Allergies

Published on 17/03/2015 by admin

Last modified 22/04/2025

Print this page

This article have been viewed 1938 times

chapter 21 Allergies

INTRODUCTION AND OVERVIEW

The purpose of this chapter is to introduce you to the basics of allergy, what the practitioner should know in order to plan an effective integrative treatment strategy, and to provide an overview of some therapies that have been used successfully to treat different aspects of allergy. For the patient, an integrative approach usually means making lifestyle changes and being more attentive to what they allow inside their body and their home. For the practitioner, it means becoming more informed about allergy and treatment options in order to make better treatment decisions for each patient.

Millions of people worldwide endure the misery of allergies and suffer from their effects, seeking relief through conventional pharmacological remedies. However, most conventional remedies only treat the symptoms of allergies with antihistamines, decongestants or immunosuppressive medications, which, while offering welcome relief or even saving lives, do not treat the allergy itself. Untreated allergies can spread, worsen or cause other health problems. Also, reliance on drugs is always problematic, as most drugs have undesirable side effects.

One problem that has so far limited our ability to successfully treat allergy is what Dr Merv Garrett of the Australasian College of Nutritional and Environmental Medicine refers to as ‘labelling disease’.¹ Allergy is a multifactorial problem, attributable to so many causal factors and appearing in so many different ways that labelling all its manifestations as allergy can mislead the practitioner into a narrow pattern of diagnosis and treatment. Any diagnosis of allergy should include a thorough investigation of the influences on that particular case, and investigation into the likely effectiveness and appropriateness of different possible treatments.

DEFINITION OF TERMS

Most natural or complementary healthcare practitioners use the term ‘allergy’ to refer to situations in which the immune system overreacts to a normally harmless substance, causing an exaggerated sensitivity (hypersensitivity) to that substance. However, medical doctors and scientists often recognise only reactions that result from the activation of immunoglobulin E (IgE) antibodies as allergies—that is, the ‘classic’ allergy. People who experience allergic symptoms without the antibody reaction are said to have an intolerance or a hypersensitivity to a particular substance.

Some people, however, may have many of the symptoms of classical allergy, but reactions, which may occur hours or days after the exposure, involving little or no IgE. While these people may experience delayed skin reactions, their immediate skin reactions and blood tests for allergens may be negative or weak. More than a decade later, there is much wider recognition of the diversity of allergic responses, and of the fact that IgE-mediated responses do not account for all allergies, especially food allergies.²^–⁴

Because medical terminology must be precise in order to facilitate proper diagnosis and treatment, the following distinctions are made between allergy, sensitivity and intolerance.

• Allergy refers to the immune system’s hypersensitivity upon re-exposure to a sensitising agent, an allergen, which results in the release of inflammatory chemicals and development of various symptoms. Although the presence of IgE has traditionally been the marker of an allergy, the correct term applies to elevation of specific antibodies due to antigen stimulus.

• Sensitivity refers to adverse reactions in the body upon exposure to a sensitising agent in the environment. It does not involve antibodies, although it may involve other immunological processes. Most food and chemical reactions are sensitivities.

• Intolerance refers to the absence of a particular chemical (e.g. the enzyme lactase) or physiological process needed to digest a food substance, and the reaction is the result of non-immunological response of the body. Food intolerance is responsible for most adverse reactions to food, but it is not a true allergy; correcting the defect ends the symptoms.

BACKGROUND AND PREVALENCE

It is difficult to obtain solid, consistent, up-to-date statistics on allergy, but throughout the Western world, a significant rise in the incidence of allergy has been reported since the 1950s. A report released by the House of Lords Select Committee on Science and Technology in July 2007 stated that, ‘Allergy in the United Kingdom has now reached epidemic proportions, with new, more complex and potentially life threatening allergies’.⁵ Allergies are also on the rise in Australia, which has one of the highest rates in the world.

