Shorts

briefed by Jule Klotter

Acetaminophen

and

Asthma

Acetaminophen, found in over-the-counter pain- and fever-relief products such as Tylenol, contributes to asthma, according to a growing body of research. While current evidence does not prove cause and effect, pediatric pulmonologist John T. McBride is convinced that those with asthma or a family history of asthma should avoid using the drug. Acetaminophen causes thousands of acute liver failure cases each year, according to Jay S. Cohen, MD. N-acetyl-benzoquinoneimine (NABQI), a toxic substance, arises as acetaminophen breaks down in the body. The liver uses up glutathione as it detoxifies this substance. If glutathione levels are low – which is common during fasts of any kind (including illness) and alcohol consumption – NABQI accumulates and damages the liver.

Glutathione is also present in airway mucus linings, where it helps repair oxidative damage and prevent inflammation. Just one dose of acetaminophen can deplete glutathione levels throughout the body, including the respiratory tract. As a result, wheezing, bronchial constriction, and other signs of asthma arise in people who are predisposed to asthma.

In a Pediatrics article, McBride cites several studies, mostly epidemiological, that link acetaminophen use to increased asthma prevalence and severity. Although epidemiological evidence in itself can never establish cause and effect, McBride comments that the studies have produced consistent results “across age, geography, and culture.” In addition, increased acetaminophen use directly corresponds to a rise in asthma prevalence and symptom severity among individuals. For example, the recent International Study of Allergy and Asthma in Childhood (ISAAC) Phase Three epidemiological study, led by R. Beasley, gathered data from 200,000 children, ages 6 to 7 years, and 320,000 children, ages 13 to 14 years. “For 6-to-7-year-olds, the risk of current asthma was increased 1.61-fold (95% confidence interval 1.46-1.77) for those who took acetaminophen more than once per year but less than once per month and 3.23-fold (95% CI: 2.91-3.60) for those who took acetaminophen at least once per month,” McBride reports. “For 13-to 14-year-olds the risks were 1.43 (95% CI: 1.33-1.53) and 2.51 (95% CI: 2.33-2.70), respectively.”

McBride also cites a double-blind trial of ibuprofen and acetaminophen for treatment of fever in children, the Boston University Fever Study led by S. M. Lesko. Almost 84,000 children, age 6 months to 12 years, received low-dose ibuprofen, high-dose ibuprofen, or acetaminophen (12 mg/kg per dose) to take as needed to treat fever. Each group had approximately the same number of children with asthma. “For asthmatic children with a respiratory infection, the subsequent need for an outpatient asthma visit was 2.3 times higher in those treated with acetaminophen (95% CI: 1.26-4.16), and the risk was dose-dependent.” McBride writes. Adult studies have also shown associations between acetaminophen use and asthma incidence.

Parents reach for acetaminophen (or ibuprofen), not realizing that fevers actually help their children heal. Sherri Tenpenny, DO, explains in “The Importance of Fever,” that elevated body temperature increases the immune response while creating an environment that discourages pathogen reproduction. Suppressing a fever with ibuprofen, acetaminophen, or aspirin increases the time that it takes the body to overcome the infection. “When doctors tell parents to give medication when a temperature rises above a certain level, say 101 F,” Tenpenny writes, “many parents automatically assume that a fever is ‘dangerous’ at that level. The result is to give children drugs to keep them from harm. In reality, the purpose of anti-fever methods is to provide comfort as the body fights off the infection. If doctors were clear about this, there would be a lot less ‘fever phobia’ around.”

Instead of reaching for drugs that suppress a fever, Tenpenny urges doctors to educate parents about more useful ways to make a child comfortable and support their healing. Small, frequent sips of water heads the list: “Fever increases fluid loss, and dehydration cause fevers to remain high.” Parents should also avoid giving the child sugary foods and drinks, such as ice cream and soda pop, because sugar decreases white blood cell activity – the very cells fighting nasty bacteria and viruses. “If the situation does not seem urgent,” writes Tenpenny, “consider a trial of echinacea tea, lavender oil, Vitamin D 5,000-50,000/IU day and Vitamin C (10 mg per pound) before … using fever drugs.”

