Identifying and Treating Allergies
A Nurturing Potential team report
“Every session I had no fewer than
sixteen girls with “allergies” to dairy and wheat—cheese and bread basically—but
also to garlic, eggplant, corn, and nuts. They had cleverly developed
“allergies,” I believe, to the foods they had seen their own mothers fearing and
loathing as diet fads passed through their homes. I could’ve strangled their
mothers for saddling these girls with the idea that food is an enemy—some of
them only eight years old and already weird about wanting a piece of bread—and I
would’ve liked to bludgeon them, too, for forcing me to participate in their
young daughters’ fucked-up relationship with food.”
― Gabrielle Hamilton, Blood, Bones, and Butter: The Inadvertent Education of a Reluctant Chef (2011)
What are allergies?
Types of allergies
Allergies are increasing. Why?
What can be done?
You're sneezing, your nose is running, you keep rubbing your eyes, and you've come out in a rash. The obvious explanation for these symptoms is that you are suffering from an allergic reaction to something. But what?
It could be a whole host of things: food, pollen, medicinal drugs, climatic conditions, dust, smells, smoke, textiles or plastic - the list is seemingly endless. All these things have one thing in common: they are known as allergens, that is, something, anything that provokes an allergic reaction. All of them may be harmless to anyone else, but if you are allergic to one or more of them your immune system will believe that it is a harmful substance and will produce the allergic reaction. It does this by producing antibodies to the allergen and these antibodies release chemicals, such as histamine, into the bloodstream.
The histamine then acts on the eyes, nose, throat, lungs, skin, or gastrointestinal tract and provokes the allergic reaction. The same reaction will then be triggered on each occasion that you are exposed to the same allergen.
The severity of an allergic reaction can vary enormously. In its mildest form it may be nothing more than a runny nose. At its most severe it could produce anaphylaxis and might prove fatal. Anaphylaxis, whose symptoms include breathing and swallowing difficulties, swelling of lips, tongue, throat and other parts of the body, and dizziness or loss of consciousness, may be induced by something as simple as eating a peanut, but more commonly is associated with an insect bite or sting.
Types of allergies
Food allergy should not be confused with food intolerance. Food intolerance does not involve the immune system; the symptoms are usually less severe and may occur hours or even days after the food is eaten. Lactose intolerance is probably the most common of these and affects people who cannot produce enough of the enzyme required to digest milk sugar. Irritable bowel syndrome is often linked to intolerance to specific foods.
The most common foods to which people are allergic are milk, eggs, ground nuts (i.e. peanuts), tree nuts, sesame seeds, fish, shellfish, wheat and soy. When any of these foods are present in or added to another edible foodstuff, that product is required to have information to that effect shown on its packaging.
Sulphites are preservatives used in the production of some foods and drinks. They are important in avoiding deterioration in the product. For example, their use in wine production helps to arrest the fermentation process which would otherwise make the wine turn sour. Although an allergic reaction to sulphites is rare, it is far more common for them to produce allergy-like symptoms in people with a history of asthma or allergic rhinitis, where they may produce symptoms of wheezing, tight chest, or cough. Treatment for sulphite reaction is similar to other types of reaction, that is, anti-histamine or steroids for rashes, and inhalers for asthma.
As described in a later section, food allergies suffered by children at a very early age are often outgrown by the time they start school. Food allergies that develop during adulthood, however, or persist into adulthood, are likely to be lifelong allergies.
Allergies can produce two main types of skin affliction: rash or eczema. The rash is usually red and itchy (urticaria). Often it is of short duration. It can appear anywhere on the body, in various shapes and sizes. It is quite common for it to appear where tight clothing, such as a belt, is worn. Sometimes no obvious cause can be found, but it may be related to food, drugs, insect bites or stings, even such external stimulus as sun, water, exercise or stress.
Variations of these allergic reactions may be traced back to the use of blood pressure lowering drugs - ACE inhibitors. Although these drugs are used mainly in the treatment of hypertension and heart failure, they are also sometimes used to treat diabetics and for some forms of kidney disease. Their ability to relax blood vessels is useful but can affect the tongue and lips (angioedema) and frequently have the side-effect of producing a persistent dry cough.
