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ABC OF ALLERGY
An Expanded View
Allergy is an abnormal immune response. Simply stated, allergy is
caused when the immune system of an individual turns against him. The presence of allergy
is readily recognized when symptoms include running nose, itchy eyes, sinus congestion,
hives, asthma, and eczema. Such allergic symptoms cause much suffering and carry an
enormous economic cost to the country. Less recognized forms of food and mold allergies
include problems of digestion and absorption, irritable bowel syndrome, headache, and
muscle pain syndromes. Much more important from the standpoint of healthful aging,
however, is the issue of systemic allergy that sets the stage for such serious disorders
as Crohn's colitis, ulcerative colitis, multiple sclerosis, lupus, scleroderma, and
vasculitis.
HOW BIG IS THE PROBLEM?
The Epidemic of Allergy and Asthma
In its November 25, 1999 issue, Nature, the most respected science
journal in the world, devoted a special issue to allergy and asthma. The following quote
from that issue tells the story:
"[a]s we approach the millennium almost half the population of the
West demonstrates sensitization to one or more environmental allergens. In countries such
as Britain or Australia, this translates to 1 in 4 children under the age of 14 years
having asthma and 1 in 5 having eczema.1"
1 in 4 children having asthma! A few years ago, New York magazine
reported that 1 in 4 children in the South Bronx carry inhalers to school.
The direct and indirect cost of allergy and related disorders easily
runs into hundreds of billions of dollars. That statement may raise some eyebrows. But
that is because many people do not recognize the underlying role of allergy in the cause
of such disorders as Crohn's colitis, ulcerative colitis, lupus, multiple sclerosis,
vasculitis, and other immune disorders.
ABC OF ALLERGY
Three factors determine who suffers from allergy and how much:
A. Allergy genes.
B. Food and environmental triggers.
C. The status of the health of the bowel, blood, and liver in allergic
patients.
A. ALLERGY GENES
Allergy runs in families. When both parents are allergic, the child has
a nearly 90% chance of developing clinical allergy sometime during life. Several specific
genes are now known to cause allergy and lead to a large number of immune diseases. There
are two important issues here. We cannot do anything about genes at this time. Some gene
enthusiasts talk about taking out allergic genes to cure allergy. I have serious reasons
to doubt that. However, it is very important to recognize the role of genes.
Allergy genes alone do not make most people sick. That, from the
clinical standpoint, is the most important issue in this matter. It is possible for
persons with allergy genes to live healthy and symptom-free lives without any treatment.
People who live in deserts (little or no molds) and away from industry (no pollutants)
rarely suffer serious allergy symptoms. Mothers who learn to rotate foods for their babies
prevent many troublesome food reactions in their children. And, of course, hives sufferers
recognize the relationship between skin rashes and itching with stress.
I have cared for a large number of allergic children with asthma,
eczema, recurrent throat and ear infections, and abdominal problems. The presence of
allergy as the underlying cause of those disorders had not been suspected before I saw
them. Allergy tests revealed the underlying food, mold, and pollen allergies. The mothers
of such children were dismayed that allergy tests had not been performed while the
children were administered repeated courses of antibiotics and steroids and, in many
cases, were subjected to ear tubes and tonsil operations. They were pleased when the
children regained health with appropriate treatment. Forearmed with that knowledge, they
managed the allergic symptoms of their babies differently by rotating foods, avoiding some
items, and, when necessary, undertaking some environmental controls and doing allergy
tests and treatment without unnecessary delay.
My colleagues at the Institute and I have seen over 5,000 patients with
chronic immune disorders, including chronic fatigue syndrome and
fibromyalgia. Almost
invariably, such patients were allergic, but their allergies had been ignored.2-5 Instead,
they had received multiple courses of antibiotics, antianxiety drugs, antidepressant, and,
in many cases, steroid therapy. All such patients learned the lesson about allergy the
hard way. And all of them became advocates of early allergy diagnosis and treatment.
B. FOOD AND ENVIRONMENTAL TRIGGERS
The need for control of food, mold, and other environmental triggers of
allergy is recognized by allergic persons as well as doctors. However, total elimination
of those triggers for most allergic persons is very difficult, if possible at all. For
example, molds (also called fungi and yeast) are present in our air, water, and foods as
well as in the human bowel and other tissues.
Genes are like hidden codes that remain unrecognized until some
environmental trigger sets them off. Here is a simple example to illustrate the
relationship between allergic genes and allergic triggers. In Sweden, people do not suffer
from ragweed allergy because the ragweed plant does not grow in that country. Swedes with
allergic genes who travel to the United States become sensitized during the first year
ragweed season and suffer hay fever symptoms during the next year.
