<<Disclaimer: Verify this information before applying it to your situation.>>
Lydia S. Boeken, MD, has provided the following general reference file on
allergies, and her clinic's experience in treating them. In light of the many
recent posts about allergic vs. celiac responses, I though it would be helpful
to post this file. Dr. Boeken's clinic does not handle CD.
Bill Elkus
Los Angeles
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Copyright c. 1996 Amsterdam Clinic
You may reproduce this entire electronic brochure and pass it on as
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Allergies and intolerances
Introduction
Through his writings, we know that Hippocrates, the father of medicine,
had already recognised the presence of allergic reactions in people as
early as ancient times. However, the term "allergy" is a relatively new
one, as compared to many other commonly used medical terms. In 1906,
Viennese paediatrician Baron Clemens von Pirquet used the term for the
first time to describe an "altered response" of his patients' bodies.
Von Pirquet believed that this altered reaction manifested itself in
changes of the immune system, effected by external influences on the
body, such as: food intake, the air breathed or direct skin contact. The
term "allergen" (the substance responsible for the altered reaction) was
born. At that point in time, however, von Pirquet had no means of
scientifically proving that these immunological changes actually
occurred in the body. It was not until the mid-1920's, that a second
significant event occurred.
Researchers found that, by injecting a minute quantity of purified
allergen under the skin, certain individuals would develop a clear skin
response; a "wheal," with or without itching and redness, could be
provoked. This positive skin test for allergies would show itself most
prominently in patients with hay fever, asthma, chronic rhinitis, hives
and eczema. The "prick test" became a method of demonstrating the
involvement of the immune system in allergic reactions. However, the
precise biological reason for the reaction continued to remain a
mystery.
It was not until the Sixties, when an important discovery occurred which
provided long-awaited scientific support for the classical allergy
theory and removed any doubts about the relationship of the immune
system with allergies. This breakthrough came about with the scientific
discovery of immunoglobulin E (IgE) by a Japanese couple named Ishizaka.
The Classical Allergic Reaction
The following are the chain of events which happen in allergic
reactions:
(1) An allergen must be present in the body. This allergen is the
substance which causes us to have an abnormal immunological response.
Allergens tend to be protein molecules. Interestingly enough, the immune
system only detects particles of a certain size as potential
troublemakers and protein molecules are just the right size. In a small
number of cases, the body actually responds to molecules other than
proteins. These molecules, which are generally much smaller, are called
haptens. By combining with protein molecules, haptens form larger
complexes which can then be detected by the immune system.
(2) The allergen is detected by the B cells. These are specialised
immune cells, capable of producing antibodies. Just like allergens,
antibodies are protein molecules, which have the capacity to neutralise
allergens.
(3) Every B cell produces its own, specific antibody, depending on the
type of intruder it needs to respond to. It is easy to understand why
the body must have a ready pool of millions of antibodies, in order to
combat these numerous offenders. There are five main categories of
antibodies (IgG, IgA, IgM, IgD and IgE) which the body releases under
different circumstances (for instance to fight off various infections,
etc.). In the case of allergies, the body produces the antibody
immunoglobulin E (IgE), first discovered by the Ishizakas.
(4) Usually, antibodies will bind directly to the appropriate damaging
substance and neutralise it. However, IgE deviates from this common
path. It first attaches one of its "legs" to one of the body's numerous
mast cells. The other leg is used to hold on to the offending allergen.
This action signals the mast cells to begin disintegrating, thereby
releasing histamine.
Histamine is a chemical substance responsible for a great number of
complaints which may arise during allergic reactions. It causes muscle
cramps and an inflammation-like process with redness and swelling of
mucous membranes.
Allergic reactions can occur under a variety of circumstances. For
instance, inhaling certain substances, such as grass pollen, house dust,
etc., may cause an allergic response. However, the consumption of
certain foods may do the same. Allergies typically bring on complaints
very rapidly upon contact with the allergen. Complaints may vary from a
runny nose, sinusitis, earache or runny eyes to itching of the skin,
eczema and shortness of breath.
Intolerances
Conventional medicine can easily diagnose and treat allergies for foods
or inhalants. Here, the so-called RAST test plays a very important role,
because this test can demonstrate the presence of IgE.
However, demonstrating the presence of intolerances is more difficult.
In this situation, similar to the case of classical allergies, the body
responds abnormally and, in addition, the immune system does not produce
IgE. It quite often takes much longer for complaints to come on, thereby
masking the possible link between the offensive substance and the
complaints themselves.
These are only a few of the reasons why food intolerance is considered a
fairly controversial concept in conventional medicine.
Intolerances can be responsible for a wide variety of complaints which,
at first glance, seem to lack a plausible explanation.
Intolerances can manifest themselves as:
* gastrointestinal complaints: stomach ache, irritable bowel,
Crohn's disease, ulcerative colitis;
* skin complaints: itching, eczema, hives, acne (in adults);
* joint and muscle complaints: ranging from atypical pains to
rheumatoid arthritis;
* headache and migraine;
* chronic fatigue;
* asthma, chronic rhinitis or sinusitis;
* pre-menstrual syndrome;
* hypoglycaemia;
* depression, anxiety;
* sleeping disorders.
