Dr. Michael Stierstorfer in his Center City office//Photo by Tessa Marie Images
A professional artist, Mairin Egge knows about color. But what she didn’t know was that red food dye might have been causing her irritable bowel syndrome. “I tried taking foods out of my diet, but I could never pinpoint it,” she says.
Credit Dr. Michael Stierstorfer, a dermatologist who lived in Rosemont for 16 years and once worked from the Ardmore office of laser dermatologist Dr. Eric Bernstein. He says he’s discovered what could be a cure for IBS, a condition that affects 10-15 percent of Americans and is characterized by unexplainable abdominal discomfort or pain associated with changes in bowel habits. He’s opened his first IBS Centers for Advanced Food Allergy Testing office at the Medical Arts Building in Center City, with the hope of expanding throughout the country.
What does a dermatologist know about IBS? Well, as it turns out, many people with IBS symptoms don’t actually have irritable bowel syndrome. Rather, they have unique food allergies that can be determined with a dermatologic procedure called skin-patch testing. Allergies observable on the skin are also likely to occur in the lining of the intestine. When specific foods are identified and excluded, IBS symptoms often diminish or disappear.
Like all medical positions, it’s only a hypothesis. Stierstorfer connected the dots after developing IBS symptoms himself. A mild bellyache and bloating led to more symptoms and persistent pain before a gastroenterologist ordered extensive, expensive and invasive testing. Shortly after, he ate at two Indian restaurants and had a flare-up, convincing him that it had to be the food—perhaps garlic. He avoided garlic, and within days, the symptoms subsided.
Stierstorfer applied a patch of garlic to his skin, removed it 48 hours later, and developed a small, itchy red spot, indicating a Type IV allergy. So why wouldn’t the lining in his gastrointestinal tract react the same? “It makes perfect sense,” says Bernstein, who, as a resident, took classes taught by Stierstorfer at what is now Drexel University College of Medicine. “Younger guys have been accused of criticizing [new work], but why not take the opposite approach: You have something new, and the first thing to say is, ‘What if this is true? How much suffering can he alleviate?’”
Of the four types of allergies, I and IV are the most prevalent and easiest to test for. Type I leads to anaphylaxis, a common reaction to peanuts or shellfish, but testing for it isn’t really helpful in IBS evaluation. Dermatologists use Type IV testing to search for causes of skin rash—or allergic contact dermatitis, a form of eczema.
Though many foods and additives in the average American diet are known to cause allergic contact dermatitis, Type IV skin-patch testing had never been used to identify the causes of IBS. Stierstorfer speculated that allergenic foods and additives may elicit a similar reaction in the gastrointestinal tract, resulting in what he’s calling a new disease: allergic contact enteritis.
A clinical study in Stierstorfer’s dermatology practice resulted in a March 2013 piece in the Journal of the American Academy of Dermatology. It was also covered in the November 2013 issue of Men’s Health. The study found that 30 of 51 participants with physician-diagnosed IBS had at least one doubtful or positive test result from a battery of 120 Type IV food-allergen patches. Stierstorfer developed the patches with licensed compounding pharmacists and university-based food scientists.
Of the 30, 14 benefited from avoiding the food and/or additive in question. “The same Type IV reaction demonstrated on the skin is occurring in the gut, resulting in chronic inflammation,” says Stierstorfer.
Stierstorfer realizes the limitations of the study. It only includes patients with active IBS, and there’s a need for a larger sample and a more balanced gender distribution. More foods and additives also need to be tested. “I would welcome the skeptics if I were him,” says Bernstein, a fellow researcher. “This is a treatment that cannot do harm. If it makes things better for some, that’s fine.”
Dr. Robert Coben is the gastro-enterologist at Thomas Jefferson University Hospital who confirmed Stierstorfer’s IBS diagnosis. He notes that his former medical-school classmate’s study prompts questions. For one, how long is a patient’s asymptomatic response sustainable for?
“IBS patients are difficult to treat,” says Coben. “There are lots of factors, triggers and ideologies. There’s also a compliance issue: Are patients really able to stay away from their allergenic food groups?”
In Stierstorfer’s office, the rows of patches with potential allergens are placed on a patient’s upper back for 48 hours and then removed. The back is examined for inflammation. Often, patients return a day or two later for a second exam, since reactions could take longer because of the skin’s protective layer.
Egge began her testing on a Monday. “It was awkward and unattractive,” she says.
On Wednesday, the taped patches came off. Initially, her skin reacted to removing the tape. By Friday, several areas had reacted to different red dyes. She was allergic to carmine—found in some yogurts and additives—and possibly Red No. 3 and Red No. 40—which is in everything from cheesecake to mouthwash.
Though much of skin-patch testing for rashes is FDA approved, food-patch testing isn’t. It is accepted by some insurers—Egge’s plan covered it as allergy testing. Without coverage, the costs are modest compared to an extensive IBS evaluation.
Egge now spends twice as much time food shopping and reading ingredients. “I aim for more organics,” she says. “I can survive [eating foods I’m allergic to] and be miserable, or make a choice to remove red dye from what I eat.”