The Roles of Genes and Stress in Asthma
Several years ago, a 52-year-old woman consulted me for asthma that
developed after a mild case of a viral infection. Not unexpectedly, she was very puzzled
as to why she should develop asthma at age 52. She vigorously denied a history of nasal,
sinus or skin allergy. Unable to uncover a history of allergy, I also expressed my
puzzlement. Toward the end of my consultation, I asked her about stress at home. She
stiffened visibly and then told me she had lost her husband of 33 years some months before
she developed asthma.
"You were close to your husband, were you not,?" I asked.
"Yes," she replied, hiding her hurt.
"Very close?" I asked.
"Very, very close," she replied, then asked, "How did
you know?"
"Because that is where your asthma came from."
"But that was almost six months aftee he died," she said,
baffled.
"That's not that unusual. People call up their full reserves after
shocks like that, appear in control for months, and then break down," I explained.
"But why asthma?"
"Because you have asthma genes."
"How do you know?" She looked at me suspiciously.
"Because you're allergic."
"But I'm not allergic," she insisted.
"Is your mom alive?"
"Yes, but what does that have to do with anything?" She grew
distrustful.
"Please ask her if you had been a colicky baby or had suffered
eczema as a child. Those are sure clues to allergic genes."
"I will and we'll see," she smiled.
The next day I received her message. She learned from her mother that
she had been a colicky baby and had suffered from eczema. Eczema and recurrent colics in
babies are considered signs of allergy.
The lesson of this case history is simple: in many persons, asthma
genes remain dormant for years until some stressor activates them.
Hyperactivity Triggered By Paint
Some years ago, I saw a boy with a severe form of ADHD
(hyperactivity/attention deficit disorder). He had been assigned to a special class for
children with learning disabilities in school. Like almost all children with ADHD l have
seen, the tests showed allergy to molds and other inhalants and sensitivity to several
foods. His mother, an intelligent woman fully committed to doing the best for her son,
assured me that she was going to follow rigidly our program for her son. The boy responded
well and within some months he was readmitted to regular class.
Then one day I received a distress call from his mother telling me that
there had been a complete breakdown and her son was back to where he had been when I first
saw him. I asked the usual questions looking for the usual answer in sugar overload,
straying off his prescribed diet, viral or bacterial infections, and exposure to dust
during renovation work at home. The mother assured me that she had diligently looked for
all those factors but had failed to identify the culprit.
I prescribed liquid Nystatin for the boy because that had worked well
in the past in similar situations. The mother called two days later and said he was 90%
better. I asked one of our nurses to call the mother to see if she had any clues to what
had triggered the relapse. There were none.
The next week the mother called and told me of her discovery.
"I know what caused Tommy's [not his real name] relapse," she
said excitedly.
"What?" I asked, my interest piqued.
"House paint," she replied.
"Paint? But didn't I ask you last week if he had been exposed to
any chemicals?"
"Yes, you did. But I didn't know then."
"Where was it?"
"Tommy was at his grandparents for the weekend and slept in a
freshly painted room."
"How do you know it was the paint?," I expressed doubt.
"I called to tell you he was 90% better in two days. Well, he went
there again last weekend and had another relapse, though not so bad. He slept in the same
room. You know they kept the windows in the room closed during the week. Interesting,
isn't it?"
"Yes. Very interesting!" I concurred.
The lesson in this case history is that chemicals can trigger
hyperactivity in children with hyperactivity and attention deficits syndrome. Furthermore,
such chemical exposures are frequently not recognized by parents.
C. THE STATUS OF THE HEALTH OF THE BOWEL, BLOOD, AND LIVER IN ALLERGIC PATIENTS
The roles of the bowel, blood, and liver in the production of allergy
symptoms are seldom, if ever, addressed in books and articles on allergy. That, in my
view, is a serious omission. In the treatment of serious allergic conditions—such as
asthma and severe forms of colitis, such as Crohn's colitis and ulcerative colitis
—ignoring the health of the bowel, blood, and liver can create life-threatening
situations.
I consider it essential to assess and restore the health of the bowel,
blood, and liver ecosystems in the management of every allergic person.
During the last few decades, we have learned many new things about the
cause and treatment of allergy. Hundreds of research papers are published each month
showing the types of:
1. Immune cells that are involved in allergy reactions.
2. Immune molecules that trigger chain reactions.
3. Immune reactions that cause symptoms.
4. Immune-suppressing drugs that are used to control symptoms.
5. Allergy injections (immunotherapy) for desensitizing allergic
persons.
