Nov
14
2020

Why We See More Food Allergies

By | Allergies

A recent review in a BBC article explained why we see more food allergies. It is important to note that one of the more important food allergies are peanut allergies. Certainly, they have risen from 1 in 250 children in 1997 to 1 in 70 children in 2008.

By all means, allergies come in various degrees of severity; an anaphylactic reaction is the most severe form. Notably, in England there was a rise of hospital admissions for anaphylaxis from 1,015 in 2013 to 1746 in 2019. This is a 72% increase in 6 years!

Theories why there may be more food allergies now

There are a number of theories why food allergies have been on the rise. There is a consensus now that the right composition of the gut bacteria is important for normal immune reactions to take place.

Hygiene theory

David Strachan proposed the hygiene theory of allergies in 1989. Briefly, his observation was that children of larger families were less likely to develop allergies. He interpreted this to mean that infections among siblings stabilized the immune system. In the meantime, it has become obvious that the gut plays an important role for the immune system.

Graham Rook’s “old friends” theory

Graham Rook’s “old friends” theory came out in 2003. This theory states that friendly microbes in the environment are mixing with the gut flora. This trains the immune system to balance.

Gut bacteria theory

There is good evidence that the more a child is given antibiotics as a child, the more likely it is that the person develops a food allergy later. The mechanism seems to go via the gut flora. In a way this is the other coin of Graham Rook’s “old friends” theory. If you kill the “good friends” bacteria in the gut by antibiotics, the immune system strikes back with allergic reactions.

Dual-allergen exposure

By exposing the child at 4 to 11 months to peanuts or peanut butter, the immune system develops tolerance to the peanut protein (LEAP=learning early about peanut). A study showed that by doing this 80% of 5-year and older children and adults do not have a peanut allergy.

Prenatal vitamin D and food allergies

A German study found that prenatal exposure to higher amounts of vitamin D resulted in a higher risk of developing food allergies before the age of two.

Use antibiotics only when necessary

Gut biome studies showed that the use of antibiotics can have long lasting effects on the composition of the gut flora. A patient in sepsis may require antibiotics. But when the patient has recovered it is important that the bowel flora is restored with probiotics. This balances the immune system and avoids allergic reactions.

Immunotherapy for food allergies

Allergists have long used desensitisation techniques to deal with inhalant allergies. Allergy shots every two or three weeks can be very helpful to suppress immune reactions to inhalants. The same technique works also for many food allergies. The allergist tests the patient’s skin on the forearm to see what positive reactions occur. Based on these findings an allergy serum is composed. A small amount is injected in intervals. The smallest amount is given first and the concentration is gradually increased until the maintenance dose is reached. This causes the immune system to produce competing antibodies that reduce the antibody-mediated reaction to the food allergies.

Why We See More Food Allergies

Why We See More Food Allergies

Conclusion

Food allergies are increasing in frequency and severity. There are several theories why food allergies develop. The most likely one is that friendly bacteria in the environment become part of the gut environment in the newborn. If we have the right composition of gut bacteria our immune system reacts normally. Administering antibiotics frequently and overcleaning our kitchens with too many cleaning agents affects our bowel flora negatively. This disbalance can cause allergic reactions. On the other hand, exposing a newborn between the age of 4 and 11 months to a variety of adult foods including peanut products will desensitize the child to peanut protein and prevent future allergies. Those who are severely affected by food allergies can see an allergist for allergy testing and consider desensitisation through allergy injections.

Mar
29
2014

Alternative Treatment Of Hyperactivity (ADHD)

By | Allergies, Hormones, Nutrition, Other neurological conditions, Prevention, Vitamins and supplements

Attention Deficit Hyperactivity Disorder (ADHD or ADD, attention deficit disorder) has been in the spotlight on and off over the years. It affects 8% to 10% of school-aged children, and about 2% to 5% of adults who still have this condition.

Typically a parent receives a note from school that they must come to a teacher/parent meeting and it is discussed that the child is disruptive in class, not paying attention, interrupting the teacher inappropriately and forgetting to do their homework. The teacher suggests that this may be a sign of hyperactivity. The school nurse is also of this opinion and they suggest getting a prescription for Ritalin or Adderall (amphetamine type medications), drugs that have been shown in other kids to be fairly effective in treating the symptoms.

Next the child is seen by the doctor who confirms the diagnosis and Ritalin (methylphenidate) is prescribed.

In an attempt to quickly control the situation, the side effects of Ritalin are often not discussed in detail: agitation, insomnia, nervousness, anxiety, nausea, vomiting and loss of appetite, palpitations, dizziness, headaches, an increase in the heart rate, blood pressure elevation, and even psychosis (Ref.1).