I would also suggest buying a low-potency (30X or 30C) homeopathic home care kit. Having remedies on hand that address a wide variety of common symptoms is a great addition to the home medicine cabinet. Some kits, like the one made by Standard Homeopathic, come with a user-friendly reference guide that makes it easy to match symptoms to remedies. These low-potency homeopathic remedies can do no harm, and it is amazing how much they can help symptoms move on.

Aschwanden C. Studies suggest an acetaminophen-asthma link. New York Times. December 19, 2011. Available at www.nytimes.com/2011/12/20/health/evidence-mounts-linking-acetaminophen-and-asthma. Accessed January 6, 2012.

Cohen JS. The little-known dangers of acetaminophen. Life Extension. December 2007;43–49.

McBride JT. The association of acetaminophen and asthma prevalence and severity. Pediatrics. Epub November 7, 2011. http://pediatrics.aappublications.org/content/early/2011/11/04/peds.2011-1106. Accessed January 11, 2012.

Tenpenny S. The importance of fever [online article]. http://drtenpenny.com/fever.aspx. Accessed January 21, 2012.

Non-IgE-mediated Allergic Response

For years, allergies have been defined as immunoglobulin E (IgE)-mediated hypersensitivity reactions. According to this view, if elevated levels of IgE aren’t present, it isn’t a true allergy – even if the symptoms have all the characteristics of an allergic reaction. (IgE is a class of antibodies concentrated in the lungs, skin, and mucous membranes that protect against environmental allergens [Mosby’s Medical Dictionary, 6th ed.]). Over the past decade, researchers have begun to look outside the IgE box for other physiological causes of allergic responses.

In 2010, a Dutch research group, led by B. C. A. M. van Esch, conducted a controlled experiment on mice sensitized to whey to follow up on previous studies involving Ig-free light chains. Normal immunoglobulins (Ig) consist of heavy chains (IgG, IgA, IgM, IgD, and IgE) and light chains (kappa or lambda). Light chains attach to the antigen binding sites of the heavy chains, forming complete antibodies. However, not all light chains produced by plasma cells attach to heavy chains; they are Ig-free, also known simply as free light chains (IgLC). Free light chains by themselves can evoke hypersensitivity reactions in the skin and airways. Both asthma and rhinitis patients have elevated free light chain levels, according to three studies cited by the Dutch researchers.

In this 2010 study, van Esch and colleagues used CD25 mAb to deplete CD25 T cells that produce IgE. Despite depletion of the CD25 T cells, sensitized mice displayed acute allergic response (swelling and inflammation) when whey was put into their ears. The symptoms subsided after topical application of F991, an IgLC-antagonizing peptide. This peptide, made by Fmoc Chemistry (Ansynth, Roosendaal, the Netherlands), inhibits free light chain activity but “does not interfere with IgE- or IgG-mediated mast cell activation.” F991 also resolved colon hyperactivity displayed by sensitized mice that were challenged orally with whey.

The Dutch researchers state: “The results indicate that after depletion or functional impairment of CD4+ CD25+ T cells, the nature of the acute allergic response to whey changed from IgE to IgLC dependent. This suggests that depending on the immunologic milieu, an IgLC- or an IgE-dependent allergic response to the same allergen can be elicited.”

International Myeloma Foundation. Understanding Serum Free Light Chain Assays [online document]. 2011. http://myeloma.org/pdfs/U-Freelite-Eng2011_g2web.pdf. Accessed January 31, 2012.

Van Esch BCAM, Schouten B, Blokhuis BRJ, et al. Depletion of CD4+ CD25+ T cells switches the whey-allergic response from immunoglobulin E- to immunoglobulin free light chain-dependent. Clin Exper Allergy. 40:1414–1421. Available at Health Source: Nursing/Academic Edition database. Accessed January 12, 2012.

