Under what conditions and how do you test for IgE food responses. What is the testing chronology of Cyrex Array? Which is IgA and IgG versus IgE testing?

For me, when I’m thinking about IgE testing, we’re thinking a lot more about, like, an allergic response, so there, you’re thinking more of, kind of, a typical allergy. I would say first of all, it’s pretty rare that I do testing for IgE food response, and then I’m normally sending out to an allergist. But most often, patients know if they’re having that allergic-type reaction because they might be getting hives or, hopefully, their throats [are] not closing and they’re not having mouth swelling, but again, that’s your allergic-type reaction. I would say clinically, the allergic and IgE-mediated responses tend to be more apparent. The IgA and IgG responses, here, we’re talking about food sensitivities, and those reactions, I think clinically, are a lot more nuanced and subtle. In terms of the chronology, I’m almost always going to be testing for IgA and IgG when I want to know about food sensitivities. IgE is pretty rare for me in terms of referring out for testing because I tend to think, “Okay, well, we’re having an allergic-type response”; it’s a little bit more clinically evident, so it’s not as much of a clinical quandary kind of thing, but we might be thinking about how do we kind of moderate the immune response—are we going to use quercetin, bromelain, etc., kind of quelling that IgE response? But it can certainly be appropriate if the patient is having a lot of allergy symptoms and you don’t know what’s triggering those. Again, then if you’re going to do IgE testing, you probably also want to test for some pollens, grasses, trees, and other common allergens, [like] dust mites, etc.

But in terms of the chronology for Cyrex Array testing, if the patient’s still eating wheat and gluten, I’m pretty much going to run the Cyrex Array 3 almost every time. If they say, “No, I want to be able to include wheat or gluten in my diet, even, like, once a month,” I’m going to run that Cyrex Array 3.

Arrays 4 and 10, those I would either run if we do the Cyrex Array 3 and there is a significant immune response to multiple antigens. In that case, I’m going to say, “Wow, your immune system is really reacting strongly to wheat and gluten.” This is sort of a trigger for me to start thinking about how your immune system is responding to things more generally. In that case, I’m going to go a little bit more quickly to Cyrex Array 4 and maybe 10, depending on what the financial burden or financial resources are, because this can get expensive. But I’m going to use Array 4 and Array 10 to help us come up with a therapeutic diet while we’re working on improving the gut, improving the immune balance, etc. That would be one reason I would move into Array 4 and Array 10 a little bit more quickly, specifically if the Array 3 is a significant immune response. Otherwise, most of the time, I’m going to hold off on doing Arrays 4 and 10 because as we improve the gut, as we rebalance the gut microbiome, as we remove gluten or some of the more obvious triggers—lower hanging fruit—the immune system and the gut are going to heal and become less reactive, so food sensitivities are going to change. If I do a food sensitivity panel Array 4 or Array 10 before I’ve done the antimicrobial treatment, those food sensitivities are going to change by the time we’ve healed the gut, and leaky gut is less of an issue. To some extent, from my bias, which is not necessarily wanting to spend a lot of money on testing, particularly when I know those test results are going to change in response to what we’re already doing, I’d prefer to hold off on testing an Array 4 and 10 until I feel like we’ve made some progress. Some people just want to do testing to have clearer numbers and some clear guidance from those numbers in terms of “Well, what should I be eating during this treatment phase?” So, that would be another option, just kind of letting the patient know how this might affect our treatment plan or the diet going forward.