Medsarticles. Medical Weblog

Lee and Rinkel originally devised the provocative/neutralizing dose for the diagnosis and treatment of food allergies. It still remained necessary to devise such a test for the inoffice diagnosis and treatment of the chemical-susceptibility problem. This test was a by-product of the alcoholism studies which I made, described in Chapter 10. In the course of those studies, a batch of pure, 100-proof synthetic ethyl alcohol was obtained, derived from a petrochemical, ethylene gas. This type of alcohol, although not approved for drinking, is found in various food products, such as lemon and orange extracts. It is not toxic per se.

When given to chemically susceptible individuals, however, it can provoke reactions similar to those they experienced from environmental chemical exposures. The synthetic alcohol was mixed in graded dilutions. Dilution no. 1 was 1:5 mixture of ethyl alcohol and a salt solution; no. 2 was in a proportion of 1:25 (that is, one-fifth as strong as no. 1); and so forth.

If a patient answered at least two questions positively on the Chemical Questionnaire he was tested with a few drops of dilution no. 2, either by injection intradermally or under the tongue. If he answered three to five questions positively, he was tested with dilution no. 3; greater degrees of susceptibility were treated with even weaker dilutions.

In this way, it was possible to test patients for this perplexing chemical-susceptibility problem in the office and to receive fairly reliable results quickly. Before that, a patient had to move out of his house for a while to get such an answer, whereas today the best tests are performed in the hospital. I published, preliminarily, the results of this test in 1964.4

Using this same synthetic ethyl alcohol as a neutralizing dose, it was possible to relieve the symptoms of some patients for a long period of time. The technique was used especially on those who could not avoid chemical exposure, either because of their jobs, the location of their homes, or for other reasons.

One patient, for example, was a domestic maid who had to travel more than five miles by bus every day, five times a week. Each day she would get a headache on the bus, often before she had even reached her destination. She was provided with a small bottle of ethyl alcohol, at the dilution which had previously been found to suit her. By taking a drop of the solution under her tongue, she was able to relieve her headaches.

Another woman lived on the edge of a golf course. Because of continual pesticide spraying, she was chronically ill. After learning to use a neutralizing dose of the synthetic ethyl alcohol, however, she was not only able to tolerate life in her home, but was even able to play golf on the course without suffering any health problems. Because both ethyl alcohol and the pesticides are ultimately derived from the same substances—petrochemicals—a neutralizing dose made of one substance can have an effect in relieving symptoms caused by another such substance.

This is not meant to imply that such drops are a kind of cure-all for the chemical-susceptibility problem. Unfortunately, they are not. Such treatments are not fully protective, because a person’s intake of chemicals varies greatly with time and place.

In addition to synthetic ethyl alcohol, various other chemical extracts now aid in the treatment of chemically susceptible patients. One of the most ingenious is an extract of automobile fumes which Dr. Harris Hosen of Port Arthur, Texas, prepared for the use of clinical ecologists.5 This is sometimes quite effective in detecting and relieving the effects of smog and the fumes of heavy traffic on susceptible patients.

Basically, however, the most effective “treatment” devised for the chemically susceptible patient is still prevention.

It should be reemphasized that patients with advanced environmentally related illness involving food and chemicals are also often sensitive to pollens, molds, dusts, animal danders, insect emanations, and other inhaled particles. Indeed, the course of environmentally related events often starts with localized allergic manifestations on such a basis. But, as Dr. Mandell has emphasized, pollens, molds, etc., may also be related causally to advanced systemic or generalized effects.6 Since skin testing with extracts of these materials is relatively reliable, this possibility should be evaluated by measuring the degree of skin sensitivity as a basis for providing optimal injection therapy.

*94\110\2*

False food allergy, as used in this book, means unusual reactions to food that are caused by the foods triggering mast cells directly. In other words, these reactions involve mast cells but they do not depend on IgE antibodies being formed to the food in question. Because the reaction is produced by mast cells releasing mediators, the symptoms are indistinguishable from true IgE-mediated food allergy.