It is easy to just write a prescription for Ritalin and hope that all is well. Had the parents heard of all the possible side effects, they may have asked whether there were alternative treatments available.

The causes of hyperactivity (ADHD)

The exact cause of ADHD remains unknown, but there is a clustering of this condition in some families, so there seems to be a clear genetic component (Ref.2). It appears that several genes are involved, namely those associated with serotonin and glutamate transporters, but also those affecting dopamine metabolism. Males are affected with ADHD more often than females (in children 3:1, in adults 1:1).

Alternative Treatment Of Hyperactivity (ADHD)

Alternative Treatment Of Hyperactivity (ADHD)

Some remarks regarding brain development are in order: Dr. Kharrazian describes that the grey matter of the brain develops before the age of 9 and the development of the white matter is completed by the age of 19 (Ref. 3, p.3). In ADHD patients the frontal brain is underdeveloped resulting in an inability to suppress unacceptable behavior, immediate desires and impulses. Prescription drugs may alter the behavior on the surface, but the frontal brain development is still lagging behind. The only thing that can influence this is behavioral/cognitive therapy and extra tutoring while the symptoms are controlled. The window of opportunity is closed by the time the ADHD patient has reached the age of 19. After that a juvenile ADHD turns into a permanent adult ADHD. The cases that had only childhood ADHD and outgrew it were the ones where the frontal lobe abnormalities had corrected themselves before the age of 19.

This review article has noted that there is an association between a Western style diet (sugar and fat rich) and ADHD.

Interestingly both Ref. 1 and 2, which I would categorize as having originated from mainstream conventional medicine circles, deny such an association. But the link also noted that a healthy diet with fiber, folate, and omega-3 fatty acids as well as supplementation with iron and zinc when these minerals are found to be low in the blood, do make a significant difference in ADHD patients towards normalization of their symptoms.

One of the under diagnosed causes of ADHD is gluten sensitivity as Dr. Perlmutter described in his book (Ref. 4, pages 150-158). This can spare the child or teenager the toxic side effects of anxiolytics, antidepressants or antipsychotics that may be inappropriately prescribed by their physicians, and a gluten free diet would allow the brain to recover very quickly in such cases. A food sensitivity history and some simple gluten sensitivity blood screening tests will diagnose this condition or rule it out.

To complicate matters even more, Dr. Amen has mentioned in several books that there are at least 7 different subcategories of ADHD that he has found in ADHD patients when studying thousands of single-photon emission computed tomography brain scans (SPECT brain scans). Dr. Amen mentions that the 7 subcategories of ADHD are the combined type ADD, the primarily inattentive ADD subtype, overfocused ADD, temporal lobe ADD, limbic ADD, ring of fire ADD and trauma induced ADD. Dr. Amen explains that each of these types needs to be treated differently and some of the treatment failures are explained by the fact that the wrong type of ADD was treated (Ref.5).

Treatment of ADHD

In the following I mention 5 steps that are useful for treating ADHD patients.

  1. A first step toward normalization of the metabolic changes in the brain metabolism of the affected child or adult is to adopt a diet that has been linked with low risk for ADHD: avoid food additives, cut out refined sugar, avoid known food allergies like gluten sensitivity and others. You may need to test the patient for food allergies using an elimination diet. Add a good amount of molecularly distilled omega-3 fatty acids (the pure form of omega-3 without mercury, lead or PCBs) as this has shown beneficial effects in ADHD patients.
  2. Involve a behavioral psychologist for behavioral/cognitive therapy treatments. This is particularly effective in the 9 to 19 year old category where the frontal region of the brain is still developing.
  3. Work together with the schoolteacher and get supplemental teaching in areas of academic weakness to reduce the frustrations in the classroom setting.
  4. In adolescent girls who just started their period, a relative lack of progesterone (estrogen dominance) may be a contributory factor. A small dose (20mg to 30 mg) of bioidentical progesterone from day 6 to 16 of the menstrual cycle may help significantly in alleviating the symptoms of ADHD. You may need to consult a naturopathic doctor or anti-aging physician to get a prescription for that.
  5. If all of this helps only marginally, then a smaller amount of Ritalin may be helpful; however, blood tests should be drawn from time to time to monitor for drug toxicity as the rate of absorption and elimination of the drug varies significantly from patient to patient.

It is interesting that studies have shown that a combination of Ritalin or Adderall with alternative treatment methods had a better outcome than either method alone.