A study by the Australian Centre for Asthma Monitoring revealed that, ‘the number of Australians hospitalised for severe life-threatening allergic reactions has more than doubled in the past 15 years’, particularly among young children.⁶ In a lecture at the Onassis Foundation in Greece, Dr Daphne Tsitoura said that if something is not done to stem this growth, one in two Europeans will have allergies or allergy-related conditions by 2015.⁷

Food allergies, many of which do not fit the IgE-mediated reaction pattern, are on the rise globally. In 2001, the US Food and Drug Administration reported that ‘Only about 1.5 percent of adults and up to 6 percent of children younger than 3 years in the United States—about 4 million people—have a true food allergy, according to researchers who have examined the prevalence of food allergies’, but those statistics only included ‘classic’ allergies involving IgE. After surveying 14,948 people about seafood allergies, Sicherer and colleagues concluded that 2.3% of the general population had credible seafood allergy, suggesting that food allergies are much more prevalent than generally allowed for in US government statistics.⁸

The House of Lords report on allergy noted the adverse effects of allergy on quality of life, especially for children, and on school and workplace performance.⁵ In addition to this, allergy places an enormous economic burden on society. For these reasons alone, it is not to be taken lightly, even when the allergies are mild. Even more insidious are the less obvious and ‘hidden’ health effects of allergy. It makes life miserable for many sufferers, and has been implicated in a large number of diseases and disorders, including degenerative disease.

AETIOLOGY

Allergy means that the person’s body, for one reason or another, has lost the normal ability to cope appropriately with one or more substances. While heredity makes some people more susceptible to allergy than others, the causes of allergy and sensitivity are multifactorial. Specifically, genetic susceptibility and some dietary, environmental and lifestyle factors that break down or disrupt the individual’s immune system and barrier defences are in varying degrees responsible for the development and progress of allergy and sensitivity.

GENETIC INFLUENCES ON ALLERGY

An allergic predisposition or tendency is inherited, so allergy often runs in families. The age of onset of an allergic condition depends on the degree of inheritance: the stronger the genetic factor, the earlier in life is the probable onset. Genes do increase children’s risk of allergies, from 50–58% if one parent has allergies to 60–80% if both are affected. This risk seems to be higher if the mother has allergies. Even with a family history of allergy, however, a child may not develop allergies until later in life, or may never develop the condition, because allergy results from a combination of other factors that determine whether a person’s genetic susceptibility will be realised.

OTHER PARENTAL INFLUENCES ON INFANT ALLERGY

The development of allergy in people with or without a family history of allergies is usually triggered by pre-existing environmental influences that can affect a person even before birth. A mother with allergies can transmit them, and the antibodies against them, to her unborn child through the placenta, or after birth in the breast milk. A mother without allergies can transmit toxins, biochemicals resulting from chronic stress or trauma, or pathogens to the unborn child or infant in the same ways: via the placenta or through breastfeeding. This can set the stage within that child’s body for allergies. Some early influences on allergy are:

• serious parental disease or condition prior to conception or birth

• maternal exposure to harmful substances during pregnancy

• parental exposure to toxins prior to conception

• toxins in the child’s body resulting from disease (e.g. streptococcal infection as in strep throat, measles or chicken pox)

• maternal emotional or physiological trauma during pregnancy

• in utero and postnatal stress. Maternal stress, including parenting stresses and maternal depression, has been identified as a factor in early onset of asthma in children by age 3 years, and research suggests that the in utero environment, including maternal stress, affects atopy ⁹^–¹¹

• weakness of the child’s immune system due to infection, drugs, malnutrition etc.

ENVIRONMENTAL AND LIFESTYLE FACTORS

External factors can cause allergy in children and adults. In 1998, Dr Stephen Holgate wrote, in the Quarterly Journal of Medicine, ‘While ∼40% of the clinical expression of an allergic disorder can be accounted for by genetic factors, for these to be manifest there is an absolute requirement for interactions with environmental factors’.¹² The World Health Organization reported that, ‘convincing evidence demonstrates that a number of environmental factors—environmental tobacco smoke, poor indoor/outdoor climate and some allergens—contribute to the onset of allergic disease. Once the disease is established, these factors may also trigger symptoms’.¹³

Additional factors linked to the development of allergies include:

• diet—lack of variety, too much of one food, overeating or binge eating

• lack of breastfeeding

• early introduction of cow’s milk

• early introduction of solid food

• dysbiosis

• toxins

• other factors such as hormonal imbalances, infections, metabolic diseases, seasons, altitude, nutritional imbalances, heredity and race.

In an article on preventing allergies, AB Becker of the University of Manitoba, Canada, wrote: ‘It is increasingly clear that gene-directed environmental manipulation of allergy in a multifaceted manner during a “window of opportunity” is critical in the primary prevention of allergy and allergic diseases like asthma’.¹⁴ The ‘window of opportunity’ for most people is in the first year of life, when a multifaceted preventive strategy can help develop the child’s resistance to allergies. Research suggests that in the first year of life, allergies may be prevented by:

• breastfeeding

• delayed introduction of cow’s milk

• delayed introduction of solid foods

• providing a wide variety of balanced dietary elements

• maternal and infant supplementation with probiotics.