Allergic Reactions to Computer and Cell Phone Use

Prolonged skin contact with cell phones made with metal allergens such as nickel sulfate and hexavalent chromium has produced several cases of contact dermatitis on the face and ear, according to a June 2010 case report and review by Anand Rajpara, MD, and Steven R. Feldman, MD, PhD. Avoiding the metal allergen – by holding the phone away from the skin, covering the metal parts with plastic film, using an earpiece to listen, or simply getting a different kind of phone – resolves the dry, itchy skin problem. Once identified, contact allergies are easily resolved; but they are not the only factor associated with cell phones that can produce or worsen an allergic response.

Electromagnetic radiation emitted by cell phones is another factor that contributes to eczema and allergic dermatitis. H. Kimata at Unitika Central Hospital (Kyoto, Japan) recruited 52 volunteers with eczema and allergies to house dust mite and Japanese cedar pollen for a 2002 study. Half of the volunteers were exposed to 60 continuous minutes of cell phone use, and the other half were not. (I couldn’t find out what the control group was doing, if anything, for 60 minutes. The study would be stronger if the controls were using a landline and listening to the same message.) Kimata reported an “enhanced skin wheal responses” to house dust mite and pollen skin scratch tests that lasted over two hours (but not more than four) in the cell phone group. In addition, the cell phone users, unlike the control group, exhibited elevated levels of substance P and vasoactive intestinal peptide (VIP), both of which are linked to the production of allergy symptoms.

Of course, cell phones are not the only producers of electromagnetic radiation. The medical literature contains references to “screen dermatitis.” The idea that electromagnetic radiation from computers and television can actually cause allergic reactions is very controversial. However, Olle Johansson and Peng-Yue Liu found that mast cells in the skin of screen dermatitis patients differed both in quantity, quality, and distribution pattern … as compared to normal healthy volunteers.” Mast cells, found in connective tissue (including skin), release pro-inflammatory mediators, such as histamine, in response to allergens and toxins.

In 2001, Johansson and colleagues found that exposure to electromagnetic radiation from television/computer screens for just two hours altered mast cell distribution and expression in the skin of healthy – not electrosensitive – volunteers. The 13 volunteers sat with their backs facing the screens, which were 40 centimeters (about 16 inches) away. Exposure lasted two or four hours. Skin biopsies were taken right before and immediately after the exposure period as well as 2, 4, and 24 hours later. “To our great surprise,” the authors exclaim, “we found the number of mast cells in the papillary and reticular dermis to increase, to varying degrees, in 5 out the 13 subjects after such an exposure.” By definition, healthy subjects were not expected to react to EMF in the same way that electrosensitive people have. Yet, EMF exposure from the screens caused mast cells in these healthy subjects to move toward the epidermis. Mast cells usually do not reside in this upper layer of the dermis. The researchers found no difference between 2-hour and 4-hour exposure times. Mast cell numbers and locations were normal 24 hours after EMF exposure.

Johansson explains in a 2009 article for Pathophysiology: “The release of inflammatory substances, such as histamine, from mast cells in the skin results in a local erythema [redness], edema, and sensation of itch and pain, and the release of somatostatin from the dendritic cells may give rise to subjective sensations of ongoing inflammation and sensitivity to ordinary light. These are common symptoms reported from persons suffering from EHS/screen dermatitis.”

This study brings up all kinds of questions in my mind. What is the maximum distance from the screen that produces this effect? What happens if healthy subjects undergo several sequences of exposure and nonexposure? Would more subjects show a change in mast cell location and prevalence with long-term repeated exposure? Would they return to normal as quickly? Or would these healthy subjects develop “screen dermatitis”? We may never get a definitive answer because, as Johansson explains, obtaining funding for EMFs’ effect on health is difficult.

Ingels D. Allergic reactions enhanced by cell phone use [online article]. Healthnotes. 2003. Available at http://bastyrcenter.org/content/view/313. Accessed January 16, 2012

Johansson O. Disturbance of the immune system by electromagnetic fields – a potentially underlying cause for cellular damage and tissue repair reduction which could lead to disease and impairment. Pathophysiology. 2009. Available at www. milieuziektes.nl/Rapporten/PATPHY_621.pdf. Accessed January 16, 2012.

