts, every third day (AXXAXXAXX).

I do have two level 2 allergens: baker’s yeast and beans. Baker’s yeast is in every bread product that needs to rise (except most quick breads like muffins and cakes). I eat lots of bread products on a regular basis, but at least I can still have all of the wonderful, non-rising carbohydrates… like crackers, and muffins, and cakes, and pastas, and… well, you get the idea. I’m also very glad I do not have to just completely eliminate them from my diet entirely, because that would be extremely difficult. The beans category is also pretty large, and includes all “staple” beans: black, red, brown, pinto, navy, kidney, etc). Unfortunately, I kind of live on beans. I’m a picky eater, and beans are one thing I love (mostly pinto, but I do love kidney beans cooked in things like chilis and soups). Moderately grumpy Lizz.

Can't have any of these on X days...

Can’t have any of these on X days…

Level +3

The level 3 foods are low level allergens. While your body does have an allergic reaction to the foods, it isn’t very severe, and may only present as stomach upset after a few days. The reactions to level 3 foods definitely are not life threatening. However, since they are an actual allergen, a little more care needs to be taken in the diet. Your body is already extremely sensitive to these foods, so it takes quite a while to process and eliminate them from the body. Since it takes so long, the rotation diet limits you to one serving of the food every third day (LXXLXXLXX) for six weeks. After six weeks you can treat the level 3 allergens like level 2 allergens (AXXAXXAXX).

Unfortunately, I do have two level 3 allergens. I’m allergic to cheddar cheese and chocolate… yes, chocolate. We’ll get back to the chocolate. But you remember how I just said I live on beans (if not, you should go read the level 2 section again…) and absolutely love pinto beans? Well, one of my main fallback and staple meals is burritos. I make burritos with flour tortillas (thankfully, no yeast), refried beans, and cheddar cheese. Sometimes I’ll get fancy and add chicken and/or tomato. They’re super easy to throw together at the last minute, and we always have the ingredients on hand. Though, now that I have a restriction on both beans and cheddar, burritos are no longer a “I’m too tired to make dinner” option. And the same goes for pretty much all of my favorite Mexican foods (or Mexican inspired foods).

... Oh but it is, it really is...

… Oh but it is, it really is…

Back to the chocolate. My obsession with chocolate is more than the stereotypical “girls and chocolate” thing… I have maybe two teeth that are NOT sweet teeth. My favorite sweet is chocolate. Pretty much the only times I will ever say no to chocolate are if I’ve had so much my stomach hurts, my nausea is extremely bad, or I’ve just brushed my teeth. I love orange chocolate, truffles, fudge, ice cream, pudding, frozen yogurt, candy bars, Crunch bars, caramel and chocolate, milk chocolate, Trader Joe’s truffle dark chocolate, etc. It’s a serious problem. Recently I’ve been on a pudding kick. I buy the packets of Jello instant chocolate pudding at the store and make it at home, and I eat it with Cool Whip mixed in. So delicious and a great summer dessert. I have been having pudding pretty much every night for most of the summer. Please excuse me while I go destroy Tokyo.

With my luck I'm allergic to that subway there...

With my luck I’m allergic to that subway…

Level +4

Level 4 foods cause more severe and noticeable allergic reactions. While level 4 reactions aren’t typically life threatening, the reactions are more what you would expect a reaction to behave like: itching mouth/lips, more mucus in the throat, upset stomach, running eyes/nose, etc. We didn’t talk too much about the level 4 reactions because, thankfully, I don’t have any level 4 foods. Now, because of the severity of the level 4 reactions, the diet is much stricter than the others. First, you have to completely purge the food from your body by completely eliminating it from your diet for three months. After the three months, you introduce the food back into the diet as if it was a level 3: LXXLXXLXX. I’m not sure if there is more testing in between the purge and the reintroduction, but I am pretty sure you have to at least wait for doctor approval to begin eating the food again.

So, now that we understand what my food allergens are, and how to treat them, I’m on a rotation diet. I’m glad that I don’t have to eliminate them, but it still sucks. I had been eating chocolate and yeast (group 1) on the same day, then cheddar and beans (group 2) the next day… so my schedule looked like: 12X12X12X. Today was supposed to be a day for group 1, but I only ate chocolate, so I can have yeast tomorrow if I want. I’m glad I had just gotten a new planner, because it will help keep track of the rotation.

rotation diet cartoon

On top of just minimizing my allergies, we are hoping the rotation diet will improve my EoE symptoms. Right now, the ranitidine has my EoE pretty well controlled, but not completely… and the triggers are still unknown. If this rotation diet doesn’t help after six weeks, we’re going to try a different medication. Apparently this medication can be pretty expensive, but should be covered by insurance. Hopefully, if I do need it, the cost won’t be prohibitive…

I do have more information to share from this visit, but this post is long enough already. I’ll post the second half tomorrow, so stay tuned!

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