(For more details, see below, under ‘Prevention’.)

THE TWO PATHWAYS TO ALLERGY

In general, some or all of the above-mentioned influences lead to allergies through one or both of two pathways:

• immune system hypersensitivity

• damage to the mucous membranes in the body’s natural defence barriers (gut, airways and skin).

Immune overreactivity

An immune system stressed by infection, stress or toxins can become hypersensitive and overreact to an otherwise safe substance. The first time this occurs, antibodies are produced that attach to basophils and mast cells embedded in the mucous membranes, creating sensitivity to that substance, but no allergic reaction. On the next exposure to that allergen, the antibodies ‘remember’ the substance, and stimulate release of chemicals, including histamines. Together with other cells also rushed to the affected site, these cause inflammation and the typical symptoms of allergy: coughing, sneezing, runny nose, swelling, itching and so on.

Failure of the mucous membranes

The cells of the mucous membranes lining the intestines, respiratory passages and skin are held together with ‘tight junctions’. When the membranes become irritated and inflamed, the tight junctions weaken, allowing food particles, bacteria or toxins to pass through the walls prematurely, which once again can lead to allergy.

One very important example of this is ‘leaky gut syndrome’, which researchers have shown to contribute to the development of allergies.¹⁵^–¹⁸ The mucous membrane lining of the gut wall can be compromised by:

• dysbiosis and/or faulty digestion

• infestation by bacteria, parasites, fungus, yeasts or protozoa

• chemical irritants or toxins

• poor diet

• inflammatory bowel conditions such as colitis, Crohn’s disease, coeliac disease (which may in turn be associated with hidden food allergies)

• chronic stress (leading to the over-release of certain chemicals and hormones)

• genetic or acquired enzyme deficiencies (e.g. lactose deficiency and coeliac disease).

DIAGNOSIS

The practitioner taking an integrative approach to allergies must be willing to look beyond the expected parameters of diagnosis, as allergies have a varied and complex pathology due to the interactions of so many different elements: physiology, psychology, genetic make-up, situation, family and environment. Not only do different people manifest the same kinds of allergies in different ways, and not only are they multifactorial in cause, but one must consider the possibility of cross-reactions, where sensitivity to one substance causes a person to be sensitive to ingredients in several other substances. For example, a person with an allergy to melons may also be allergic to other fruits or even to pollen because of certain similar ingredients. Assessment of cross-reactive food allergens requires careful history, testing and perhaps oral food challenges.¹⁹

Below is a simple but practical model for diagnosing allergies. Note the central role of the history in determining what might be causing the allergic symptoms.

HISTORY

The clinical pattern of allergies and food intolerances is often exposed in the history taken from the patient. The practitioner needs to identify childhood problems such as intolerance to milk feeding, frequent diagnosis of upper respiratory tract infections, ear infections, tonsillitis and sinusitis, which could all be due to dairy intolerance in particular. The history should include any history of eczema, information about dairy and wheat reactions, frequency and duration of reactions, possible or likely triggers, seasonal or other influences on reactions, such as presence of animals or certain locations, family history of any reactions or allergy disorders, age of onset of reactions or condition, and changes over time.

Through an examination of an infant’s dietary history, for instance, it is easy to establish a relationship between severe colic and cow’s milk, from which the practitioner can surmise that the colic is associated with cow’s milk intolerance (as reported by Iacono and colleagues ²⁰ and Hill & Hosking²¹) without resorting to distressing skin tests, and recommend dietary treatment.

Also ask about the emotional environment and the emotional context of reactions, as this can play a role in the onset and worsening of allergies.

History and other investigations are critical, even when the symptoms seem to indicate one kind of allergy. Food allergies or sensitivities, for instance, can lead to lung disease, asthma, eczema, and rhinitis, wheezing and other respiratory symptoms. Asthma can show up as food allergies and gastrointestinal symptoms. Food allergy or sensitivity is, in fact, often overlooked as a cause of asthma, especially because food allergies do not always show up in standard skin tests. Multiple chemical sensitivity with its complex combination of factors can also be missed by standard tests, and is usually diagnosed by history.²²

Dietary and environmental history

The purpose of taking a dietary and environmental history is to get an idea of which foods and toxins may be causing reactions. A week-long food diary can be adequate, showing where the food was bought, prepared and eaten, and any effects from eating the food. Include snacks, takeaway food, beverages and meals out.

