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Archive for the ‘Allergies’ Category.

COMPLICATIONS OF RHINITIS: TYPES OF SINUSITIS

There are two types of sinusitis: acute and chronic. Whether you have one or the other depends upon how long your symptoms have been present.

Acute Sinusitis
If your sinusitis has been present for less than three weeks, it is called acute, meaning that it is of short duration. In older children and adults, there are three typical symptoms of acute sinusitis:
1. Pain or a sensation of pressure in the face over the area of the infected sinus is common. This is made worse by bending over, straining, jogging, or going down stairs.
2. A cloudy nasal discharge, from one or both sides, or a cloudy postnasal drip.
3. Fever, which is not a part of chronic sinusitis.
In younger children symptoms are not specific. A nighttime cough that doesn’t respond well to cough medications may be the only symptom.

Chronic Sinusitis
This is the term used to describe sinusitis present for longer than three weeks. It is not unusual for this condition to continue for months. In older children and adults there are three typical symptoms:
1. Chronic nasal congestion or stuffiness
2. Frequent, or almost constant colds
3. A persistent cough

In younger children, typical symptoms include the following:
1. The child seems to always “keep a cold”
2. Cough, particularly a nighttime cough, is a nuisance
3. Recurring ear infections
In all age groups, a cloudy postnasal drip, otherwise unexplained bad breath and recurring ear infections are common associations. Facial pain and fever are not frequent in chronic sinusitis.
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COPING WITH THE MODERN ENVIRONMENT: TESTING FOR FOOD ALLERGIES

In the office, we use what are called provocative tests to detect food allergies. This is an excellent technique, although not quite as reliable or convincing as the food ingestion tests employed in the hospital. These provocative tests provide reactions in miniature, as it were, between four and thirty minutes after their application.

The tests are called provocative, since they seek to provoke a response in the patient to a suspected food. Clinical ecologists maintain a large number of extracts of various substances. If, in his history, the patient indicates exposures to any food once every three days or more frequently, or if he himself suspects a particular one, he will be tested with a drop of an extract of it placed under his tongue. Generally, the patient can complete two such tests on each visit, until he has tested all of the foods which he most commonly encounters. If a reaction is severe, however, only one test will be given.

As with a number of other innovations in this field, the provocative test was discovered by a doctor who himself had allergies he wished to control. Dr. Carleton Lee, of St. Joseph, Missouri, was highly susceptible to coffee. In the early 1960s, Lee found that he was able to create his characteristic coffee “hangover” with a minute intradermal (skin-deep) injection of coffee extract. In other words, he “provoked” the symptoms with a small dose. Even more intriguing was the fact that a still smaller dose would relieve the same symptoms and keep them in check for hours or days, even when he then drank coffee freely. He called this latter injection the “neutralizing” dose.

Intradermal injections for food allergies had been tried before but with little consistent success. For inhaled allergy-causing substances, such as pollen and dust, they had worked well, but for foods and chemicals they had never been very valuable. Lee presented his findings to food-allergy pioneer Herbert Rinkel, and together they published the first paper on the provocative/neutralizing technique in January, 1962.1

Dr. Guy Pfeiffer and Dr. Lawrence D. Dickey soon refined Lee’s intradermal test by making it a sublingual (under-the-tongue) procedure. The veins under the tongue are close to the surface and readily absorb traces of foods, beverages, and drugs. (It is for this reason that nitroglycerine and some other drugs are placed under the tongue for immediate absorption.) Sublingual extracts worked approximately as well as intradermal injections and avoided the unpleasantness of the injections. Both techniques are currently employed by clinical ecologists, although I myself prefer, and actually use, the sublingual provocative test in my office procedures.

Why the provocative/neutralizing technique works, we do not yet know. That it does work has been demonstrated in hundreds of physicians’ offices, although some orthodox allergists committed to the immunological theory remain skeptical. The provocative/neutralizing technique is a truly empirical procedure, used because it has been found to be effective. If we were to wait until the mechanism of every medical procedure were known before being used, few drugs, new or old, could be employed in medicine. Even the mechanism by which aspirin works is still something of a mystery, and the action of electroshock and tricyclic drugs for depression still must be accounted for. The provocative/neutralizing technique can be used in the same spirit, while research is performed on its mechanism of action.

After performing a provocative test with an extract of a commonly eaten food, we are likely to provoke a positive reaction. In about nine out of ten cases, the patient will respond with the same symptoms which the food is secretly responsible for in real life. If wheat, for example, is the hidden cause of respiratory symptoms, the patient might respond by suddenly coughing or wheezing. Sometimes, however, the symptoms provoked are one notch worse than the real-life symptoms. Thus, a patient who gets headaches (minus-two symptom) from cane sugar under normal conditions might become depressed (minus-three) or brain-fagged (minus-three) after a provocative test with cane.