When food bites back

Food is not necessarily the nice, passive, innocuous stuff that we have traditionally believed it to be: neither plants nor animals want to be eaten, and they have ways of fighting back. In plants, particularly, there are many chemical weapons to deter would-be diners, and some of these chemicals persist, even in modern crop plants. That we are not made ill by them more often is a tribute to our own abilities in breaking down such chemicals – abilities that have been acquired in the course of evolution.

One particularly cunning type of chemical weapon turns the body’s most potent defence force on itself: it fools the mast cells into degranulating. There are dozens of different substances found in food that can perform this trick. Some bind to IgE molecules, effectively bridging two adjacent molecules, in much the same way as an antigen might bridge them. Others bind to the receptors on the mast cell that normally attach themselves to IgE, thus bridging the receptors. Because bridging of the IgEs (and thus bridging the receptors) is the signal for the mast cell to degranulate, both types of substance cause the release of damaging mediators such as histamine. Other substances may produce the same effect simply by binding to the mast cell membrane and

changing its structure so that it becomes more permeable.

One group of compounds that can have this effect on mast cells are the lectins. They are produced in particularly high concentrations by peanuts, beans, peas and lentils, all of which are members of the legume family of plants. Lectins are also found in edible snails, and in wheat, where they may be responsible for producing coeliac disease.

*90\180\8*

It is perhaps inevitable that the doctor identifies or becomes identified with the medical methods of contraception so that when they me rejected he or she feels rejected too. This can lead to a feeling of uselessness and inadequacy with a sense that there is nothing to offer the patient. In this situation there is a risk of a retaliatory response, either dismissing the patient or attempting to impose a method against her wishes. In that case contraceptive pills are likely to be lost, intrauterine devices pulled out or the patient fails to return.

In these days of clinical audit, when successful contraceptive practice is measured against a fall in the number of terminations, the doctor may feel that all unintended pregnancies must be stopped. Acceptance that not all such pregnancies can be prevented nor every child a wanted one is something the doctor will need to come to terms with. Helping a woman to delay her next child by a few months may be a major achievement, especially if she is struggling with serious internal conflicts or a chaotic lifestyle. Taking time to create a relationship of trust and understanding, rather than one of nonproductive authoritarianism, may well pay dividends in the long run, and the doctor should not feel too much of a failure if there are some contraceptive mishaps along the way.

*11/197/1*

Vaccination

Some people react to the sera on which immunising vaccines are cultivated. These have been greatly purified and refined, and adverse reactions are rare, but it is worth asking your doctor what the base of any vaccine is before it is given. Horse serum and eggs are sometimes used, for instance, and might affect you if you are sensitive to these. For advice on babies and immunization.

Anaesthetics

It is known for people to have adverse reactions to anaesthetics more commonly to general anaesthetics than to local anaesthetics. A surgeon or anaesthesist will usually check with you before any procedure whether you have any history of allergy or sensitivity, but make sure they know if you have such a history. Local anaesthetics are less hazardous – opt for a local, rather than general, anaesthetic if a choice is offered. If you have already had an adverse reaction, you can be tested in advance of any operation to see what chemical you react to, and a more appropriate mix of drugs chosen for you. Your GP can contact the National Adverse Reaction Consultancy Service (NARCOS) which is a specialist advisory service.

*421\117\8*

Tap AC Filters

AC filters are available which fit on the end of a tap, or which are simple to plumb in to the sink top tap inlet pipe. They provide water on tap, at normal flow-rates. They are cheap, more convenient often than jug filters, and avoid any of the need to be careful about bacterial hygiene that jug filters involve. They are portable and can be taken with you if you go out or away. They cost between £11 and £90. Filters needs replacing every one to four months and cost between £8 and £19. They can be cheaper to run than jug filters. The quality of water is comparable to jug filters, and less pure generally than plumbed-in undersink AC or KDF filters.

