Infants are frequently allergic to cow’s milk. Some of them can tolerate goat’s milk, while others need milk-free formulas in which the protein is furnished by soybeans, meat, or casein hydrolysate. The tolerance to milk often improves as the child grows older.

Building on the elimination diet
When the offending foods have been identified, the simplest treatment is to avoid those foods. This is not difficult when such foods as strawberries or chocolate are the allergens. Because of the wide occurrence of milk, eggs, and wheat in many foods, it is much more difficult to plan a diet that will avoid recurrences.
Let us suppose that a patient remained symptom-free on a given elimination diet. Then, all foods on that diet become the starting point for building the diet. Cautiously, one food at a time is added to the diet, and the patient’s reactions are observed for a few days. If the added food provokes no reaction, it is added to the list of the foods allowed, and another food is tested in the same way.

Hyposensitization
When an important food such as milk or wheat is producing symptoms, hyposensitization (also known as desensitization) is practical. It consists in giving the patient minute amounts of the offending substance. For example, a drop of milk might be diluted in a pint of water, and a few drops of this dilution fed once a day. If there is no reaction after a few days, the patient is given a slightly greater amount of the dilution. If reactions do occur, it is necessary to move back to an amount that does not produce symptoms. Because additions must be made so gradually, the hyposensitization requires weeks, months, or even longer.
*3/234/5*

In the mid-1950s, William Petersen came to me as a patient, complaining that eating a single commercial apple would cause him to have a severe headache. Petersen was fed on apples twice in my office after having avoided this food for a week, and on both occasions was struck with searing attacks of head pain. I naturally diagnosed him as allergic to apples.

Petersen was an inquisitive man, with a determination to understand why he reacted in the way he did. He lived in a nearby state which had a large fruit-producing belt. Upon returning home, working on a hunch, he slipped into an abandoned orchard and gathered some apples from the trees. These apples had not been sprayed or cared for in years. He picked about half a peck of sound ones and took them home. Surprisingly, he was able to eat these unsprayed, untreated apples with complete abandon: he ate three or four of them at a time, every day for a week. He had no headache or any other reaction whatsoever. He then reported the result of his experiment to me.

I therefore obtained my own source of unsprayed apples and tested Petersen on these in my office. Again, he had no reaction to unsprayed apples but responded with a severe headache to any commercial variety. Petersen went on to eat apples thereafter, provided he obtained them from uncontaminated sources. He didn’t have an apple allergy at all; he had something else, something which still did not have a name.

To extend this observation, in 1953 I obtained samples of apples sprayed with several major pesticides from the horticulture department of the College of Agriculture of the University of Illinois. By using these apples, as well as completely unsprayed and untreated ones, the problem of the “multiple fruit sensitivity” was finally worked out. The majority of the patients who reacted to these fruits were usually not allergic to fruit at all. What they were susceptibile to was the chemical pollution of fruit. The unsprayed fruit could be tolerated quite well, but the commercially available varieties, such as are obtained in supermarkets and fruit stores, caused chronic health problems such as arthritis, colitis, nervousness, and depression.

This observation raised a host of questions about health and sickness, questions which struck at the basis of much of Western technology.

How safe is our present chemical environment? To what extent does it contribute to chronic illness? How much do we know about the long-term effects of such by-products of “progress” as the chemical pollutants in the air of our homes and cities, chemical additives and contaminants in our foods, water, cosmetics, and drugs?

Supposedly these environmental chemicals had been tested and found safe.

However, there were serious questions to be asked about the validity of long-term toxicity studies carried out by government or industry. If only a minority of rats responded adversely to a chemical, were these results averaged out in the final report? What about the minority of people who are similarly afflicted? Were they being similarly ignored or lost in our statistical studies? These were important questions, since even if only one or two percent of the population were made chronically ill by daily exposure to such chemicals, this would still amount to two to four million people in the United States alone, enough to keep all our physicians busy for a long time. We doctors were the ones who had to deal with the unusual reactions, yet the medical profession seemed completely unaware of the potential danger.

Many of the chemicals in common use had become “profitable ventures” by the time anyone began to suspect that they were harmful. They thus became the focal point, individually and collectively, of defensive public relations operations by giant companies.

Indeed, some of the most troublesome chemical exposures have not been adequately described, and there is still no general knowledge of their potential hazards. The chief reason for this is that these materials have become integral parts of our current existence. Since they are so common, they are not usually suspected. Not being suspected, they are not usually avoided deliberately. Thus, not being eliminated either by chance or design, certain common chemical exposures remain unsuspected causes of chronic physical and “mental” illnesses.