Once a troublesome reaction has been provoked in this manner, we then attempt to find a neutralizing dose of the same substance. The purpose of this, in our office, is to spare the patient from having to go home with aggravated symptoms. This is the only use to which I generally put the neutralizing technique. Some doctors use the neutralizing dose as a regular treatment for food and chemical susceptibilities, however, providing the patient with a vial of extract to take on a daily or interim basis.

I generally do not do this, since the majority of my patients come to me from out of town. The dose frequently needs readjusting, as, for example, during hay-fever season, at times of virus infection, or for other reasons. It does little good for a patient to call me and say, “Doctor, my dose is no longer working,” when he lives five hundred or a thousand miles from Chicago. I generally help such patients to find a doctor nearer home who will provide such treatments: a list of such clinical ecologists can be obtained from the Society for Clinical Ecology, whose address is listed in Appendix C.

Clinical ecologists, it should be noted, do not generally use the familiar scratch or skin tests employed by most conventional allergists, since they do not give definitive results. According to Albert Rowe, M.D., “It is generally agreed that clinical allergy may exist in the absence of positive skin reactions, especially those to the scratch test. This is true primarily in food allergy and to a lesser extent in inhalant allergy.”2 In a statistical study of intradermal skin tests, Rinkel found such tests to be only forty percent accurate, and often less so.

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OTHER FORMS OF FOOD ALLERGY: BIRD-FANCIER’S LUNG

Those who are exposed to large quantities of airborne allergens can develop a serious inflammation of the lungs known as alveolitis. In this disorder it is not the tubes leading to the lung that are affected (as in asthma) but the lungs themselves. Tiny air-sacs known as alveoli perform the actual work of the lung in extracting oxygen from the air and passing it to the blood. If an allergic reaction to airborne allergens occurs in the alveoli, the large number of immune complexes produced can be deposited there and cause highly damaging inflammation. The structure of the alveoli begins to break down, causing shortness of breath,-tightness in the chest, fever and a dry cough.

There are several forms of alveolitis including farmer’s lung and mushroom-worker’s lung, but the only one likely to have any relevance to food allergy is bird-fancier’s lung. In this disorder, it is tiny particles from the birds’ droppings that initiate the allergic reaction in the alveoli. The connection with food allergy is a tenuous one, but some doctors claim that eating eggs can exacerbate the symptoms in a few patients. This might occur if the antibodies produced to the antigens in the droppings also bind to antigens from egg proteins carried in the bloodstream. This dual binding – known as cross-reactivity – can occur where antigens are chemically similar. Laboratory experiments suggest that there is cross-reactivity between the antigens of chicken’s eggs and the antigens found in the droppings of budgerigars and pigeons.

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ALLERGY\MEDICAL HELP: ENZYME-POTENTIATED DESENSITISATION (EPD)

In Enzyme-Potentiated Desensitisation (EPD), an enzyme (S-glu-curonidase is used in combination with allergen extracts to enhance the desensitising effect. A wide range of extracts of allergens, foods and chemicals is mixed with the enzyme which is held by a small plastic cup against a scrape on the skin for 24-48 hours, or injected into the skin. Symptoms usually show some improvement within a week, lasting two to three months at first. Treatment is repeated about once every three months, for between one and two years.

The same mixture of extract at the same dose is given to everyone, so there is no need for individual, time-consuming testing. Elimination diets or challenge testing are less important (these are usually necessary with neutralisation) but best results are obtained if these are carried out in conjunction with treatment.

Developed by Dr Len McEwen at St Mary’s Hospital, Paddington, this method works very well for some people, although some do get worse before they improve.

EPD is a less costly and less disruptive form of desensitisation and has achieved some impressive results. For more information, contact the National Society for Research into Allergy which has a leaflet on the subject, and Action Against Allergy.

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WATER TREATMENTS METHODS: UNDERSINK AC FILTERS

AC filters are plumbed in undersink to supply one tap, within the scope of the skilled DIYer. They cost between £50 and £200, before any plumbing costs. Most cost between £100 and £200. Replacement cartridges cost between £10 and £60, and need replacing every six to twelve months. Some systems offer filters which have indicators of when the cartridge needs replacing. Cartridges are generally slightly cheaper than KDF filters and the cost of water correspondingly lower. Nitrate-reducing versions of undersink filters are available. Tap-flow is not affected, unlike RO systems.