Jug Filters

Jug filters cost between £10 and £20. A plastic container holding an activated carbon filter cartridge sits on a glass or plastic jug. You pour water through the tap container and it collects in the jug below.

Jug filters reduce the level of chemicals and metals in tapwater. They do not remove them completely, but people using them say that they do make a real difference.

You need to change the filter cartridge frequently – every 60-110 litres (13-24 gallons), or every month or so. If you live in a hard-water area, it will last less long than if you live in a soft-water area. Some jugs have a change-filter indicator to remind you when to change. The replacement cartridges cost between £2.50 and £3.50 (at 1992 prices). This can mean an annual running cost of £30-40, which is much cheaper than buying bottled water.

You need to take care not to allow bacteria to grow in the jug. Jugs and reservoirs are best cleaned weekly; filtered water should be kept in a fridge (best decanted into a bottle to save space). If water has stood in a jug for some time, it should not be used or it should be boiled before use.

The advantages of jug filters are their low initial cost and their flexibility – you can take them with you to work or if you visit or travel. You can buy filter systems with glass jugs if you are sensitive to plastic, and some filters will reduce nitrates significantly, although, again, not completely.

*405\117\8*

For people who are allergic to inhaled particles which collect in dust -such as house dust mites, moulds, animal and pet debris, or fibres such as cotton or wool – using a filtration vacuum cleaner can make an enormous difference. For more information on detecting and avoiding allergens.

Conventional vacuum cleaners, even the most efficient, blow a share of dust and particles back into the room. Tests have shown that they actually increase the level of airborne particles in a room which explains why so many people with allergies feel worse during and after vacuuming.

Filtration vacuum cleaners, often called ‘allergy vacuum cleaners’, use a special filter which takes out virtually all particles of major allergens. Tests by Which?, by Good Housekeeping and other independent bodies, have shown that the two market leaders, Medivac and Nilfisk, both filter out over 99.9 per cent of particles down to 0.3 micron (three-hundredths of a millimetre) in diameter. So virtually no dust is blown around while using the machine, and allergens can be removed from sites where they have collected, such as beds, carpets, curtains or furniture, without dispersing them into the air.

These cleaners are expensive compared to other vacuum cleaners (see below) but people who use them say they would not be without them. Not only do they make cleaning possible in the environment of the highly sensitive with minimum dispersal of dust, but they reduce progressively the level of old or dead allergens collected in furniture, furnishings and bedding.

Most people who have such a machine report that their effect accumulates as time goes on and that they clear out the environment progressively. More than any other product designed to help people with allergies, these cleaners receive shining endorsement from their users. If you can possibly find the money, they are one item really worth buying.

There are two market leaders whose performance is measurably superior to other makes – Medivac and Nilfisk. There are some differences between them, notably price, the Medivac being more expensive (at over £300 at 1992 prices) than the Nilfisk (around £270). They are both canister models on wheels. The Nilfisk is lighter than the

Medivac, but it is made of plastic rather than metal, and if you are sensitive to plastics, the Medivac is preferable. Medivac and Nilfisk both provide efficient service and spares backup.

At the time of writing, Medivac is introducing a new lightweight model at a considerably reduced price. It has similar filters and performance characteristics to the original model, according to the manufacturer, but is not made of stainless steel. It is called the Medivac Lighterweight cleaner. We have no user reports to date, but if Medivac’s claims are correct, it should be the most competitive filter cleaner available for people who do not have to have a metal version.

*390\117\8*

Any symptom can result from reaction to things used in connection with sex and contraception, including the classic symptoms of allergy, such as asthma and rhinitis, and the symptoms of chemical sensitivity. Most commonly, however, localised symptoms result, on the genitals, anus and surrounding skin and tissues, plus urinary symptoms and, for women, inflammation or pain in the pelvic region. Dermatitis can also be connected to sexual activity, especially around the mouth, neck, lower face and upper thighs.

