Recently, singer and musician Halsey shared her recent allergy testing results on TikTok along with the news of her recent diagnosis of Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), and Sjogren’s Disease. Pictured were the telltale red welts we inflict day in and day out in allergy clinic with our scratch tests and a long list of foods to which she was possibly allergic.

Halsey has a history of being open and advocating for improved health care following her diagnosis of endometriosis in 2016.

As a fellow Sjogren’s patient and allergy/immunology physician, Halsey, I want to thank you for adding your face and powerful voice to commonly misunderstood and underdiagnosed invisible illnesses.

I thought it to be a great opportunity to share three misperceptions and myths that I routinely encounter about food allergies, intolerances, and testing.

1. Food allergy is a clinical diagnosis that is supported by testing IgE testing. Food allergy is an immune response mediated by immunoglobulin E (IgE) antibodies resulting in the degranulation of mast cells. Reactions are reproducible and nearly always occur within minutes of exposure to the trigger food. Symptoms are suggestive of the release of histamine, tryptase, and dozens of other chemical mediators found within the mast cells. They include itching, swelling of the lips or tongue, vomiting, diarrhea, hives, trouble breathing, low blood pressure, and loss of consciousness. There are no hidden food allergies.

Anaphylaxis occurs when two or more organ systems are involved. The only treatment for acute anaphylaxis is intramuscular epinephrine. The role of allergy skin testing or serum IgE testing (RAST testing) is confirmatory. An elevated level of IgE in food on its own is called sensitization. Elevated IgE, along with a history of clinical symptoms, is allergy.

Why the distinction? Many of us eat foods we are sensitized to all day every day and don’t have any problems with them. There are a lot of false positives on both serum and skin testing.

Many times, unnecessarily dietary restriction, anxiety, and fear result but in the worst-case scenario, we see this restriction result in loss of tolerance, and subsequent diagnosis of an IgE mediated allergy.

2. Food sensitivity testing is a waste of time, energy, and money. The most common food sensitivity tests measure immunoglobulin G (IgG) antibodies. IgG is the body’s memory antibodies. They are a great way to tell if you have made and maintained memory of prior infections or vaccination, commonly referred to as titers. So food memory should tell us if a food is a problem, right?

Wrong. Many times IgG actually signals tolerance. The other issue is that food intolerances or sensitivities are not due to an immunologic response but are due to interactions between the food, microbiome, and products of the digestion or fermentation process.
It can be incredibly beneficial for patients to keep a food and symptom journal and review it with a trained dietician who can help identify possible triggers such as salicylates, histamine, or FODMAP. They can also help with an elimination trial if necessary and re-introduction of foods as soon as possible. The least restrictive diverse diet is the goal for convenience and is also associated with improved health outcomes.

3. There is no substitute for a thorough medical history and a trusting therapeutic relationship in the care of invisible illness patients. This is medicine that cannot be rushed. It requires active listening and conscious, deliberative “slow thinking” that internists (and pediatricians) pride themselves on. Complicating things further, most invisible illness patients have played the game of hot potato as they are passed off from one specialist to the next in search of a diagnosis. Data would also tell us that most will have a history of adverse childhood events and trauma and yet have encountered a medical system that is far from trauma-informed.

So what can we do?

1. Don’t order food IgE testing to screen for food allergies.
2. Don’t recommend food sensitivity testing but instead encourage patients to keep a food and symptom journal. They can consider using the money they saved towards the cost of a visit with a dietician.
3. Get curious. Listen to your patient’s history: It is their lived experience. Don’t discount it. If you don’t know what is causing their symptoms, be honest with them (and then ask for help).

Kara Wada is a quadruple board-certified pediatric and adult allergy and immunology, lifestyle, and functional medicine physician, a Sjögren’s disease specialist, and a Sjögren’s patient herself. She spent nine years on faculty at The Ohio State University Wexner Medical Center, where she served as associate program director of the allergy and immunology fellowship and led the Mast Cell Center of Excellence.

In 2025, she left academic medicine to build the kind of practice she could not find as a patient: the Immune Confident Institute, a national direct-care immunology practice licensed in 27 states. She treats the patients the health care system sends ping-ponging between specialists, people with complex, chronic, multisystem disease including mast cell activation syndrome (MCAS), dysautonomia, Sjögren’s disease, immune dysfunction, and the seronegative and “in-between” diagnoses that do not fit neatly into a single specialty.

Her premise is simple: These patients are not the problem. Fragmented care is. Medicine has become exceptionally good at looking through microscopes while losing sight of the telescope, the bigger picture of the person in front of us. Her work challenges a health care culture that demands compliance when it should assume competence, and aims to make strategic, compassionate immune-directed care the standard, and the exam room a place where patients are finally seen, heard, and believed.

Most of her reach is built outside the exam room. Her YouTube channel drew roughly two million views this past year, and more than 100,000 people follow her work across platforms, including a Sjögren’s community of about 6,600. She founded and hosts the Virtual Sjögren’s Summit, now in its sixth year and drawing some 4,300 registrants worldwide. She appears regularly on national television and in the health press, including Prevention, SELF, Good Housekeeping, WebMD, Medscape, and MedPage Today, and she writes for KevinMD on the diagnoses that live in the shadows and the medical gaslighting that surrounds them.

A TEDx speaker and sought-after keynote, Wada speaks to clinician and patient audiences about complex immune disease, the experience of being disbelieved, and what changes when the physician is also the patient. She is also an unlikely pageant titleholder, having served as Dr. Ohio America 2022 and Dr. Midwest America 2023, and has written about how pageantry sharpened skills medicine rewards but rarely teaches.

She earned her medical degree with honors from the University of Illinois College of Medicine at Peoria and completed internal medicine-pediatrics residency, allergy and immunology fellowship, and clinician educator fellowship at The Ohio State University and Nationwide Children’s Hospital. She lives in Columbus, Ohio, with her medical school sweetheart turned husband, Akira, and their three children.

Image credit: Shutterstock.com