Conclusion

It is important to think about the various possible causes of ADHD and not just get caught up in the knee-jerk reflex of treating ADHD with Ritalin (note that this was only step 5 above, if all the other things failed). In co-operation with the school system and using alternative ways at home first (change of diet, possible addition of low dose bioidentical progesterone cream in girls) and additional tutoring in weak school subjects the need for Ritalin may be avoided. If all else fails, the conservative approach is still available, but I suggest that drug monitoring (blood levels that should be done from time to time to avoid toxicity) is important.

More information about ADHD: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

References

1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed., © 2013 Mosby.

2. Jacobson: Psychiatric Secrets, 2nd ed., © 2001 Hanley and Belfus

3. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

4. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

5. Daniel G. Amen: “Use Your Brain To Change Your Age” © 2012, Harmony Books, An imprint of Crown Publishing.

Last edited Nov. 7, 2014

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Aug
31
2013

Peanut Allergies Are Deadly

By | Allergies, Asthma, Health, Nutrition, Prevention

Introduction

This article is about “peanut allergies are deadly”. In the US 1.5 million suffer from peanut allergies (Ref.1). People who have peanut allergies have to avoid peanuts and foods that contain even traces of peanuts lifelong. Here is a recent example of a 13-year old girl who died at a camp when she tried food contaminated with peanuts. Before we discuss peanut allergies in detail, we need to review first how the immune system is functioning.

How the immune system is primed to develop an allergy

Our immune system knows the difference between our own body components and substances that come from the outside. Scientists call this tolerance to our own surface proteins; and scientists call it an immune reaction that is mounting as a reaction to anything different from the surface antigens. There are different cells that make up the immune system. One of the main working cells of the immune system are the lymphocytes. A subtype are B cells that originate from the bone marrow producing antibodies when an immune reaction occurs. Antibodies fit like a lock and key to the surface of an antigen, in this case the peanut protein. T helper cells are T lymphocytes (thymus derived lymphocytes). They help the B cells to recognize the difference between the own protein components and the outside components.

IgE antibodies directed against peanut protein

There are also T killer cells, which when parasites or viruses enter the body activate them. With regard to peanut allergies, it is the B cells and T helper cells that interact. The B cells produce a powerful, very specific IgE antibody directed against peanut protein. There are memory B cells, which continue to produce these specific anti-peanut protein antibodies. They can cause severe allergic reactions when future exposure to peanuts (even traces) occurs. The more often a person allergic to peanuts encounters traces of peanuts, the more  the immune system gets boosted. This produces even more antibodies of the IgE type through reactivated B memory cells (Ref. 2). 98% of the population does not react to peanut exposure with allergies. But the other 2% who may have genetic susceptibility factors that predispose them to this often develop life-threatening reactions. These have the name “anaphylactic reaction”.

What is an anaphylactic reaction to peanuts?

The most extreme form of allergies involving IgE antibodies can cause anaphylaxis. In the beginning stages of a peanut allergy there may only mild symptoms such as hives on the skin, itching and tingling around the mouth, a runny nose, a scratchy throat, wheezing, stomach cramps, vomiting or diarrhea. However, with a more severe allergy an asthma attack can develop. In this case the blood pressure drops leading to fainting or shock. In addition, severe airway obstruction in the throat or lungs can cause suffocation.

I vividly remember an 11-year-old boy who arrived by ambulance in the emergency room of the hospital where I was working as the on-call physician. He had a hard time talking as his throat was swelling up as part of his anaphylactic reaction, within minutes he passed out completely (shock). Fortunately, an anesthetist was in the department and could intubate him very quickly.

Period of unconsciousness

However, despite adrenaline treatment, oxygen by artificial ventilation and high doses of corticosteroid drugs he did not wake up until 10 hours later. In retrospect it turned out that he had eaten some crackers of a familiar brand that he knew as being free of peanut flour. However, he saw an ad that the same brand of crackers was available as cheese crackers and he tried one of these. This prompted his admission to the hospital. The parents read the ingredients later: the label on the cheese crackers noted in small print that the flour of the cheese crackers contained peanut flour! Always read labels, even if it is a familiar brand! Fortunately for this boy he did not have brain damage from the time of his unconsciousness. He has been extremely careful since and is reading labels and avoiding unknown food items.