We have already referred (under skin allergy) to the allergic reactions to ACE inhibitors. But there are many other forms of allergic reaction to prescription drugs.
Despite the rigorous process of testing before prescription drugs are released on to the market, side effects will inevitably be developed by a number of patients. Although these are usually fairly minor and may not even influence the decision to persist with use of the drug, occasionally relatively severe symptoms may occur.
An example of a widespread adverse drug reaction is that of aspirin producing a mild form of gastritis, or warfarin inducing bleeding. Equally well-known is the type of reaction that may follow topically applied creams or ointments, for example peeling of the skin.
Patients being admitted to hospital or being medically treated are typically asked if they are suffer any allergies, and it is quite usual for them to inform their medical practitioner that they are allergic to an antibiotic (most frequently penicillin, possibly because it is the one of longest historical use) or to a local anaesthetic. The latter can be particularly problematic in the case of dental treatment.
Some patients experience severe allergic reactions after being vaccinated.
Allergy in children
Most food allergies affect younger children under the age of three. According to Allergy UK, it is estimated that more than ten per cent of children of this age who have food allergies to milk, eggs, soya or wheat will outgrow the allergy by the time they start school. Peanut and tree-nut allergies are usually more persistent. Four out of five children with peanut allergies are estimated to remain allergic to peanuts for the rest of their lives.
Allergies are increasing. Why?
Both the number of sufferers and the pattern of the allergy from which they are suffering are apparently increasing throughout the world. According to Allergy UK, recent studies have shown "a significant increase in the incidence of food allergies, in particular amongst children. In the UK, it is estimated that up to 50% of children are diagnosed with an allergic condition." But whereas the increase was initially seen in developed countries such as the UK, Europe and USA, it can now be identified in all countries undergoing industrial development, affecting up to 30-35% of people at some stage in their lives.
Some of the suggested reasons for this increase include:
Environmental factors and improvement in hygiene
One of the postulates for the increased susceptibility to allergic conditions is the improvement in environmental exposure to disease that has resulted in a reduced immune tolerance. This has been called the hygiene hypothesis. It was developed in 1989 by David Strachan of the London School of Hygiene and Tropical Medicine whereby the exposure to hygiene in early life was linked to an increase in allergies later in life. He reached the conclusion that hygiene leads to more allergies after observing that members of large families were less likely to get allergic rhinitis (hay fever) than those of smaller families. He felt that this was because the immune system of large family members had adapted to a tolerance of foreign pathogens.
Furthermore, one of the main differences between modern, wealthy countries and less developed countries is the presence of parasites and other microorganisms. Wealthy countries have developed advanced sanitation technology and have become very hygienic, eliminating many parasites and bacteria from the water supply, ensuring clean sources of food, and treating infection. This advance has drastically reduced the exposure of people to preventable diseases in wealthy countries.
This conclusion is supported by epidemiological data revealing that several immunological and autoimmune diseases are less common in the developing world than in the industrialised world and that immigrants to the industrialised world from third world countries would develop immunological disorders in ratio with the length of time since arrival. This applied equally for sufferers of asthma and other chronic inflammatory complaints.
Altered exposure to food allergens
A large number of cosmetic products include ingredients derived from nuts and other potentially allergenic foods. Some researchers suggest that exposing the body to potential allergens through skin creams may cause the development of allergy in people at risk of allergy. There is only a limited evidence for this, and the situation is likely to be much more complicated than just applying the wrong sort of cream to a child’s skin.
Changes in eating habits
Our diets tend to include more processed foods and less fruit and vegetables. It has been suggested that the increase in food allergy might be due to more allergenic foods, such as peanuts, in our diet. However, there is no evidence that this has happened, and many cultures, such as some Asian communities traditionally eat large quantities of peanuts.
Research has been undertaken into whether reduced
levels of nutrients – in particular vitamin D, omega-3 fatty
acids (in fish) or antioxidants – might contribute to the
development of allergy. While a diet low in oily fish has been
associated with increased risk of childhood asthma and allergies
in some studies, one study giving extra fish oils to babies did
not prevent the occurrence of allergies.
