At the risk of making things too simple, the controversy surrounding allergies can be narrowed down to one word: the definition of the word ALLERGY itself.
When first coined in 1907 this word meant simply ‘some foreign substance which causes an unpleasant reaction in the tissue of the body but which doesn’t happen to everyone’. For example, an individual might be made sick by drinking milk: clearly this doesn’t happen to the majority of people. It is a specific effect, acquired only by certain sensitive individuals. That’s an allergy.
Such an effect is obviously different from poisoning. For example, someone who swallowed lysol would probably feel very sick indeed, perhaps even die. But that would happen to everyone. In other words, this effect isn’t peculiar or abnormal but a universal cause of tissue damage.
We can start with a basic definition of allergy, then, by saying it is an unpleasant reaction to foreign matter, specific to that substance, which is altered from the normal response and peculiar to the individual concerned.
Over the following two decades, researchers showed that the mechanism often involved was a malfunction of the body’s immune system. Soon the word ‘allergy’ came to mean only this sort of response and other reactions, if any, were simply ignored. Not very scientific, you’d probably think, and you would be right.
Disordered Immune Response
The body has a series of wonderful defence mechanisms, designed to keep us healthy, and without which we would be dead in a matter of hours. One of these we call the immune system. Briefly, it works like this: if a foreign substance such as a bacteria or virus enters the body, the tissues learn to identify the special proteins of the invader and make a chemical antidote which attacks only that specific protein. The attacking (or defending) chemical, manufactured by ourselves, we call an ANTIBODY. The foreign protein it is designed to immobilize, we call the ANTIGEN (Greek suffix -gen: meaning something which creates or causes something to occur).
It is a clever and spectacularly successful system, the detailed complexity of which surpasses our full understanding so far. The main drawback is that the body has to meet the foreign protein (antigen) before it can mobilize its counter-attack (the antibody). In other words, we must be invaded before we can fight back. This may not matter much with an illness like German measles or chicken-pox, but it is a serious inadequacy when it comes to potentially fatal diseases such as smallpox and diphtheria. Basically, those who survive such dangerous infections do so because their immune systems work very fast and start to produce antibodies in the nick of time, just before death supervenes. Those with a slower immune response are not so lucky and will die.
Or at least they used to. Now we can use vaccination to prevent such deaths. We introduce an artificial infection, commonly done by injecting a dead or weakened virus which does not harm the patient, but teaches his or her body to recognize the virus protein and make antibodies. Thus when the real invaders come along the body is ready and can start its counter-offensive by mobilizing antibodies within hours, instead of days, and so beat off the attack.
White blood cells, particularly lymphocytes, make antibodies. The frightening new disease AIDS (Acquired Immune Deficiency Syndrome) destroys lymphocytes so that the body cannot make antibodies. The victim, therefore, dies of simple everyday infections which can no longer be resisted in the way in which a healthy individual routinely shrugs them off. Ironically, of course, it means also that the body is hampered in its ability to round on the AIDS virus and so this is a particularly grim infection. The search for a vaccine seems very bleak.
Allergy And Immunity.
I have discussed this topic in some detail because, without understanding immunity, it is hard to understand certain types of allergy reaction. What might be called the conventional view of allergy is based on this mechanism.
It seems that dusts, pollens, foods and other basically harmless substances can act as antigens in some individuals. They enter the body through the lungs or digestive tract and gain access to the tissues where they cause antibodies to be formed. The resulting interaction between antigen and antibody harms the tissues involved and this gives rise to symptoms.
Note that the body must meet the substance before it can become allergic to it: that is, the allergy reaction (symptoms) could only occur on the second or subsequent exposures. Also the symptoms are referred to the organ affected. Pollens and dust affect the eyes (redness and itching) and the nose (catarrh and sneezing). A food allergy will cause abdominal pain, upset and perhaps vomiting or diarrhoea.
The trouble with this glib and satisfying explanation, which conventional allergists defend with a fervour bordering on hytena, is that it is totally unsupportable. To begin with it doesn’t fit the facts. Allergy can have a much more widespread effect than local tissue irritation, as you will see shortly. But more importantly, if you think again about the mechanism described above, you will see that, if it’s true, we all should get food or other allergies. In fact we should be continuously sick, if not dead, due to permanent incapacitating reactions to everything we eat and breathe, since all such substances are foreign protein.