There is an element of addiction to some of these chemicals, as well. Even though certain chemical exposures may be suspected of causing harm, avoidance is not only inconvenient, and sometimes expensive, but, because of the addictionlike responses that may be involved, sometimes the victims do not even wish to avoid exposure to the chemicals. Thus, understanding of this problem has been obstructed both by the constant nature of the chemical exposure and the self-perpetuation of the process.

I called this the chemical susceptibility problem, instead of the chemical allergy or sensitivity problem, to avoid prolonged and pointless debates over whether such small doses could cause classic allergic reactions. Whatever their name, such reactions were real and increasingly common, as many cases were to show.

*9\110\2*

These are drugs which mimic the effects of naturally produced adrenaline, the messenger of the sympathetic nervous system (see p144) which produces the ‘flight or fight’ reaction. Sympathomimetics have various effects, but one local effect is to make small blood vessels (capillaries) contract. Thus they have an opposing effect to histamine. This is exploited in some nasal sprays for hay-fever and perennial rhinitis. The drugs concerned are phenylephrine (Neophryn), oxymetazoline (Afrazine) and xylometazoline (Otrivine).

These sprays make the capillaries in the nose contract providing immediate relief from congestion, but if used for more than two weeks they can-have adverse effects. The blood vessels become ‘hooked’ on the drug so that when the spray is discontinued they react by expanding, causing congestion again. These sprays are for short-term use only.

Some sprays combine sympathomimetics with antihistamines (eg Hayphryn and Otrivine-Antistin). Others combine sympathomimetics with antihistamines and antibiotics (Vibrocil) or with corticosteroids and antibiotics (Dexa-Rhinaspray). Sprays containing antibiotics are only used where there are signs of infection as well as allergy.

Sympathomimetics such as pseudoephedrine and ephedrine are sometimes combined with antihistamines in medicines taken by mouth, such as Congesteeze (pseudoephedrine and azatamine), Haymine (ephedrine and chlorpheniramine) and Sudafed Plus (psudoephedrine and triprolidine) When taken by mouth, the sympathomimetic helps to overcome the main side-effect of the antihistamine, drowsiness.

*424\180\8*

The simplest and most effective method of treating food intolerance is to avoid the culprit foods. Assuming that you have successfully identified your culprit foods, by following an elimination diet, the next step is to establish an adequate menu that excludes those foods. Make a list of the foods you cannot eat, and a list of those that you can. Talk to your doctor about your proposed diet, and ask for advice on its nutritional value.

After about six months, you can retest each of the incriminated foods, to see if you still react to them. If you do react, then try again six months later. If not, then you can begin eating them once in every four days. After a year of this, you can increase the frequency cautiously, but you should never go back to eating the food every day, or in large amounts. If symptoms recur, cut out the culprit foods again for a couple of months.

If you are not fully well, even after the elimination diet, then it is worth considering other possibilities – it could be that you have other problems, in addition to food intolerance. Nutritional deficiencies, candidiasis and chemical sensitivity are possible candidates. A continuing tendency to diarrhoea and wind may indicate gut-flora disturbances. The only treatment for this is to eat plenty of live yoghurt.

*377\180\8*

The most drastic form of the elimination diet is to fast for the first five days, taking nothing but bottled spring water. This method has several drawbacks. Fasting requires a great deal of will-power and it is bad for anyone who is underweight and in poor health. Even for those who are not underweight, there are major metabolic changes that occur during fasting, as the body begins to break down its fat reserves. These metabolic changes, and others which occur when food is reintroduced, may themselves produce symptoms. For these reasons, we would not recommend fasting except in certain very difficult cases.

One step up from fasting is the lamb-and-pears diet, probably the best known type of elimination diet. This is something of an oddity because lamb is quite a common food in Britain. The diet originated in the United States in the early days of clinical ecology – America does not have the steep upland pastures that have made sheep-farming so popular in Great Britain, so lamb is not widely eaten there. While sensitivity to lamb is unusual, it does occur in Britain, so a lamb-and-pears exclusion phase is less appropriate here than on the other side of the Atlantic.

