Brian E. Lacy, PhD, MD, a board-certified gastroenterologist at the Mayo Clinic in Jacksonville.

When Abdominal Pain Is Actually a Food Allergy: A GI Workup

At the 2026 Eastern Allergy Conference (EAC) in Palm Beach, Florida, Brian Lacy, MD, PhD, a gastroenterologist at Mayo Clinic, discussed the diagnostic challenges surrounding 

, including adult-onset food protein-induced enterocolitis syndrome (FPIES) presenting as recurrent abdominal episodes.

Lacy acknowledged that these conditions remain underrecognized in gastroenterology. While meal-related abdominal symptoms are common, most gastroenterologists prioritize the more prevalent diagnoses—ulcers, vascular disorders, and structural abnormalities—before considering food hypersensitivity.

When a patient predictably reports meal-triggered symptoms with no clear structural cause, Lacy said clinicians should begin thinking about food allergies, both IgE and non-IgE mediated. He noted that more often than not, the patient will ultimately be referred to an allergist, who is best positioned to make this less common diagnosis.

When building a workup for unexplained recurrent abdominal symptoms, Lacy outlined a stepwise approach beginning with a thorough history—characterizing symptom type, frequency, previous treatments, and prior testing. Physical examination also plays a key role, including evaluation for the Carnett sign, which can distinguish abdominal wall nerve entrapment from true gastrointestinal pathology.

Initial laboratory testing typically includes a CBC, erythrocyte sedimentation rate, lipase, and liver chemistries. A plain abdominal x-ray is often ordered next, followed by gastroenterology referral if symptoms persist. Endoscopic evaluation, such as upper endoscopy and colonoscopy, along with cross-sectional imaging via CT are standard components of the workup at that stage.

Lacy said that only when this initial evaluation returns unremarkable results should clinicians turn their attention to allergic etiologies. At that point, testing for mucosal mast cells and eosinophils, along with serum tryptase levels, becomes appropriate—or referral to an allergist for further evaluation.

In the first part of the interview, Lacy discussed several allergic conditions that could present with episodic abdominal symptoms: hereditary angioedema (HAE), mast cell activation syndrome (MCAS), and eosinophilic GI disorders.

HAE is often the last condition a clinician thinks to check for given its rarity. Abdominal HAE attacks tend to present as discrete episodes separated by symptom-free intervals, with significant bloating and distension and, crucially, dilated intestinal loops on imaging.

MCAS can be identified by episodic symptom patterns and multi-organ involvement as the primary clinical filters—daily abdominal pain or bloating makes MCAS an unlikely diagnosis. Eosinophilic GI disorders require diagnosis through multiple biopsies across GI segments.

His key takeaway for attendees: resist diagnostic tunnel vision. Not all recurrent abdominal pain stems from ulcers, reflux, or gastritis. When standard therapies fail, allergic conditions deserve serious consideration.

“Keep your blinders off,” Lacy said. “All abdominal pain is not due to an ulcer or gastritis or reflux disease. Think outside the box. When somebody is not responding to what you think is good empiric therapy, think about some allergic condition. Although they’re not as common as many of the other things we deal with, they are out there, and we would feel badly if something was missed.”

Part 1 of the interview with Lacy can be watched here: 

Abdominal Pain and Bloating: When to Consider HAE, MCAS, and EGIDs

Editor’s note: Relevant disclosures for Lacy include Ardelyx, Salix Pharmaceuticals, and IRONWOOD PHARMACEUTICALS.

Lacy B. Evaluation and Management of Intermittent Abdominal Pain and Bloating. Poster presented at the Eastern Allergy Conference (EAC) in Palm Beach, Florida, on May 29.

Lacy B. Abdominal Pain and Bloating: When to Consider HAE, MCAS, and EGIDs. HCPLive. Published on June 15, 2026. Accessed June 16, 2026. 

https://www.hcplive.com/view/intermittent-abdominal-pain-bloating-hae-mcas-egid-evaluation

Videos

Brian Lacy, MD, PhD, of Mayo Clinic discussed the stepwise approach to diagnosing non-IgE mediated food hypersensitivity at EAC 2026.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Food Allergy

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Strategic Alliance Partnership

Identifying Patients for Systemic Therapy: Beyond

Selecting the right patients for systemic therapy in alopecia areata requires moving beyond any single numeric threshold and into a more nuanced, individualized clinical assessment. Patients with limited, stable, localized disease may be well managed with topical corticosteroids, topical immunotherapy, or intralesional corticosteroid injections targeting discrete patches. These approaches are reasonable first-line options when disease burden is contained and the patient is not experiencing rapid progression. The clinical calculus shifts, however, when disease begins to evolve in ways that localized treatments cannot adequately address: SALT scores climbing within weeks rather than months, new patches appearing at previously uninvolved sites on the scalp or body, or intralesional injection sites multiplying in a "whack-a-mole" pattern where new lesions consistently outpace targeted treatment. At that point, continuing to chase individual patches with local therapies risks wasting time that could be spent arresting the disease systemically.