Some reactions to food will be almost immediate, within an hour or two of consumption or even of contact with the food. These are usually obvious reactions such as stomach cramps, itching, vomiting or anaphylaxis, a severe and potentially fatal reaction which can involve light-headedness, swollen tongue or throat, difficulty breathing, fainting or facial swelling. Anaphylaxis usually occurs immediately or within 2 hours of food ingestion, and requires immediate emergency care. Other reactions may be ‘hidden’, occurring from 24 hours to days after ingestion, and this can make it difficult to relate them to particular foods. This is why a food diary is so important, as it can reveal otherwise hidden patterns of reaction. An elimination diet can be a useful diagnostic tool in this case (see below, under ‘Investigations’). Hidden reactions can include physiological reactions such as swollen lymph nodes or unexplained body aches, or they can be psychological, showing up as clusters of cognitive or behavioural problems.

Exposure to toxins

Clues to environmental factors are also to be found in the patterns of presentation of symptoms, and also in chemical testing, such as hair or urinary testing to identify environmental pollutants such as arsenic or mercury.²² Because a person can be allergic to just about anything, everything with which the person comes into contact should be considered, including common household chemicals such as:

• fluoride in toothpaste

• chlorine and/or fluoride in water (which can enter through the skin when bathing)

• chemical solvents and toxic fumes in building materials

• aluminium in deodorants

• nickel in jewellery

• latex in dish-washing gloves

• petrochemicals in many personal care products and cleaning products

• food additives and colours

• electromagnetic frequencies from computers, microwaves and mobile phones

• dust, which contains allergens such as mould, dust mites, pollen, debris from cockroaches, and household and animal dander

• toxins in sprays and treatments against cockroaches and ants

• formaldehyde in carpets, polyester clothing, spray starch and paper products

• Scotchgard™ on furniture

• poisons in fire retardants in clothing and upholstery.

SIGNS AND SYMPTOMS

How do you recognise an allergy? You look for signs, though you will only be able to see some for yourself, if any, so history is your primary diagnostic tool and can lead you to a correct diagnosis even when tests indicate to the contrary. Below are some signs and symptoms that can indicate allergy. You can include them in your consultation interviews or checklists.

First, suspect allergy whenever inflammation is present. If the allergic reaction is near the skin, you will often see all four cardinal signs of inflammation: pain, swelling, heat and redness. For example, hives will show up as a red, warm, painful and swollen rash. In the gut, allergies will cause inflammation in the gut lining, compromising nutrient absorption and digestion. Depending on where the reaction takes place, you will have different symptoms. Allergy can occur anywhere in the body, even in the brain.

There are two categories of allergy sufferers: those with obvious allergy symptoms and signs, and those with ‘hidden’ signs that may be easily overlooked. Signs of allergy include:

• nasal congestion, drippy nose, itchy teary eyes

• tender sinuses

• swelling of face, tongue or limbs

• skin rashes, eczema or hives

• coughing or wheezing

• dark, blue or black eye circles (sometimes called ‘allergic shiners’)

• crease at the bridge of the nose.

• wrinkles or abnormally puffy bags under the eyes

• a ‘spaced-out’ look

• bright red cheeks, nose tip or earlobes

• ‘wiggly’ or restless legs

• frequent nose rubbing

• frequent throat clearing or coughing

• a puffy look to face, hands and knuckles, ankles and lower leg

• eye problems—red, itching, burning, running, heavy puffy eyelids

• acne, acne rosacea, hives, eczema, dermatitis, boils, psoriasis

• sleep disturbances

• frequent colds and flu

• mental and behavioural—depression, irritability, agitation, mood swings, anxiety, anger, panic attacks, delusions, epilepsy, insomnia, restlessness, falling asleep at inappropriate times, or manifesting unusual behaviour

• persistent throat clearing, coughing

• burning or numbness of the face, arms, legs or feet, or a creepy crawly feeling under the skin.