Diagnosing Intolerances
It is impossible to accurately demonstrate intolerances through
conventional testing methods.
The Amsterdam Clinic currently uses two test procedures which have
proven to be very reliable.
(1) In the cytotoxic test, a drop of the patient's blood is mixed with a
drop of pure, liquefied food concentrate. If the body has a normal
tolerance to this specific food, microscopic examination will show that
certain white blood cells (granulocytes, which deal with immune
response) remain intact. However, in response to lesser degrees of
tolerance, these white blood cells swell and possibly granulate. In
severe cases the cells will actually blow up and disintegrate. Detection
of intolerances with this method can be done with an 80% reliability.
(2) Another useful test is the IgG(4) antibody test. Here, the presence
of IgG(4) antibodies is determined. These antibodies are the slowly
occurring variety, which do not appear in the blood until 24 to 48 hours
after exposure to an offending food or substance. The reliability of
this test varies between 80 and 90%.
Treatment
Diet
In the treatment of inhalant allergies (such as asthma, hay fever) and
food allergies and intolerances, avoidance (elimination) of allergens
plays an extremely important role. In the case of food sensitivities,
either the cytotoxic test or IgG(4) test can help determine reactions to
specific foods. Based on the test results, an elimination/rotation diet
can be specifically tailored.
Foods causing strong reactions in these tests, should (temporarily) be
excluded from the diet. More moderate reactions allow for rotation of
certain food items in the diet. These may be eaten once every four days.
Especially during the first week(s) of the diet, withdrawal symptoms,
similar to complaints stemming from the cessation of coffee, tobacco or
alcohol consumption, may occur. The body seems to crave offending food
items. Generally, these withdrawal symptoms disappear after a couple of
weeks. Concurrently, those complaints relating to food sensitivity also
diminish.
Using this dietary approach, the reaction to food allergens may decrease
in the course of time. After a three month moratorium, reintroduction of
"forbidden" food items can be attempted, one at a time. In this way,
food items still causing reactions can be isolated more easily. Often,
at least part of existing intolerances completely disappear after an
elimination/rotation diet.
With the treatment for inhalant allergies, elimination is also the first
step. It is obvious that patients having an allergy for cats or dogs,
should avoid any contact with these pets. The situation becomes more
difficult when dealing with allergies to grass or tree pollen, since
total elimination is basically impossible. The same goes for house dust
mite allergy. The house dust mite lives in mattresses, pillows,
carpeting, drapes, upholstery, etc. Through mite-killing pesticides,
special mattress and pillow covers, non-carpeted floors, etc. reasonable
results can be obtained.
Medication
Medicines for inhalant allergies, such as antihistamines (Triludan),
corticosteroids (Prednisone, Pulmicort, Becotide), cromoglycates
(Lomudal, Lomusol), and airway dilating medication (Ventolin, Berotec,
Atrovent) do suppress symptoms, however, they do not cure the allergy!
In the realm of conventional medicine, effective medications for food
allergy and intolerances do not exist at all.
Desensitisation
Enzyme-potentiated desensitisation (EPD) and the
provocation/neutralisation method are very effective treatments for food
allergy/intolerance and inhalant allergy problems. These methods tackle
allergy problems at the root.
(1) During EPD treatment, a small quantity of a food or inhalant
allergen mixture is injected intradermally into the skin, in conjunction
with the enzyme beta-glucuronidase. This combination causes the body to
gradually adjust its exaggerated responses to food and inhalant
allergens. In this way, the immune system is readjusted and reset.
Initially, the injections have to be given once every two months.
Gradually, however, the intervals between injections become longer and
the injections can often be discontinued after a time.
According to conservative estimates, at least 80% of those patients
treated with EPD show considerable improvement in the course of time.
(2) Provocation/neutralisation can be used both diagnostically and
therapeutically. Here, separate extracts of food or inhalants, suspected
as possibly offending, are injected intradermally. This causes a wheal
to appear in the skin. After 10 minutes, the size and nature (firmness,
colour, etc.) of the wheal are evaluated. A positive wheal will
generally bring on symptoms (provocation). Depending on the size and
nature of the wheal, as well as, the presence of symptoms, varying
concentrations are injected, until a dose is found which does not cause
any wheal changes or symptoms. This is the neutralising dose. Injections
with the proper neutralising dose will bring on immediate protection
against the symptoms caused by the offending food and/or inhalant.
For further information please contact:
Amsterdam Clinic
Located at THE HALE CLINIC
7 Park Crescent
London W1N 3HE
Telephone 44 (0)171 631 0156
Telefax 44 (0)171 323 1693
Also in THE NETHERLANDS:
Amsterdam Kliniek
Reigersbos 100
1107 ES Amsterdam Z.O.
Telephone 31 (0)20 697 53 61
Telefax 31 (0)20 697 53 67
Lydia S. Boeken M.D. London/Amsterdam
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