The SALT-50 enrollment criterion used in pivotal clinical trials served an important scientific function—

ensuring that trial populations had sufficient disease burden to

detect a meaningful treatment signal-but it does not translate directly into a clinical rule requiring practitioners to withhold systemic therapy until patients cross a specific threshold of scalp involvement. A patient losing 10% to 30% of scalp hair in discrete, rapidly expanding, psychologically distressing patches is, by any meaningful definition, experiencing a severe impact on quality of life. The dermatologist's role is to evaluate the full picture: pace of progression, functional impairment, emotional burden, and patient goals. Patient-reported outcomes-how frequently the individual thinks about their hair loss, whether they are avoiding work or social activities, whether they rely on hairpieces daily-carry genuine clinical weight and belong in the documentation.

Waiting for a patient at SALT-20 to reach SALT-50 before initiating systemic therapy is not conservative practice; it is a delay that narrows the window of best therapeutic response.

In this segment, Nader Aboul-Fettouh, MD, double board-certified dermatologist and fellowship-trained Mohs Micrographic Surgeon and founder and managing director of Blue Ribbon Dermatology in the Dallas area, explains his framework for evaluating patients as candidates for systemic therapy. He describes how he tracks the pace of disease progression, assesses functional and psychosocial impairment, and engages patients in shared decision-making conversations that center on their own goals and olerance for disease burden-rather than on a single population-derived scoring threshold that was designed for research, not clinical gatekeeping.

Aboul-Fettouh walks through the clinical and patient-centered factors that move a patient from localized, monitored disease to systemic JAK-inhibitor therapy, emphasizing that SALT score thresholds from clinical trials do not define the real-world trigger for treatment escalation.


Video Series

Elizabeth A. Kiracofe, MD, is a board-certified dermatologist and the founder of Airia Comprehensive Dermatology, located in downtown Chicago's Fulton Market District, where she practices medical, surgical, and cosmetic dermatology.

Avery LaChance, MD, MPH, is a dermatologist at Brigham and Women’s Hospital and director of multiple specialty clinics focused on autoimmune and inflammatory skin disease.

Barry Gardner, is a biologic coordinator and medical assistant with LARK Dermatology who is currently completing his path toward becoming a physician assistant.

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Skin of Color Savvy: Patient Power—Voices Driving Change in Skin of Color Care

 leaders, host Elizabeth A. Kiracofe, MD, a board-certified dermatologist and founder of Airia Comprehensive Dermatology, led a discussion on patient empowerment, shared decision-making, and advancing equitable dermatologic care for patients with skin of color.

Patient empowerment begins with education, trust, and shared decision-making between clinicians and patients.

Historical mistrust and underrepresentation continue to affect engagement in dermatologic care and clinical research among patients with skin of color.

Effective communication, including listening to patients’ concerns and treatment goals, is essential for improving adherence, satisfaction, and outcomes.

Greater representation in dermatology education, clinical trials, and provider training is critical to advancing equitable care for diverse patient populations.

Joining her were Avery LaChance, MD, MPH, a dermatologist at Brigham and Women’s Hospital and director of multiple specialty clinics focused on autoimmune and inflammatory skin disease, and Barry Gardner, a biologic coordinator and medical assistant with LARK Dermatology who is currently completing his path toward becoming a physician assistant.

The conversation centered on the growing influence of patients in shaping their own care and how clinicians can better partner with them to improve outcomes. Kiracofe framed patient power as a shift away from a physician-directed model of care toward one in which patients actively participate in treatment decisions. Throughout the episode, the speakers emphasized that successful dermatologic care depends not only on clinical expertise but also on trust, education, and meaningful communication.

LaChance noted that today’s patients have unprecedented access to medical information, making treatment discussions more collaborative than ever before. She described patient power as the combination of personal beliefs, cultural values, education, and conversations with healthcare professionals that ultimately shape healthcare decisions. However, she stressed that these conversations are particularly important for patients with skin of color, many of whom may carry a historical mistrust of the healthcare system stemming from past inequities, biases, and underrepresentation in research.

Gardner echoed the importance of trust and education, drawing from his experience working directly with patients. He explained that many patients with darker skin tones arrive at specialty dermatology clinics after multiple misdiagnoses or unsuccessful treatment experiences. For him, empowering patients begins with ensuring they understand their diagnosis, available treatment options, and the evidence supporting those therapies. He highlighted the value of accessible educational materials, clear communication, and creating opportunities for patients to ask questions even after appointments have ended.

