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Had ITP as child resulting in splenectomy. Developing increasing food allergies, fatigue. No detectable IGM. Advise?

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Allergist and Immunologist
Practicing since : 1999
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I had ITP as a child resulting in a splenectomy with no complications. I am now 44 and as I age am developing increasing food allergies (I can eat only a few foods). Recently al alternative medicine doctor discovered via bloodwork that I have no detectable IGM. Tis was confirmed by a recheck at 3 months. I suffer chronic fatigue as well. Wondering if anyone had any insight into how all this is connected and what to do about it. Tired of feeling tired and hungry
Posted Wed, 4 Sep 2013 in Asthma and Allergy
 
 
Answered by Dr. Sujoy Khan 7 hours later
Brief Answer:
Absent IgM needs serum electrophoresis check.

Detailed Answer:
Hello XXXXXXX

Absent IgM is sometimes an isolated finding. It is does not require further investigation if other Igs - IgA, IgG, IgE are detectable. If IgG or IgA are undetectable, you need a serum electrophoresis, Serum Free Light Chain estimation (SFLC) and/or urine electrophoresis to exclude myeloma that can cause suppression of immunoglobulin production. And if serum/urine/SFLC are normal and IgG/IgA are absent, you have developed an immunodeficiency and the cause then needs to be established.

ITP in the past does suggest an immune mediated mechanism operating within you. In this instance it is important to exclude known causes of immunodeficiency, i.e., viral infections. That can explain the fatigue.
Alternatively, absent immunoglobulins that protect you from infections and if absent will lead to chronic infections thereby causing 'fatigue'.

If IgE is present, specific IgE against the foods you think you may be allergic to can be done to see if there is any evidence of allergy.

In simple terms, it is too precocious to term you as immunodeficient. If I were to be your treating doctor, I would investigate further as described above. Further management will depend accordingly.

I hope that was useful.
Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Had ITP as child resulting in splenectomy. Developing increasing food allergies, fatigue. No detectable IGM. Advise? 10 hours later
Thank you. All of my other immune antibodies are normal. I have a "reaction" to many, many foods but despite this, my IgE levels are normal, indicating that I don't actually have any food " allergies" per say.

Thank you!
 
 
Answered by Dr. Sujoy Khan 1 hour later
Brief Answer:
Negative specific IgE does not exclude intolerance

Detailed Answer:
Hello,

The fact that specific IgE to foods are negative indicates that you do not have immediate hypersensitivity, but 2 things are not diagnosed with this:
1. Celiac disease - where TTG-IgA levels are positive;
2. Food intolerances - where you do not have enough 'levels' of enzymes to breakdown food proteins and have abdominal pain and/or diarrhoea a few hours after eating.

I hope that was useful.
Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Had ITP as child resulting in splenectomy. Developing increasing food allergies, fatigue. No detectable IGM. Advise? 34 minutes later
I have been tested for celiac disease via biopsy and it was negative. My reactions to food are not necessarily digestive....many of them are neurological.....blurry vision, strange sensations, insomnia etc. MS, blood sugar issues and almost everything else have been ruled out. These reactions are definitely triggered by food though.
 
 
Answered by Dr. Sujoy Khan 43 minutes later
Brief Answer:
Atypical reactions to food

Detailed Answer:
Hello,

The symptoms that you mention are quite atypical of food allergic reactions.
Migraine and other neurological disorders are (however) seen with cheese, chocolate and foods XXXXXXX in tyramine.
So you may want to avoid foods XXXXXXX in tyramine should your neurologist feels the symptoms are bad enough to require treatment every time.

Best Wishes.
Above answer was peer-reviewed by
 
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