A modified version of the lamb-and-pears diet, used by some doctors, is turkey-and-pears or turkey-rice-and-pears – turkey being less commonly eaten in Britain than lamb. While these diets are useful when someone has a great many sensitivities, they are unnecessarily strict for most people. Again, they require a lot of will-power, and they involve eating huge quantities of two or three foods, which is never a good idea.

*330\180\8*

Always bear in mind that the diet may not be the answer. If you pin all your hopes on it, you may see improvements where there are none, and in the long run this could be very damaging to your child. Be careful, also, not to give the child the impression that the diet will ‘make everything alright’. He may be so anxious to please you that he tries extra hard to be good. Psychogenic reactions on food testing can occur just as easily in children as in adults, and if knows he is expected to go wild when he tries milk he may well oblige. Throughout the diet, try to keep an open mind about the outcome, and do not put any ideas into the child’s head about what might happen.

On the other hand, you do need the child’s cooperation, especially if he is old enough to go out and buy sweets or other foods for himself. Rather than forcing the diet on him, you should explain that it might help and ask if he would like to try it. You need to impress on him that it will only work if it is done properly – that there must be absolutely no cheating.

Because food additives are so important in hyperkinetic syndrome, you need to be aware of other ways in which they can be consumed. The colourings in toothpaste are identical to certain food colourings, so white toothpaste should be used. Put any coloured toothpaste well out of reach. Medicines also contain colourants, often in very large amounts, which is why you should try to discontinue syrups and tablets during the diet (as long as your doctor agrees) or get colouring-free alternatives. Try to stop your child from chewing things, and from licking sticky paper or stamps. Bear in mind that there can be additives in unlabelled food such as bread from a bakery, fish-and-chips, other take-away food, and restaurant food eg French fries.

*280\180\8*

One of the main chemicals to be released is called histamine -hence the use of drugs that counteract its effects, antihistamines, in the treatment of allergies. The packets of chemicals inside the resting mast cell look like small granules under the microscope, so the process of releasing the chemicals is called degranulation.

Histamine and other chemicals released by mast cells are called mediators because they bring about or ‘mediate’ changes in the body. A powerful cocktail of mediators, containing ten or more separate substances, spills out of a degranulating mast cell. Each mediator has its own particular effect on the body – some make the blood vessels open out, others make them more leaky so that blood escapes through the vessel wall. Several mediators make smooth muscles contract – these are not the muscles by which we move around, but those that operate our lungs, stomach, intestine and bladder. When they contract sharply, air may be expelled from the tubes leading to our lungs, or semi-digested food from our bowels.

This is bad news for parasites, which may be directly affected by the mediators themselves, and then assaulted by the body’s reaction to the mediators. In the case of parasites in the gut, for example, the direct effect of the mediators may make the parasites loosen their grip, and the diarrhoea that follows flushes them out of the body. For parasites in the blood, the expansion and leakiness of blood vessels produces the redness and swelling that we describe as inflammation. One feature of inflammation is that all-purpose defensive cells called phagocytes (which simply means ‘eating cells’) are attracted to die site of the invasion.

One group of phagocytes, the macrophages (‘big eaters’) have the role of perpetuating the inflammation reaction. They produce an enzyme called phospholipase or PLA. What PLA then does is to cut up certain fat molecules – the phospholipids – found in the membranes of all our body cells. The fragments released from the phospholipids by PLA are then worked on by other enzymes, which turn them into potent chemical mediators, known as prostaglandins.

*31\180\8*

If you want to go beyond this and reduce your exposure to chemicals even further, then there is more that you can do. You can avoid contaminants in water and food, avoid using plastics and you can avoid synthetic fibres and fabrics. You can also, if you are prepared to do it, stay indoors totally for the elimination programme and place conditions on what the people who live with you, or come into your home, use and wear. This is really hard-line and does not make you popular, but it can sometimes bring results.

To avoid contaminants in water, use a jug filter for water for drinking, cooking, food preparation, and for washing as far as you can. Alternatively, use bottled water – Malvern, Evian and Buxton are good choices (in glass bottles, if possible).

To avoid contaminants in food, eat fresh, unprocessed food -organic, if possible. To reduce your use of plastics, stop using plastic containers, wraps and bags for food – use glass or ceramic containers, if possible. Cellophane poses no problems. Do not use plastic carrier bags – old ones are usually little problem, but avoid new ones particularly.