A major theme throughout the episode was shared decision-making. LaChance described the process as presenting patients with appropriate treatment options while allowing their goals, concerns, and preferences to guide the ultimate plan. Rather than directing patients toward a single choice, she advocated for helping patients understand the spectrum of available therapies and tailoring recommendations based on individual priorities, whether that involves speed of improvement, convenience, safety considerations, or treatment experience.

The discussion also addressed the importance of representation in dermatology education, clinical practice, and research. LaChance emphasized that clinicians must be trained to recognize how skin diseases present across a wide range of skin tones and avoid relying solely on textbook descriptions that often focus on lighter skin. She also discussed the need for more diverse participation in clinical trials and the importance of thoughtfully addressing concerns that patients with skin of color may have about research participation.

Another key topic was setting realistic expectations for treatment outcomes. Both Kiracofe and LaChance highlighted the significance of post-inflammatory hyperpigmentation in patients with skin of color, noting that lingering discoloration can often be more distressing to patients than active disease itself.

 They stressed the importance of discussing these concerns openly and helping patients understand the timeline for improvement.

In closing, the speakers encouraged clinicians to prioritize listening, self-education, and humility when caring for diverse patient populations. They emphasized that improving equity in dermatology requires effort from the entire healthcare team, from physicians and advanced practice providers to medical assistants and biologic coordinators, and that meaningful progress begins with ensuring every patient feels heard, respected, and empowered to participate in their care.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This episode was summarized with the help of AI tools.

Disclosures: Kiracofe, LaChance, and Gardner had no relevant disclosures of note.

Narla S, Heath CR, Alexis A, et al. Racial disparities in dermatology. Arch Dermatol Res. 2023 Jul;315(5):1215-1223. doi: 10.1007/s00403-022-02507-z. Epub 2022 Dec 12. PMID: 36508020; PMCID: PMC9743121.

Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010 Jul;3(7):20-31. PMID: 20725554; PMCID: PMC2921758.

Podcasts

This discussion centers on patient empowerment, shared decision-making, and advancing equitable dermatologic care for those with skin of color.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally intelligent care practices in dermatology with leading experts. 

Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

What Referring Physicians Should Know: Avoiding the "Wait and See" Approach

A longstanding misconception in the broader medical community holds that alopecia areata is a self-limited condition that warrants watchful observation rather than active intervention. The origins of this perspective are historically understandable: for most of the disease's recorded medical history, no systemic therapies existed that reliably halted progression or restored meaningful amounts of hair. Dermatologists and generalists alike counseled patients to reduce stress, remain patient, and hope for spontaneous regrowth—not because the evidence supported this approach, but because the alternatives were limited, unpredictable, and offered no guarantee. The field has since changed fundamentally with the arrival of JAK inhibitors, yet the cultural inertia of "wait and see" has proven difficult to dislodge, particularly among clinicians who trained or practiced extensively before these agents became available.

The clinical evidence now clearly supports earlier treatment initiation. Disease progression in AA appears more amenable to reversal when systemic therapy is introduced before extensive and prolonged follicular injury accumulates. Patients who are advised to wait and monitor may arrive at the dermatologist months or years later with far greater scalp involvement, potentially having passed the window of best therapeutic response. Dermatologists managing AA should actively communicate this message to referring physicians: lower the threshold for referral, stop framing the consultation as elective or cosmetic, and recognize that counseling a patient to simply reduce stress—a behavior that cannot be reliably enacted on command-adds delay without benefit. Every visit in which a patient is told their hair will likely return on its own is a visit in which the window for optimal treatment response narrows further.

In this segment, Nader Aboul-Fettouh, MD, double board-certified dermatologist and fellowship-trained Mohs Micrographic Surgeon and founder and managing director of Blue Ribbon Dermatology in the Dallas area, discusses the most common referral-related misconception he encounters-the assumption that alopecia areata will self-resolve-and explains in direct clinical terms why that framing, while historically rooted in the absence of effective treatments, now actively undermines patient outcomes. He also describes the specific guidance he gives his own patients: to alert him immediately if new patches appear, if existing lesions are expanding rapidly, or if involvement is spreading to new body sites, because the pace and pattern of progression directly inform which therapeutic approach is most appropriate.

Aboul-Fettouh addresses a persistent misconception among referring clinicians-that AA hair loss will resolve spontaneously-and makes the case for earlier referral and treatment initiation to preserve the greatest opportunity for hair regrowth.


Experts explore why FCS remains one of the most emotionally and clinically challenging lipid disorders despite decades of management effort.

Clinical Burden and Unmet Need in Familial Chylomicronemia Syndrome

For lipidologists who manage patients with familial chylomicronemia syndrome (FCS), the disease carries a weight that extends well beyond laboratory values. Patients are known by name, their emergency room admissions are anticipated, and despite decades of effort, the tools available to prevent recurrent pancreatitis have historically fallen short.