Contaminants can flush back into the system from the filter with some systems. Compared to jug or end-of-tap filters, plumbed-in undersink filters are much more convenient to use and offer a higher level of purity. Depending on the model chosen, the cartridge costs are not necessarily more expensive than jug or tap filters, and the water can be comparable in cost.

Two makes of undersink filter, at the more expensive end of the range. These were the Everpure Citmart BW100 and the Ametek Fileder HM, priced at around £150-200. These systems did not flush back contaminants, and had indicators for cartridge change.

One smaller filter, the Berglen Tapmate AC 200, requiring more frequent cartridge replacement. Cartridges cost £12 and need replacing monthly.

One undersink filter, the Opella Castalia, can be adapted to filter a whole house system. The system is designed primarily for use with a sediment filter, not a carbon filter, but a carbon filter can be used. This means that all your water, including toilet, bath and laundry, can be filtered. The disadvantage is that cartridges will need replacing monthly or every six weeks. This is costly – about £3.50 per week -and inconvenient. Some plumbing advisors also discourage using carbon filters in this way, since bacteria can grow in the system when chlorine has been removed.

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YOUR CAR AND ALLERGY: PORTABLE INTERIOR FILTERS

Portable interior filters are powered by plugging into the car cigarette lighter. They draw the air inside the car through a filter medium inside them – either fabric, activated charcoal or an electrostatic surface which attracts particles – or some combination of these. For full effectiveness, keep windows closed.

The benefits of this type of filter compared to the air intake filters are that they are portable, and you can use them in any car or vehicle in which you travel. They also filter the air inside the car -so they can take out particles such as moulds, dust mites, pet hairs, and fumes from plastics, foams and materials in the car. Their main disadvantage is that unless you have a car with a recirculating air system (see page 427), they are much less effective when you use the ventilating or heating system because of fumes entering from outside. They are best used without operating air vents or heating.

One model – the NSA 600A Auto Air System – has only just been introduced in the UK and there are no reports from users of its effectiveness. It has an electrostatic filter, fabric filters and a thin activated carbon filter to absorb chemical vapours. It has an optional fragrancer which you should not use if you are chemically sensitive. It is close to 30 cm (1 foot) high and has a Velcro mounting to hold it to a surface. Its price is quoted at £110 (at 1992): replacement filters will be required regularly, depending on how much you drive. Contact NSA for names of distributors; ask for a trial period (address below).

Another portable car filter is available for import direct from the United States. The Foust #160A Air Purifier is a free-standing cylinder resting horizontally on a small bracket, about 40 cm (16 inches) in length and 23 cm (9 inches) in height. Made of metal, it contains filter media of activated carbon, alumina with potassium permanganate and a particle filter. If you think you might be sensitive to any filter media, you can obtain test samples in advance of buying a filter and Foust will supply cartridges with different types of filter mix to your needs. The Foust purifier is very effective against chemical fumes. It can be noisy, and get in the way if you have a full car load of people.

The purifier costs $242. Replacement charcoal, needed every six to twelve months, costs $18. The Test Kit costs $19. To these prices, you will need to add shipping charges, plus duty and

VAT, to be paid when the parcel arrives in this country. Duty at 4.25 per cent and VAT at 17.5 per cent will mean adding £28 to the filter, £2.20 to the cartridge, and £2.60 to the Test Kit. Shipping charges are quoted separately by Foust at time of order.

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SEX AND ALLERGY

Genital and urinary symptoms are commonly caused by infections. Make sure that you have eliminated these as possible causes before considering allergy or sensitivity. Consult your doctor.

If allergy or sensitivity is the cause, genital and urinary symptoms are not always caused by sexual activity and contraception. Symptoms such as itchy discharge, cystitis, rashes, irritation and hives around the genitals, can also result from sensitivity to foods, and to chemicals that you use elsewhere, not just from sexual contact. So if you are sensitive to these, or you find that the advice in this section does not help, it may be worth investigating foods and chemicals further.

Candidiasis and thrush can also cause genital and urinary symptoms in men and women. An overgrowth of a fungal organism which grows naturally in the body, candidiasis often accompanies allergy and sensitivity.

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HOW TO PREVENT ALLERGY REACTION TO FURNITURE

Some people react to even tiny traces of varnishes and sealing polishes used on solid wood furniture. Furniture that is not new is usually little problem. Furniture made before the 1940s is usually trouble free, since many varnishes, lacquers and polishes used then were water-based, so buy or use older furniture for preference.

If you are exceptionally sensitive to varnish fumes, or need to buy or have made a new piece of furniture, you could use water-based varnishes rather than solvent-based ones. These are well tolerated, but do not give full protection against splashes, spills or marks, and are thus not really satisfactory in everyday use. There are alternative compromise solutions which are satisfactory. If you have furniture made specially, ask the maker to use a varnish of your choice. If you buy new wooden furniture, allow it to air off varnish before use.