INVESTIGATIONS

Most information will come from the history, and tests may also be administered, to identify or confirm major allergies and allow strategies to be precisely targeted. Various diagnostic procedures are available to test allergies and IgE-mediated allergies. Allopathic medicine uses various testing modalities to identify allergens and allergic reactions in sensitive individuals. Other diagnostic approaches include allergy symptom-rating questionnaire, food avoidance test, food challenge test, scratch test, elimination and challenge diet, rotation diet,²³ pulse difference test,^24,²⁵ patch test, skin prick test (SPT), radioallergosorbent test (RAST), provocative neutralisation testing, immunoglobulin studies (IgE, IgA, IgM, IgG) and IgE-specific antigen studies.

The most commonly performed allergy tests are the SPT, the RAST and the enzyme-linked immunosorbent assay (ELISA). They evaluate whether a person is producing specific IgE to ingested or inhaled allergens.

Elimination diet

This very reliable and effective test for food allergies was first developed by Californian Dr Albert Rowe and expounded in his book, Elimination Diets and the Patient’s Allergies (1941), and later enabled Australian researchers to establish the role played by dietary factors in certain allergies.²⁷ Dr Rowe, formerly of the University of California School of Medicine in San Francisco, California, is considered the father of the concept of food allergy. He realised that foods can cause a problem even though the reaction is not IgE mediated. He is best known for his elimination diet, which is still important in identifying and treating food allergy.

The procedure involves two steps: elimination and reintroduction of foods.

Step 1: Elimination phase

Eliminate all suspect foods for 4–7 days, to clear the body of any delayed reactions to the food. This may require a semi-fast of mainly vegetables, which has the added benefit of giving the person’s system a break from unhealthy or allergenic foods. Eliminating suspect foods one at a time is not recommended, as a person often has multiple food allergies. If a semi-fast is not feasible, begin by eliminating:

• those foods that are suspect (any foods that appear to affect the person physically or mentally)

• common allergenic foods—dairy, wheat, eggs, nuts, fish and seafood, citrus, food additives, sugar

• foods that are craved or eaten a lot, as food cravings and addictions can result from allergies.

If the person continues to show any signs of allergy, continue eliminating foods, starting with chocolate, pork and beef, tomatoes and kiwifruit. The person may experience withdrawal symptoms—irritability, emotionality, headaches or lethargy—which may also show that the body is detoxifying, but these will pass quickly.

Step 2: Challenge phase

It may take 4–5 days to completely clear the body of food allergens and eliminate allergy symptoms, and to notice the positive effects on health and behaviour. Then you can begin to reintroduce the eliminated foods in the following way, to allow more accurate identification of food allergens.

• At first, reintroduce organic, whole foods where possible, as the person may be reacting to pesticides or additives in a food or during food processing, not to the food itself.

• Add only one food each day, to be eaten alone as a meal, not in combination with other foods.

• Portions should be moderate, not large.

• Note any symptoms—such as pain, bloating, gas, fatigue, difficulty concentrating, gloominess, over-excitability, stuffy nose—that occur after that food is eaten. If symptoms are noted, this indicates a food allergy, sensitivity or intolerance, and the food should be avoided. Some symptoms may surface a few days later, and foods reintroduced over that time may need to be re-tested for.

• Sugary, fatty and stimulant foods should be avoided, as they can interfere with the results.

• The foods used in the test meals must be free of chemical contaminants and seasonings, to avoid confusing the results.

When done properly, the food challenge gives very accurate results. Although the test can be done at home, it is not safe for everyone. Also, because of the allergy/addiction phenomenon, withdrawal symptoms from foods can be severe. For those with strong or severe allergic reactions, multiple symptoms or other medical conditions, the challenge phase is best done under medical supervision. There is a risk of a severe reaction associated with the challenge, but given its diagnostic benefit, it might be considered worthwhile if carried out under the guidance of an experienced practitioner who is also equipped for emergencies.

Rotation diet

If the elimination/challenge test is not successful or is too difficult, a rotation diet can be used to reduce symptoms and reduce the likelihood that the patient will develop further food sensitivities. This is because food from each food category is only eaten once every 4 days, which is about the time it takes most allergens to clear the body. Therefore, the allergen does not build up in the body, so food allergens can be identified with little risk of an allergic reaction.

Alternative testing methods

Alternative medicine practitioners also employ a variety of other tests for detecting allergies, sensitivities and food intolerances. Some of the commonly used non-traditional medical screening tests include: electrodermal screening test (also known as electroacupuncture by Voll (EAV)), muscle response testing, cytotoxic test, prime test, applied kinesiological screening, pulse test, saliva test, meridian scanning test, computerised organ scanners, Kirlian photography, electromagnetic force measurements and serial endpoint titration, which is also used therapeutically (see below, under ‘Complementary or alternative therapies for allergy’).