Alan Brown, MD, MHA, opens by capturing what separates FCS from most lipid disorders: physicians know these patients intimately, because despite fibrates, omega-3 fatty acids, and every available intervention, patients return month after month in crisis. The relationship between physician and patient often deteriorates under the weight of repeated hospitalizations and failed treatment.

Stephan P. Babirak, MD, PhD, echoes that characterization, describing FCS as the most difficult lipid disorder to treat. First described in the medical literature in 1932, the disease has proved largely resistant to pharmacotherapy and only partially responsive to dietary intervention, while inflicting morbidity and mortality that can permanently alter a patient's life. Babirak notes that the diagnosis can be suspected from the appearance of a blood draw alone, which takes on a creamy or tomato-soup consistency in patients with severe chylomicronemia.

Both experts describe the longitudinal relationship with FCS patients as distinct from almost any other in lipid medicine. Babirak recounts a patient who left his practice for 8 years out of frustration, only to be recontacted once new therapeutic options became available. Brown describes the cycle of waiting for the emergency room call, and the frustration that arises when physicians unfamiliar with the syndrome attribute the presentation to poor adherence or alcohol use. These dynamics, both experts note, are central to the clinical challenge of FCS management.

Oksana Hamidi, DO, is an associate professor in the division of endocrinology and metabolism at UT Southwestern Medical Center

Two-year CAHtalyst data show crinecerfont sustained glucocorticoid reduction and improved metabolic outcomes in classic CAH.


Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

This page also hosts content previously published by EndocrinologyNetwork. 


Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Crinecerfont Sustains Glucocorticoid Reduction, Improves Cardiometabolic Outcomes in Classic CAH

Elena Christofides, MD, is the chief executive officer of Endocrinology Associates, the scientific and medical advisor for Sparrow Pharmaceuticals, and a clinical associate professor at the Ohio University Heritage College of Osteopathic Medicine.

Elena Christofides, MD, discusses her recent analysis of patients with ulcerative colitis receiving corticosteroids.

Ulcerative Colitis

Ulcerative Colitis condition center page, resources on the topics of medical news and expert insight into colitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on UC research, treatment, and drug development.

HPA-Axis Assessment Allows for Improved Corticosteroid Response Analysis

Gastroenterologist Brian Lacy, MD, PhD, discusses how to differentiate HAE, MCAS, and eosinophilic GI disorders in patients with unexplained abdominal pain and bloating.

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

Articles

Baseline characteristics, including sex and comorbidities, were associated with semaglutide weight loss outcomes in >36,000 adults.


Sex, Comorbidities Linked to Semaglutide Weight Loss Trajectories

Fezolinetant's CNS safety Profile Reassures Across More Than 3,000 Women in Pooled Phase 3 Analysis at ENDO 2026

Fezolinetant Shows No CNS Safety Signal in Pooled Analysis of 3100 Women, With Marla Shapiro, CM

Elena Christofides, MD, discusses the interim results of CAPTAIN-T2D, a trial that plans to evaluate clofutriben’s efficacy in these patients.

Type 2 Diabetes

Hypertension

The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

CAPTAIN-T2D: Interim Results Display High Cortisol Prevalence in Difficult-to-Control T2D

David Fleischer, MD, professor of pediatrics at Children’s Hospital Colorado.

Phase 3 VITESSE subgroup data show response rates of 46% to 48% in children with peanut allergy and concomitant asthma, atopic dermatitis, or food allergies, says David Fleischer, MD.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

VIASKIN Peanut Patch Efficacy Holds in Kids With Atopic Comorbidities

Experts introduce the 2026 AACE type 2 diabetes algorithm’s new classification pathway and frame misclassification—especially of adult-onset type 1 diabetes—as a central problem the update is designed to address.

Rethinking “Type 2”: Inside the 2026 AACE Diabetes Classification Algorithm

Michelle Min, MD, MSCi, is an associate professor and serves as the director of Rheumatologic Dermatology at the UC Irvine School of Medicine.

In her SDPA interview, Min discusses dermatology and rheumatology collaboration, exploring treatment options for connective tissue disease.

Diagnostic Pearls and New Therapies in Connective Tissue Disease, With Michelle Min, MD

Elif Oral, MD, is a professor in the Division of Metabolism, Endocrinology, and Diabetes at the University of Michigan.

Elif Oral, MD, discusses the clinical implications of the recent data emphasizing metreleptin’s anti-drug antibodies and their llack of impact on efficacy.

Latest News

When Abdominal Pain Is Actually a Food Allergy: A GI Workup

Identifying Patients for Systemic Therapy: Beyond

Skin of Color Savvy: Patient Power—Voices Driving Change in Skin of Color Care

What Referring Physicians Should Know: Avoiding the "Wait and See" Approach

Clinical Burden and Unmet Need in Familial Chylomicronemia Syndrome