However, there is another face of this problem of allergy that is not
adequately addressed. Many basic questions concerning allergic disorders remain
unanswered. For example:
1. Skin rashes of eczema flare more in some weeks than in others in the
same person.
2. Wheezing and air hunger is worse on some days than others in the same
person.
3. Symptoms of Crohn's colitis and ulcerative colitis remit and relapse
for no apparent
reason in most instances.
4. Food sensitivity reactions vary over a broad range in the same
individual.
5. Allergic rhinitis becomes more intense on some days when pollen count
is low and abates
on days when pollen
counts are high.
6. Lifestyle stressors exaggerate bronchospasm more on some days than on
others in the same
asthma sufferer.
7. The phenomenon of "spreading sensitivity reactions" is
increasingly recognized in chronic fatigue
syndrome, fibromyalgia, and multiple
chemical sensitivity syndrome.
The scientific basis of all of the above cannot be explained by any of
the advances in immunology of allergic reactions. However, there is a direct relationship
between allergic symptoms and the health of bowel, blood, and liver.
Mold allergy and food sensitivity cause many allergy reactions that are
directly related to events taking place in the bowel, including ovegrowth of
disease-causing microbes and poor digestion. The symptoms include abdominal bloating,
flatulence, cramps, poor digestion, and episodes of diarrhea and constipation. Allergy
reactions also lead leaky gut syndrome and blood toxicity. Liver is the primary detox
organ of the body, and is adversely affected by events in the bowel and blood of persons
with allergic genes.
THREE PROBLEMS WITH ALLERGY DIAGNOSIS:
The False Negative Test Results
There are three main problems with diagnosis of allergy: (1) Allergy is
not suspected even when the presence of immune disorders is known; (2) Diagnostic tests
are used that are not sufficiently sensitive; and (3) Even when allergy tests are
positive, the treatment is limited to allergy injection therapy, while the critical issues
of the damaged bowel, blood, and liver ecosystems are completely ignored.
Proper allergy diagnosis and treatment, I regretfully recognize,
continue to be a low priority for some doctors. Amazingly, that happens in the majority of
disorders which they themselves consider immune in nature. The main reason for that is
that most family practitioners, pediatricians, and internists have neither the necessary
training nor the inclination to diagnose allergy in those patients. Indeed, many of them
seem convinced that allergy has no role to play in such immune disorders as lupus,
scleroderma, rheumatoid arthritis, vasculitis, multiple sclerosis, autoimmune thyroiditis,
fibromyalgia, chronic fatigue syndrome, and others. That seems especially odd in the face
of spreading epidemics of fibromyalgia (eight million Americans affected) and chronic
fatigue syndrome (another estimated five million Americans).
Even when those physicians consider the possibility of allergy, they
often fail to use optimal tests. The commonly used RAST test is simply inadequate for the
diagnosis of mold allergy. In a paper published in 1981 in American Journal of Clinical
Pathology, my colleague, Madhava Ramanarayanan, and I showed that the RAST test misses
almost one half as many mold allergies as detected by the micro-ELISA test. Even though
the RAST test since then has been improved, I still many allergic persons who are told
they not allergic simply becuase the insensitive blood test employed gave false negative
results.
SUMMARY
There are growing epidemics of asthma, eczema, fibromyalgia, and other
serious immune disorders. The flames of those epidemics are fanned by undiagnosed food and
mold allergies, functional nutritional deficiencies, and the ever-increasing total body
burden of environmental pollutants.
For good results, persons with allergy need to address three primary
issues: (1) recognize the underlying role of genes (allergy runs in families); (2)
recognize food and environmental triggers; (3) Assess the health status of the bowel,
blood, and liver.
Three main problems with allergy diagnosis are identified: (1) Allergy
is not suspected when it exists; (2) Insufficiently sensitive diagnostic tests are used;
and (3) the issues the bowel, blood, and liver health are not addressed. Clinical allergy
can be optimally managed with ecologic and integrative thinking.
References
1. Holgate ST. The epidemics of allergy and asthma. Nature
1999;402:B2-B4.
2. Ali M. Recent Advances in Integrative Allergy. Current Opinion in
Otolaryngology. 2000; 8:260-266.
3. Ali M. Ali M: Fibromyalgia: an oxidative-dysoxygenative disorder
(ODD). J Integrative Medicine 1999; 3:17-37.
Comments? e-mail Dr. Ali
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