Dr. Amy Nett: So to me, the reintroduction would not be after 60 days. If you wanted to reevaluate dairy, what I would do is figure out what are the underlying contributing factors to inflammation, immune dysregulation. So do you need to treat the gut first? Do you need to get rid of heavy metals? What do you need to do to bring this patient’s immune system back into balance as best you can? Once you feel like you’ve done treatment, improved symptoms, if the antibodies are really high, I would actually repeat the Cyrex Array 4. I don’t think I would do a reintroduction of food. I would want to see have the antibodies actually changed? Because I probably would be a little bit more cautious in someone who has celiac disease. And I would want to be a little bit more clear.
So if we repeated that and then saw that the antibodies were in that yellow or equivocal range or in that green column, then I would be more open to slowly reintroducing dairy and remember to do the higher-fat options first. So that’s also a little bit tricky though, right? Because in order to repeat the Cyrex Array 4, that patient is going to have to eat dairy for 7 to 10 days. So in a way you are going to be reintroducing, but I would do the most limited eating of those foods as possible like only for the 7 to 10 days or the specific time that’s recommended. And then bring them off and then follow up on what the antibody titers look like. So in answer, be a little bit more cautious probably when they’re both celiac and when the antibodies are just really high out of range.