French polish, shellac and Japanese lacquer are solvent-based and can cause sensitivity when being applied, and shortly after, while vapours are being released. Do not use these if possible. If you do use them, ventilate well afterwards and leave the piece of furniture to air before use. If using adhesives in upholstery or repairs to furniture. If you are sensitive to resinous woods, like pine and cedar, look for furniture of less troublesome wood, such as beech, ash or oak. It may help to apply several coats of varnish to pine or cedar furniture to cut down fumes. Varnish the inside of drawers and cupboards and shelves as well. If you are sensitive to enamel paints on metal furniture, sniff carefully before buying. Wash down surfaces with a solution of one dessertspoonful of domestic Borax in a bowl of warm water. Allow to air before use and keep away from sources of heat.

Use glass and marble furniture, and mirrors, stone, slate or ceramic tiles and surfaces if you can.

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FOOD ALLERGY: TOTAL EXCLUSION DIET

The principle of a total exclusion diet is that you either fast, or eat just one or two specific foods, for a period of up to five days, then reintroduce and test foods. The fast or two-food period will clear your system of foods that you eat commonly, and should unmask background symptoms. You can become very weak and HI on a diet of this kind. You can do it at home, but should never do it without a doctor’s knowledge and supervision.

The best-known version of a two-food diet, the lamb and pear diet, is often prescribed for up to five days. You eat nothing but lamb (baked or grilled, with no oil or cooking fat) and pears, and drink nothing but water, preferably filtered or bottled. You can eat as much of these two foods as you want or need – for breakfast, lunch, tea or dinner – but nothing else at all.

Lamb and pears are chosen for the diet because, it is argued, they rarely cause reactions. The diet originated in the United States where lamb and pears are not common items in the diet, and hence are uncommon causes of allergy and intolerance. In the UK, however, they are much more frequently eaten and do cause reactions, although relatively rarely. Some doctors in the UK therefore prefer to use other, less often eaten foods, such as turkey and peaches, or rabbit and raspberry.

After the fast, or two-food diet, you start reintroducing and testing foods. Reintroduction is usually done on a stricter basis than for single-food testing or a special exclusion diet. It is usually recommended that you eat foods singly (not combined with any other foods), that you leave four hours or more in between testing foods, and that you organise foods on a rotation, so as to avoid problems with cross-reaction between related foods. (For more information on testing foods and organising a rotation diet. A doctor will usually give you a diet sheet to follow, based on your own history and preferences, which will help you with the complexity of planning. Depending on how many foods you test (and how many you react to), it can take between two and four weeks to devise a permanent diet.

The drawbacks of this type of exclusion diet are fairly obvious. It is time-consuming and almost impossible to combine with an active life. The foods you eat can be costly. You can be very weak and hungry while carrying it through, apart from any reactions you might get to foods you test. If you have a lot of food sensitivities, it can take a long time to devise a manageable diet.

On the other hand, if you are as highly sensitive as that, this is the only way to work out a tolerable diet, and it can turn up some surprises. People often find that they are not sensitive to foods that they had assumed to be a problem, and that, conversely, something unexpected turns up to be a real villain. Often just one or two foods turn out to be the root causes of symptoms and that can be an enormous relief. It really does sort out what is going on and if you can stick it out, it is an invaluable process.

There are two in-patient units in the UK where you can go through this type of diet with constant medical supervision.

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UNDERTAKING AN ELIMINATION PROGRAMME FOR ALLERGY TREATMENT

The basic principle of an elimination programme is to remove from your environment, as far as is practicable, the things that you suspect of causing reactions. You then monitor your symptoms and see if they improve after a period of time. If you want to confirm the results of the trial, you can then reintroduce the substances or start using them again. You do this with care, monitoring your symptoms as you do it.

To make the programme work, you have to be thorough and you have to be systematic. You also have to be patient and to give things time to settle before you make a judgement. It is better to eliminate only one group of substances at a time, say only foods, only house dust mites, or only chemicals, and do it thoroughly, rather than to try several things at once and only do each partially. People often start by doing the latter because it seems less work and they hope it will be sufficient to make them feel better.

If you have only mild allergies or sensitivities, a partial approach will work well. However, if you are significantly affected by your reactions or if you have multiple sensitivity, most people find that the only way to work out what affects them is to eliminate one thing at a time, and to do it wholeheartedly. Although it appears more work, it is shorter in the long run and less confusing.

Choose yourself which approach you will adopt. Whichever way you go, keep an open mind as you go along, monitor symptoms carefully and retest things whenever you are not sure.

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