Vitamin D is important for the immune system and in early lung development. Deficiency of vitamin D is increasing throughout the world mainly because of sunlight avoidance through spending more time indoors or using sun-screen to reduce risk of skin cancer (most vitamin D is produced by the action of natural sunlight on skin). However, the data linking vitamin D deficiency to allergy is conflicting. Furthermore, giving pregnant women vitamin D supplements does not appear to have a consistent effect on reducing the risk of allergies in children.
Genetics and epigenetics
Children born into families where allergies already exist have a higher than average chance of developing allergies themselves. In the UK today, children have a 1 in 5 predisposition of developing an allergy. However, the risk is doubled if one parent has an allergy (particularly if that parent is the mother). If both parents have allergies, the risk is increased to 60-80%. This increased tendency for individuals to develop allergies because of their genes is known as being atopic.
Atopy results in an increased risk to any allergy, not just a specific type of allergic disease. So a child of parents who suffer from hay fever is no more likely to develop hay fever than asthma or food allergy. Similarly, the severity of the allergy in a child bears no relation to the severity of the parents’ allergic disease.
However, within the human population, changes in genes take many hundreds of years to cause consequences in disease. So atopy/genetic tendency alone cannot account for the current increase in allergy seen over the past few decades. Current research is investigating the effect of the environment in which we live on genetic factors. It is now clear that many genes can be ‘turned on or off’ by environmental factors. For example, viral infections are able to modulate our immune systems by switching certain genes on or off, promoting an allergic tendency in immune cells.
Epigenetics is the branch of biology that deals with the effect of external influences on development including, In recent years, the development of various diseases such as allergic disorders. Continuing research using animal models have revealed that environmental factors such as maternal tobacco smoke can alter gene transcription and, as a result, the structure and function of lungs, thus influencing asthma and other allergic diseases, without effecting changes to the underlying DNA sequence. It is also offering explanations as to how our diets, our exposure to toxins, our stress levels, even one-off traumatic events, may be subtly altering the genetic legacy we pass on to our descendents.
What can be done?
There is no treatment to cure a food allergy. The best way of preventing an allergic reaction is to identify the food that causes the allergy and then avoid it.
There are, however, steps that can be taken to reduce symptoms. Medications such as anti-histamines and decongestants are the most common of these. More drastic is epinephrine which is injected in the treatment of anaphylactic reactions. Immunotherapy uses injected allergens to desensitise the body's response, but this is merely ameliorative and not curative, and is used for mild allergies such as allergic rhinitis.
Antihistamines remain the major sedative treatment for most minor allergies, but really the only effective remedy is to avoid the food, product, or environment that induces the allergic reaction.
If you choose to take the complementary path, there are several options. We have referred to a standby reference work that we have used regularly since its first publication in 1988(1). According to Your Health Your Choice
Each therapy has its own merits. The conventional view is strong on simple practicality, but avoidance of irritation and use of suppressive medication can be counter-productive. And there is also the problem of side effects.
The acupuncturist has perhaps the most impressive image of the disturbance in constitutional terms, but confirms the difficulty that acupuncture can have in dealing with deep-seated allergies.
The homeopath possibly has the best chance of making an impact here. Using potentized homeopathic preparations of an allergen has been shown in clinical trials to be effective.
The osteopath and naturopath provides a useful reminder of the possibility of parallel food sensitivities , but also recognises that treatment might involve choosing from a wide range of regimes.
The medical herbalist, by contrast, opts for cautious measures, but ones which can provide a measure of long-term relief.
The choice facing the patient is between the practical yet rather negative prognosis of the family doctor, and a bewildering variety of other approaches. One might safely suggest homeopathy as the most gentle, natural alternative.
(1) Your Health Your Choice, edited by Simon Mills. Macmillan, 1988.
General allergy information : http://www.allergyuk.org/
Allergies in children: http://kidshealth.org/
European initiatives: http://www.eaaci.org/
Allergies and the hygiene hypothesis: http://www.thenakedscientists.com/HTML/articles/article/the-hygiene-hypothesis-unraveled/