FINAL THOUGHTS ON DIAGNOSING ALLERGIES

Food allergies and intolerances are suggested by: early age of onset of symptoms (before 12 months old); past history of atopic dermatitis; infective pattern to asthma, sinusitis, recurrent ear infections, repeated grommets, recurrent croup; and associated symptoms such as migraines, undue fatigue, irritable bowel syndrome, behaviour problems in children, obstructive nasal or pharyngeal symptoms, poor response to prophylactic drug therapy, and negative skin tests to inhalants. A family history of atopy needs to be identified, as food sensitivities often run right through families.

Inhalant allergies are often suggested by: age of onset after 18 months; anterior nasal symptoms such as itching, sneezing, clear rhinorrhoea; ticklish cough; history of asthma; and skin prick tests. They usually respond well to prophylactic drug therapy. Parents often have similar allergies. Also consider that around 20% of people with inhalant allergies also have food allergies or sensitivities. There are many cross-reactions between foods and pollens, probably because of the underlying phenolics and the homologous conserved proteins in these foods and non-food proteins.²⁸

MANAGEMENT

PREVENTION

The first major challenge in treating allergies is to change the emphasis from drug treatment to prevention. Prevention is rarely funded, but it is the best approach to ward off the development of allergies, chronic disease and morbidity. The most effective preventive strategies are those targeting the newborn and small child, but the onset of allergies can occur at any time of life. Therefore, the preventive strategies below include some that are also relevant to adults.

FIGURE 21.3 Testing and treatment options

Exclusive breastfeeding

If continued for at least the first 4 months, breastfeeding helps protect against allergies, strengthens the immune system and ensures good use of nutrients to build a strong barrier system. Exclusive breastfeeding means no additional liquids or foods. If breastfeeding isn’t possible, a hydrolysed (hypoallergenic) formula rather than one based on cow’s milk is recommended for the first 12 months. Because allergies and allergens can be transmitted by an allergic mother to her infant via breastfeeding, preventive measures should begin with identification and avoidance of all allergens that affect the mother before pregnancy and during breastfeeding.

Delayed introduction of cow’s milk

Cow’s milk is best avoided for the first 12 months of life. It is higher in fat and protein than breast milk, and contains substances that the infant’s digestive tract is not normally able to handle. The infant’s immature digestive system must therefore work much harder to digest cow’s milk. This probably explains why it is one of the most common allergens for children. Also, cow’s milk and milk-based formulas lack the enzymes found in breast milk that help break it down. This means that partially digested protein may be absorbed by the infant’s more permeable digestive system, resulting in an allergy to cow’s milk. Allergy to milk will cause colic in infants, and can result in gastrointestinal bleeding, anaemia, chronic diarrhoea, fibrosis and coeliac disease.

Later introduction of solid foods

With the rapid rise in food allergies over the past decades, dietary strategies are especially crucial. Solid foods put an unnecessary burden on the infant’s immature digestive system, and may not be properly digested; therefore, it is advisable to delay solids until at least 6 months, when the child’s digestive tract has been able to develop healthy colonies of microflora, and is more mature. This also helps minimise the child’s exposure to toxins, such as those found in many foods, including baby foods, and to potentially allergic foods, until the child’s system is better able to handle them.

Foods should be introduced one at a time, beginning with mostly vegetables and some fruits (many fruits are quite allergenic). Rice and oatmeal can be added later, but common allergenic foods—wheat, eggs, nuts, corn, fish, beef, kiwifruit and citrus—should only be added after 12–18 months, and withdrawn if they seem to bring on symptoms such as rash, hyperactivity, ear infection, red cheeks, diarrhoea, runny or stuffy nose, pain, itchiness or unusual irritability.

Modified maternal diet during pregnancy and breastfeeding

An allergic mother should eliminate common allergenic foods and foods to which she is allergic from her diet before (if possible) and during pregnancy, to eliminate common allergens. The Allergy Unit of the Royal Prince Alfred Hospital in Sydney reported that children whose mothers eliminated allergenic foods from their diet had at least 50% fewer allergies than children whose mothers did not modify their diet, and that ‘there were fewer problems with egg, milk, and peanut allergies’.²⁹ Citrus, kiwifruit, large fish, soy, legumes and wheat should also be avoided.