Clearly, this is not so and therefore something is wrong with the classic explanation’ of allergy. Thus the doctors who are clinging most closely to their ‘scientific’ theories are being the least scientific of all! What they say sounds good, but it is incorrect and is blinding them to the facts.
It was Professor John Soothil who first pointed out this paradox. He is a clever and adventurous thinker, free of many of the strictures that bedevil his conventional colleagues (though, unfortunately, he hasn’t much time for doctors like myself who are rebellious and accord no respect to the medical hierarchy!). He was, incidentally, the head of the first team to show incontrovertibly that people can be allergic to foods without any of the classic criteria or tests for allergy being fulfilled, thus confirming what a group of doctors around the world have been saying for decades.
Having introduced you to the elements of this heated debate, let us now invent our own ‘working definition’ for the word ALLERGY, and state simply: if you can show that a substance is making someone ill, that reaction is an allergy. Really, that’s all that matters so far as the sick individual is concerned. Being healthier means avoiding such substances, so it is essentially a practical definition. It also fits very well with the popular use of the word. The average man or woman in the street doesn’t know much about immune disorders, but the concept of ‘something to avoid’ is simple enough for anyone to grasp.
Of course there must be some way of supporting the assertion that the substance is bad for a person. He or she must be shown to feel better by avoiding it and suffer symptoms when re-exposed to it. To be really sure, the re-exposure test would be done without the patient knowing what to expect. The medical term for this is ‘blind’ and prevents the patient from colouring the results with opinion or psychological ‘reactions’. If the practitioner doesn’t know what is being given either — perhaps the substances are coded and the key kept by a third person — we call this ‘double-blind’.
Blind challenge tests are all very well for scientific study but not for day-to-day work in a clinic, as it is an unnecessary imposition on the routine. We do not assume the patient will bluff, dissemble, or is feeble minded. This trust seems eminently successful in practice, I’m glad to say!
Once again, I will point out that allergy is not poisoning. Yet the reader will quickly see that a toxic chemical in the environment will fulfill the criteria for the working definition above. Instead of being contradictory, this underlines the value of using a practical concept for the term allergy. In the end, it doesn’t matter if the substance is a poison or an allergy: the patient still feels better for avoiding it.
Other names you may encounter for the allergy phenomenon need not distract us long. IDIOSYNCRACY and HYPERSENSITIVITY are two suggestions. INIOLERANCE has fewer indigestible syllables. Dr Arthur Coca, a famous American allergist spanning the conventional and unconventional, suggested FAMILIAL NON REAGINIC FOOD ALLERGY. This is somewhat lengthy but conveys the notion that: (a) it tends to run in families (which are true), and (b) antibodies may not be demonstrated. It never caught on, probably because he was decades ahead of his time.
I prefer the term MALADAPTATION SYNDROME, which is explained below (see ‘Three stages of allergy’).
But there is no doubt that the most widely known, used and understood label is the one with which we started:
Now the problem In actual fact matters are not always so straightforward. It may be possible for someone to be exposed to an allergen (allergic substance) and not experience symptoms if the quantity is below what we call the THRESHOLD DOSE. Only if this critical dose is exceeded will anything happen. This can vary from the tiny traces of pollen floating on the breeze, which makes hay-fever sufferers wretched, to eating several platefuls of a d on successive days before symptoms emerge.
Secondly, the patient may not get well by avoiding a substance if there are several allergies present. If someone is allergic to several foods and gives up eating one while continuing to eat the others, this may bring no relief at all. Sometimes there is no detectable improvement until the last offending substance is located, when there is dramatic and sudden cessation of the illness.
Finally, there is one other problem to add confusion — the hidden allergy — and I am convinced it is the main reason that the extent of allergic illness has gone undiscovered for so long. It is the vital missing datum, without which the whole subject remains a mystery.
The Hidden Allergy.
An entirely new concept is that of the hidden allergy, first described by Dr Herbert Rinkel. As its name suggests, it makes you ill but you don’t know it is doing so. Hidden allergies are far from rare — in fact, they are very common, once you know what to look for.
Masked allergy is another expression for the same thing. The masking is almost complete so that the sufferer would never guess correctly from where the trouble is coming. This, of course, makes things terribly difficult.
Anyone can recognize a food allergy when the reaction is acute and the patient flares up in a violent rash each time he or she eats the offending substance. The unlucky sufferer simply avoids the food in question, thus giving rise to the impression that food allergy is rare.