To avoid synthetic fibres and fabrics, wear pure cotton clothes, for preference. Make sure these are well washed if they are new. Avoid pure synthetics where possible – polycotton blends are usually better tolerated than synthetics if you have no pure cotton clothes at all. For bedding, use a pure cotton pillowcase, well washed before use, and lay a well-washed pure cotton cloth or sheet over the top of the duvet or blankets if you cannot borrow or replace a synthetic duvet or blankets with others of a different material.

If you are allergic to cotton.

*76\117\8*

For wall and ceiling linings, you can use plasterboard which is made from a layer of gypsum dried and hardened on paper. This does not cause sensitivity. You can also use hardboard in some uses. For solid floors, you can use concrete, wood or stone.

In general, it is better to avoid built-in furniture, or surfaces with veneers if you can, since these will usually be constructed with particle boards. If you instal fitted furniture, do so on solid wood frames, and use glass or solid wood doors and sides. If you need to replace a fitted kitchen and cannot afford to use solid wood throughout, one way to cope is to leave the old gassed-out chipboard frame in place, and to replace doors with glass and solid wood doors. Alternatively, you could use boards such as fibre building boards, plywood or block-board. These are much less troublesome than particle boards and cheaper than, and sometimes technically preferable to, solid wood.

Fibre building boards (such as hardboard, medium board or soft-board) are made with a natural bonding process, using the lignin present in wood fibres as an adhesive. They contain no formaldehyde resins and generally very few chemical additives (except for some which contain bitumen as a water repellent – avoid using these). They can only be produced in relatively thin widths – up to 4 mm (1/8 inch) – and thus have limited applications, such as linings for walls or ceilings, or thin work on furniture. Medium-density fibreboard (MDF) is a particle board, not a fibre building board and has a high resin content.

Plywood is made from thin sheets of wood, usually softwood, bonded together with resins under heat and pressure. The grain of each sheet is set at right angles, so that it provides a very strong and stable material at low thicknesses. The resins used are formaldehyde resins, at very much lower concentrations than those used in particle board. Plywood uses a different process of manufacture and if the manufacture has been correct, it does not release free formaldehyde as particle boards do and thus can be used without problems. A well-aired plywood sheet, used in moderate quantities, should not give problems. Plywood is available in thicknesses similar to chipboard and has similar applications.

Blockboard is made by glueing a veneer with resin to a core of solid wood blocks, usually of softwood. Like plywood, formaldehyde resins are used but, if manufacture is correct, do not release free formaldehyde at all. Blockboard can be used for kitchen cupboards and built-in furniture.

If you are sensitive to pine wood, you can obtain plywood or blockboard made of hardwood from DIY shops. If you want to specify a particular wood, you can order woods of your choice through the trade.

*281\117\8*

Of the higher efficiency filters, two medium-size ones receive very positive reports, the Biotech 500 and the Anatomia Filtaire 300.

The Biotech 500 is an oblong, desktop device – compact and light, more portable than the Anatomia Filtaire 300. It has an electrostatic filter, and a thicker carbon layer than the smaller devices. It has an optional ioniser, which is useful if you want the possibility but do not want one in operation the whole time. It is very quiet in operation, with no vibration, and its hard plastic case does not give off fumes. It is noticeably effective on particles and good on chemicals. It makes a very real difference to air quality. It is large enough to clean the air effectively in a large bedroom or living room. Prices are quoted at between £110 and £135 (1992), with replacement filters costing £8, renewable every six months. It is available from Air Improvement Centre or The Healthy House. The Anatomia Filtaire 300 is made of a plastic casing which does not give off fumes once aired well. It is circular, about 30 cm (12 inches) in diameter and 23 cm (9 inches) in height. It draws in the air through round, revolving thick fabric filters, and pushes it out into the room through a thick wad of activated carbon. It has two speeds of operation. It is extremely effective for its size and price, and receives consistently the best reports for removing both particles and chemicals. Some people find it very noisy and do not like to run it if they are in same room. The noise is probably more subdued than a fan heater, but louder in volume. This device is more bulky and heavier than the Biotech 500, or the smaller filters, but is still readily portable by car, or in a strong bag.

The fabric filters need vacuuming and washing once every two to three months, unless you are very sensitive, when you should wash them as often as you need. The fabric filters need replacing every nine to twelve months and cost £7. The carbon filter needs replacing every eighteen months to two years and costs £18.

The Anatomia Filtaire 300 is priced at between £155 and £165, available from Ascot Heath, The Healthy House and Patent Filtration.

*213\117\8*