Peanut Allergies Are Deadly

Peanut Allergies Are Deadly

Cross-reactions between peanuts and other allergens

Allergies can be made worse when a person has inhalant allergies from pollens of trees or grasses that can share protein components from protein found in foods. The latest findings are that there are cross allergies between Fenugreek and lupine, which are both legumes, as are peanuts, so there are common antigens present in their proteins. A mouse-testing model has shed more light on this. Fenugreek has been shown to control mild diabetes by improving insulin resistance, but it cannot be consumed by persons who are highly allergic to peanuts because of the cross allergy mentioned.

There are other possible cross allergies to legumes like lentils, soy and chickpeas.

Other factors that can cause allergies to get worse

In the past the RAST test was often used.  This is a blood test for common food allergies that can cause severe allergic reactions like egg, milk, peanut, tree nuts, wheat, crustacean shellfish and soy. However, since about 2010 this has been replaced by the more sensitive ImmunoCAP Specific IgE test. Children who have food allergies to egg, milk, wheat, nuts, peanuts and soy often outgrow these allergies when they age, in other words their immune system can develop tolerance to many of these foods. Not so with peanut allergies! They tend to be very persistent.

Immune responses to food allergies are complicated

There are complications with immune responses to food allergies. They contained immediate type immune reactions and delayed type immune reactions. Allergists investigate the immediate immune responses with the above mentioned ImmunoCAP Specific IgE test. They can measure the delayed immune responses using the ELISA test. Positive IgE antibody tests for peanut protein are a marker that the person likely has more other allergies. An allergist should investigate them in that regard (Ref. 2).

New wheat varieties complicate the lives of people with allergies

What complicates the allergy sufferers’ lives even more is the fact that new wheat varieties were introduced. This happened in the 1970’s. The new wheat has the name Clearfield wheat. It has a much higher gliadin (gluten) and lectin content than the old wheat varieties. As a result of exposure to this new type of wheat gluten intolerance and leaky gut syndrome have increased substantially in the world population (Ref.3). In addition, genetically modified foods like soy, corn, sugar beets, canola and others have challenged the immune system of sensitive humans even more.

Autoimmune diseases from GMO food and modern wheat

We do know that some people can develop autoimmune diseases from GMO foods and modern wheat, and this may be the reason that a host of diseases that belong into this disease category (MS, rheumatoid arthritis, Hashimoto’s thyroiditis, ankylosing spondylitis etc.) are much more common now than in the past. The geneticists developing GMO foods were unaware how sensitive the immune system is.  The immune system detects a few different amino acid sequences in a protein mounting a strong immune response to it.

Treatment for peanut allergies

The key for sufferers from peanut allergies is to avoid exposure to it. Read labels and use common sense. If a food item has no label, do not attempt to eat it. Food manufacturers often mix peanut flour into the dough of crackers. But not every product has a label that identifies whether peanut flour is in it. Alternatively it says so only in fine print. With peanuts the antibodies usually circulate in the blood life long. The reason is that the B memory cells do not diminish and experience reactivation very quickly on repeat exposure. At this time they produce antibodies again. As exposure to peanuts can cause severe asthma or anaphylactic shock, it is important to carry an EpiPen with you and to know how to use it.

Oral immunotherapy

In Europe attempts have been made to develop an oral desensitization method for food allergies including peanut allergies, but it has not produced concrete results yet. Recently, however, research from Texas, USA showed that it is possible to desensitize patients with peanut allergy by oral desensitization. In Australia where food allergies are more prevalent than in the US, tolerance to peanut, nut and shellfish allergies is being pursued by oral immunotherapy. Another group in Australia has developed a vaccination method using peptides, which are a sequence of amino acids, but shorter than the full peanut protein. It appears that this is the future direction of treatment for peanut and other IgE allergies: a kind of vaccination treatment to induce competing antibodies, which will neutralize the allergic IgE antibodies.

Conclusion

Peanut allergies have become more troublesome as the food industry has mixed peanut flour into Thai sauces, drinks, cookies, crackers and such. The person allergic to peanuts must read food labels and eat as much single-ingredient natural food as possible. This goes against the tendency of food processors who produce foods with a long rat tale of ingredients. If you see a label “may contain nuts or peanuts”, stay away from this product, as it is safer. Always carry an EpiPen or Twinject with you, just in case you develop an anaphylactic reaction (you only have a few minutes to stop the allergic reaction with adrenaline). In the future vaccination with a peanut protein specific peptide vaccine as mentioned regarding the Australian research, will probably become the treatment of choice.

More information on status asthmaticus (an acute asthma attack).

References

1. Adkinson: Middleton’s Allergy: Principles and Practice, 7th ed. Chapter: Food Allergy. © 2008 Mosby.

2. Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed.© 2009 Churchill Livingstone.

3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

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