But supposing the allergy is something being eaten every day, or several times a week. The body becomes accustomed to the food in a sickly sort of way, the reaction damps down. Indeed, for many years or even decades, it may seem to disappear altogether, perhaps emerging only occasionally when a little too much is taken at one sitting or some other complicating factor, such as stress, temporarily lowers resistance. Because of the very infrequency of the effect, it is most unlikely that the sufferer will ever recognize the cause of the symptoms.
Eventually, however, resistance runs out. The body can no longer cope and sickness emerges. The final form of the disease suffered may vary greatly from person to person and really depends on what part of the body receives the brunt of the attack.
Not all hidden allergies are foods, but the fact that we become tolerant to such an effect is easy to explain in terms of food. If you eat something to which you are allergic every few days — and as you will see, allergy foods are often consumed daily — it means the body is never really free of this offending substance. As fast as you evacuate it from the bowel, more is introduced into the stomach. Precisely because the body is never completely free of the substance, the new dose doesn’t make any significant difference, so it tends not to react. It is very important to understand this point.
This is so that it will clear the bowel and no longer be masked. Chemicals and other substances can become masked in exactly the same way by frequent exposure. The maximum length of time between doses needed to keep up the masking depends on how rapidly each substance is excreted from the body or detoxified by the liver.
Another key phenomenon that makes allergy confusing is the concept of threshold doses. It takes a certain quantity of an allergen to trigger a symptom. Below this level, the individual can tolerate the substance and remain quite well. If the allergen is a food, it could mean that person can eat reasonable quantities of the food. Only when indulging it to excess do symptoms appear? Naturally, this can make it very confusing when trying to track down such an allergen. At other times, even the most infinitesimal dose of the allergen sets off a reaction. In other words, the threshold is then very low. Just to make things complicated, thresholds vary from substance to substance in the same individual.
Allergens can also combine in their effect. This could result in symptoms due to a mysterious combination of substances, even though each separate item is incapable of having an effect on its own. This explains the sometimes peculiar behaviour of allergies which so bedevils investigation, if you don’t understand what the problem is.
Three Stages Of Alergy.
Already, then, we can pinpoint three different stages in the allergy process. Stage 1 occurs when the allergy reacts directly on the body. Symptoms are produced. In fact if you have understood everything so far, there has to be a prior step. On first meeting the food nothing unpleasant happens at all, except that the body is sensitized to it and only subsequent to this can an allergy come into being. We can call this Stage O.
Stage 2 occurs when the body has become accustomed to the allergen. By frequent exposure the reaction is muted. Ill effects become disguised or masked. For a time there may be no symptoms at all, simply the storing up of trouble. We could call Stage 2 one of adaptation to an unhealthy substance.
What happens if the person goes on eating the food? If an individual continues to expose himself to an adapted allergen, eventually the body’s ability to resist runs out. At first this may only happen from time to time, say when the person is under stress, but eventually symptoms start up in earnest. We are now in Stage 3 and logically, this is called MALADAPTATION.
The Three Stages Of Allergy.
Stage 1 Alarm stage
Meeting the offending substance causes a symptom.
Stage 2 Adaptation
Frequent exposure to the offending substance accustoms the body to it. Symptoms usually subside.
Stage 3 Maladaptation
The body can no longer cope. Resistance has run out.
Symptoms return. This may entail Addiction, when symptoms appear to be relieved by intake of the offending substance.
Finally, we reach a stage of addiction: the patient craves the food and wants to eat it often, even to binge the food. The reason is that by this stage, ironically, the patient gets the symptoms only if he or she doesn’t eat the food. We call these withdrawal symptoms. Even a small helping of the allergen in question actually relieves these symptoms.
However, it only appears to improve matters, because eating the food masks the symptoms (this is the real meaning of a masked allergy). The truth is that the body is already on the slippery slope to ruin.
Incidentally, one of the reasons alcohol is consumed so liberally in our society is that it readily masks food withdrawal symptoms. Feeling rough? A good stiff drink will soon fix that!
The curious thing is that if you give someone who is craving a drink a dose of pure alcohol, it does no good at all. If, however, you give him or her just a tiny dose of wheat, sugar, yeast, corn or whatever foodstuff the person is addicted to, the craving for the drink goes away!
So that’s allergy in a nutshell, Now, let us take a look at the effects allergies produce.