Delayed vaccinations

Some researchers have raised concerns about possible effects of early vaccinations on the child’s immature immune system.^30,³¹ The general consensus, however, is that the protective benefits of vaccines outweigh the possible risks. Vaccination induces a predominately Th2-mediated immune response and probiotics may be beneficial during routine vaccinations, to manage the effects of vaccinations in children.

Promotion of beneficial intestinal microflora

Beneficial intestinal microflora help protect against damage to the digestive tract, reverse intestinal permeability and reduce antigen load in the gut by degrading and modifying potentially harmful macromolecules. A maternal probiotic supplement is suggested during pregnancy and breastfeeding, and also for the baby from birth, and in the event of antibiotic treatment. Antibiotics can disrupt the balance of intestinal bacteria, allowing pathogens to proliferate, which has been shown to cause allergies.^32,³³ Research into the effects of intestinal microflora on allergy indicated that infants with greater diversity of microbial colonisation by 1 month of age were less likely to develop allergies.³³

A wide variety of balanced dietary elements

Good nutrition can help prevent allergies in both children and adults. Allergies can result from eating too much of one kind of food, perhaps because the enzymes for that food are depleted or due to biochemical changes. A balanced, varied diet also ensures adequate nutrition, a key factor in allergy prevention and treatment, and can help reduce allergy symptoms, as particular foods are less likely to accumulate in the body.

Stress management

Stress is increasingly recognised as a factor in the onset of allergies, possibly even a major factor. Effective stress management can prevent the development of some allergies, and can significantly reduce the severity of reactions.

Reduced exposure to toxins

Toxic chemicals, pesticides, heavy metals and fumes are ubiquitous in the modern environment, found in our soil, water, air, food, medications, homes, workplaces and personal care products. Toxins are a major culprit in the onset of allergies and many other diseases. While the body can usually cope with a certain level of toxins, when the body is overloaded with toxins, its normal detoxification processes are overwhelmed, and key organs can be affected. Toxic overload severely disrupts body processes and stresses the immune system, leading to allergies. In our increasingly toxic world, the best protection one can have against allergies is reduced exposure to toxins, which in most situations requires conscious lifestyle choices.

PLANNING THE INTEGRATIVE STRATEGY

You have investigated the situation for your client who has allergies. Some preventive measures can already be put into place to prevent the development of further or worse allergies, but you are ready to consider treatment options. The next step is to work out what the triggers are and what causes the allergy symptoms in the first place. For example, we have to stop regarding asthma, glue ears, migraines, hay fever, irritable bowel syndrome and sinusitis as the end of the story. They should all qualify for a thorough diagnostic work-up to establish the underlying causes and triggers. For example, a 5-year-old with a recurring wheezy bronchitis since birth could be suffering from classic cow milk intolerance, and a 5-year-old with a 2-year history of recurring nocturnal asthmatic symptoms could be suffering from dust mite sensitivity. Both children have similar symptom presentations, but a closer look at the history reveals different aetiologies that require different management strategies.

To understand the clinical patterns of allergies, you need to ask some critical questions:

1. Could the patient’s symptoms be related to underlying allergies? Chemical sensitivities? Food intolerance?

2. What additional tests would be useful to identify triggers or causes?

3. What are the treatment options? Is antigen desensitisation with immunotherapy an option?

4. Are changes to the environment necessary? Are dietary modifications required?

5. What prophylactic pharmacology is likely to be effective?

6. What is the overall toxic load on the patient’s immune system?

7. What is the nutritional status of the patient and can it be improved?

The answers to these questions will assist in planning treatment strategies. While different doctors may respond to this information by selecting different methods and resources, a multi-track strategy is the only way to address the complexity of factors associated with allergy, and to provide a holistic healing framework for each patient. Some of the many possible treatment options that different practitioners and patients have reported to be effective are described in the following sections.

A six-step approach to allergy

Once the contributing factors and nature of the allergy have been defined, the first line of action is to address the person’s lifestyle, diet and environment, in order to reduce or remove those elements that caused the development of allergy and contribute to allergic symptoms. The second line of action is to rebuild the person’s health and capacity to heal, thereby building lasting resistance to allergies.

