Joint Inflammation and food allergy
Reviewed: February 24, 2020
I recently had a patient referred for food allergy testing by her orthopedic surgeon due to severe inflammation in her joints. I did send celiac disease blood testing but did not perform broad food testing on the patient as I am unaware of any known association between food allergy and joint disease. Possible oral allergy syndrome based on history of mouth burning and itching with ingestion of plums and oranges and thus I recommended avoidance of these foods for that condition. Skin prick testing to orange and plum extracts were negative; did not test with fresh fruits. Do you have any recommendations for further testing or know of any studies which indicate a relationship between food allergy and joint inflammation?
There is no evidence that IgE mediated food sensitivity will cause chronic joint inflammation. There have been case reports of an association with food and joint pain, usually with rheumatoid arthritis. Dr. Panush in 1990 reported that in his clinic “Probably not more than 5% of rheumatic disease patients have immunologic sensitivity to food(s).” This statement was based upon a combination of detecting IgG-food immune complexes, of measuring IgG, IgG4, IgA, IgM and IgE to food and of assessing the effects of unblended diet on symptoms. He concluded “These observations suggest a role for food allergy in at least some patients with rheumatic disease.”
In summary, there is no definitive relationship between food allergy and joint inflammation. Avoidance diets, including reduction of foods with long chain n-3 polyunsaturated fats and polyunsaturated omega-6 fatty acid (arachidonic acid) and substitution with fish (rich in omega-3 fatty acids and eicosapentaenoic acid), have been associated with improvement in joint complaints but there is no evidence of immunologic basis for these diets. Immunologic responses to food have been measured but the roles of specific immune responses in joint diseases have not been established. Most data suggest diet effects, if any, are metabolic. Any recommendations for specific immunologic testing to food, specifically IgE testing, is speculative and, in my opinion, not advisable.
Darlington, L. G., N. W. Ramsey, and J. R. Mansfield. "Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis." The Lancet 327.8475 (1986): 236-238.
Hafström, I., et al. "A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens." Rheumatology 40.10 (2001): 1175-1179.
Parke, A. L., and G. R. V. Hughes. "Rheumatoid arthritis and food: a case study." BMJ 282.6281 (1981): 2027-2029.
Panush, R. S. "Food induced (" allergic") arthritis: clinical and serologic studies." The Journal of Rheumatology 17.3 (1990): 291-294.
Giuseppe, Daniela Di, and Alicja Wolk. "Diet and rheumatoid arthritis development: what does the evidence say?" International Journal of Clinical Rheumatology 9.2 (2014): 169-182.
I hope this information is of help to you and your patient.
All my best.
Dennis K. Ledford, MD, FAAAAI