There are three main categories of causes. The first, and most common, is chemicals used by you or your partner as toiletries, personal hygiene, or cosmetics; as laundry agents; or on products such as sanitary towels, tampons or incontinence protection. You may be sensitive to things that you use, or that your partner has used. They may be things that you tolerate well unless you have contact in an intimate area. Sweat and friction increase the likelihood of reaction – they make the skin and tissues more permeable and more likely to absorb chemicals. So, for instance, a soap powder or deodorant that normally does not bother you, may make you react where you have intimate contact.

Drugs or ointments that you are taking to treat these symptoms, or some other condition, can also cause genitourinary symptoms. Take medical advice on whether to discontinue these.

*374\117\8*

Untreated cotton fabrics for upholstery use are available, but they need to be combined with a pure cotton interliner which meets fire safety regulations. It is possible to do this in a combination which minimises exposure to chemicals and meets the fire safety regulations.

One way to use totally untreated materials and meet the fire safety regulations is to re-upholster furniture made before 1950, to which the regulations do not apply. You can legally buy older (pre-1950) or antique furniture in totally untreated materials, or you can re-upholster yourself, or have it re-upholstered in untreated materials of your choice.

Your first problem in doing this is to obtain the materials. Sources of fabrics are given in Fabrics (page 387). John Cotton manufacture cotton wadding and will give names of stockists. Your second problem is to persuade an upholsterer to do the work if you do not do it yourself. Many are reluctant to use untreated materials on old furniture, even though it is legal, because they may be liable in case of accident. It is legal, however, and you can persist in persuading them. Contact the Association of Master Upholsterers for specialists in upholstery who may be able to help.

*359\117\8*

The principle of a rotation diet is to manage your diet formally, so that you only eat certain foods at given intervals. Its purpose is both to prevent and to cure. It helps prevent you developing new intolerances or allergies by keeping your diet varied and unrepetitive. It can help cure mild allergy or intolerance by reducing the load of a food in your diet, while still allowing you to eat it in moderation.

A rotation diet is usually planned on a four-day basis. You are allowed to eat a particular food on one day in the rotation, and not again until that day comes around once more. The foods that you tolerate are allocated to each of the days of the rotation and you stick to that system. So on Day One you have a list of foods from which you can choose what you will eat that day; on Day Two, you have your Day Two list, and so on.

A four-day basis is chosen because four days gives the body time to clear the food from the system, and most people are able to tolerate foods well at four-day intervals. You usually start out on a four-day rotation, keep to it strictly and then modify it to suit your own system, or way of life.

*122\117\8*

Allergy and sensitivity to chemicals is a contentious and highly controversial area. Many doctors and scientists would agree that they have an inadequate understanding of many people’s apparent reactions to chemicals in their environment. There is little research data to explain what chemicals cause reactions, what symptoms result, and what the underlying mechanisms in the body actually are.

The areas that are best documented, and where most doctors and scientists agree, are those of allergy to chemicals (where the immune system is involved, and which can be detected by skin and laboratory tests), and irritant and toxic reactions, where exposure to high levels of chemicals, usually at work, causes symptoms and disease.

The area that is most disputed and under-researched is the one which some doctors call ‘chemical sensitivity’. The definition of chemical sensitivity is substantially empirical, based on clinical practice and observation of large numbers of people with a common history of disease and presenting symptoms. In this definition, chemical sensitivity means adverse reactions to tiny or very low levels of chemicals in the environment, in which the immune system is not demonstrably involved.

It may appear to you, if you react to chemicals, that this controversy over allergy versus toxic reactions versus sensitivity has very little relevance for you. However, it is important in that it conditions the response of any doctor who may treat you. You will get very widely differing diagnoses, sympathy and treatment, according to the individual doctor’s own beliefs and attitudes.

*53\117\8*