A basic program for treating and even preventing nearly all allergies and sensitivities is as follows:

1. Avoid/eliminate and/or desensitise the person to the identified allergens in their environment.

2. Alleviate the chronic inflammatory action.

3. Detoxify and reduce the total toxic load (in the body and the environment).

4. Stabilise the barrier systems, whether gut, skin or respiratory system.

5. Correct nutritional deficiencies and rebuild the immune system.

6. Reduce and manage stress.

KEY ELEMENTS OF AN INTEGRATIVE APPROACH TO TREATING ALLERGIES

The processes discussed below are the backbone of the six-step program outlined above, because they address the major contributing factors of allergy and allergy-related disorders. These processes are: detoxification, reduced exposure to toxins and allergen, identification of the allergens causing reactions, and desensitisation to those allergens, repair of the body’s natural defence barriers, recolonisation of the gut with beneficial microflora, correction of digestive processes, nutritional therapy, and stress reduction and management.

The overall aim of these processes is to restore health to the whole patient, rather than simply providing superficial allergy symptom relief, and to also help the person achieve a balance between the physical, mental–emotional and even spiritual aspects of life. Many healthcare practitioners have successfully and effectively integrated these processes into holistic programs of treatment for allergies and other disorders.

Reducing toxic load

Studies by environmental scientists and physicians indicate that pollutants play a role in the creation of all allergies, as well as arthritis and autoimmune illnesses. Reducing the toxic load on a person’s body involves reducing exposure to environmental toxins in the home, workplace or outdoors as well as detoxifying the body. Enzyme therapy is also very helpful, as some enzymes help break down toxins and irritants that would otherwise accumulate and aggravate or cause allergies. The broken-down toxins can then be more easily eliminated.

Nutritional support

Nutrition should be part of any comprehensive allergy treatment program, firstly because good nutrition helps to build a strong immune system and flush allergens and toxins from the body, and secondly because it is needed to correct existing nutritional imbalances and to protect against allergy. Essential foods include essential fatty acids, probiotic and prebiotic foods, fruits and vegetables, greens and lots of water.

Essential fatty acids (EFAs) can inhibit the inflammation that leads to many allergic reactions and help strengthen the body’s mucous membranes, reducing the risk and severity of allergic reaction, including eczema and bronchial symptoms. EFAs also reduce inflammation in the nerves and brain that can cause behavioural symptoms such as autism, which has been also associated with EFA deficiencies. EFAs include omega-3, found in fish oil, and omega-6, found in evening primrose oil, blackcurrant seed oil and borage oil. Foods high in EFAs include sardines, mackerel, salmon, tuna, sunflower and pumpkin seeds, nuts, olives, soybeans, pumpkin, walnuts, eggs, soybeans, avocados and certain oils, such as olive, flaxseed, sunflower and borage oil.

Prebiotics are indigestible ingredients found in some foods whose role is to nourish probiotics: they feed the probiotics in the gut. They are found in fruits and vegetables, and some whole grains. Recommended foods include whole oats and barley (and whole wheat if the person is not allergic to it), legumes, artichokes, asparagus, onions, leeks, garlic, chicory, burdock, bananas, raw honey and maple syrup.

Probiotics are supplements or foods containing beneficial bacteria that help maintain digestive and gut health, preventing leaky gut and other causes of allergy. Clinical studies suggest that they help reduce inflammatory bowel conditions, improve milk intolerance and reduce atopic eczema in children. They may also reduce the symptoms of food allergies, and are associated with increased overall health. Probiotic foods include unsweetened, live culture yoghurt, buttermilk, sauerkraut, lightly cooked and raw cabbage, blueberries and miso.

Supplements—because allergies often deplete the body of certain nutrients, supplements may also be required, including vitamin C to reduce atopy in infants,³⁴ essential fatty acids, minerals and vitamin E. Consumption of sugar and unhealthy fats should be reduced, as they impair immunity.

Avoidance of allergens

Exposure to allergens has been shown to set off allergies,³⁵ and some people with multiple chemical sensitivities (acute hypersensitivity to low levels of everyday chemicals) can begin reacting to more and more specific environmental chemicals found in the workplace, school or home as their allergies spread.³⁶ Avoidance and clearing the home of known contact and inhalant allergens is especially recommended for high-risk children or adults, and for those with a weakened immune system. Avoidance is an essential component of treatment as it allows the person’s system to become clear of allergens and recover from the effects of reactions, many of which do not show up as symptoms. Pay particular attention to substances that are known to commonly cause allergies, such as dust mites, pesticides and household chemicals.