Johansson O, Gangi S, Yong L, Yoshimura K, Chen J, Peng-Yue L. Cutaneous mast cells are altered in normal healthy volunteers sitting in front of ordinary TVs/PCs – results from open-field provocation experiments. J Cutan Pathol. 2001:28:513–519. Available at www.foodsmatter.com/es/computers_wifi_bluetooth/articles/johansson_tv_healthy_volunteers.pdf. Accessed January 6, 2012.

Kimata H. Enhancement of allergic skin wheal responses by microwave radiation from mobile phones in patients with atopic eczema/dermatitis syndrome [abstract]. Int Arch Allergy Immunol. December 2002;129(4):348–350. Available at www.mcbi.nlm.nih.gov/pubmed/12483040. Accessed January 30, 2012.

Rajpara A, Feldman SR. Cell phone allergic contact dermatitis: Case report and review. Dermatol Online J. June 2010;16(6):9. Available at http://dermatology.cdlib.org/1606/3_case_presentations/9_10-00190/rajpara.html. Accessed January 16, 2012.

Cow’s Milk Allergy

Got allergies? In the 2010 book Whitewash, Joseph Keon explains why cow’s milk and its products are neither beneficial nor essential for children or adults. Cow’s milk products are a common cause of allergic-type reactions. Keon discusses numerous ailments linked to cow’s milk products such as irritability, asthma, ear infections, eczema, and gastrointestinal problems. He quotes the book Preventing and Reversing Osteoporosis, in which Dr. Alan Gaby wrote: “‘In my experience and in the experience of many of my colleagues, dairy products rank with wheat as the two most common symptom-evoking foods in allergic adults.’” According to Gaby, cow’s milk allergy can cause inflammatory bowel disease, irritable bowel syndrome, Crohn’s disease, chronic nasal congestion, fatigue, depression, migraine headache, and arthritis symptoms.

Too often, people equate lactose intolerance with milk allergy. As Keon explains, lactose intolerance reflects a lack of lactase, the enzyme used to digest the milk sugar lactose. The human body normally stops producing lactase around age 4, by which time a child has been weaned. Milk allergies, however, refer to an immune response to one or more of the 30 proteins in cow’s milk – proteins that can be passed on to a breast-fed infant from its milk-drinking mother. Lactose-free dairy products provide no benefit to people who are reacting to a milk protein. Casein is just one of the milk proteins that can provoke an allergic response. “Reactions can be immediate (manifesting in minutes or a few hours) or delayed (24 to 72 hours),” Keon writes. “Symptoms can last from several days to several weeks.”

Dairy promoters emphasize milk’s calcium content, but dairy products are not the only source of calcium. One cup of almonds, amaranth, or arugula contains as much or more calcium than one cup of milk; and the calcium in these sources and others, such as kale and broccoli, are more easily absorbed than the calcium in dairy products.

Keon also refutes the assumption that high doses of calcium guarantee bone health. Bone mineral density in adolescent girls was best among those who engaged in weight-bearing exercise; consuming more calcium did not produce the healthiest bones, according to a 2000 Pediatrics study led by T. Lloyd. A 2005 Pediatrics meta-analysis, led by Amy Joy Lanou, agreed. “‘Under scientific scrutiny, the support for the milk myth crumbles’ wrote Dr. Amy Lanou. … ‘This analysis of 58 published studies shows that the evidence on which US dairy intake recommendations are based is scant. … A clear majority of the studies we examined for this review found no relationship between dairy or dietary calcium intake and measures of bone health.’”

If you want to learn more about “the disturbing truth about cow’s milk and your health,” pick up a copy of Whitewash, published by New Society Publishers (Gabriola Island, British Columbia, Canada). Its listed cost is $19.95.

Dogs, Cats,

and Allergies

Contrary to expectations, exposure during the first year of life to pets – dogs, in particular – actually reduces allergy incidence. Dennis R. Ownby and colleagues analyzed data from The Childhood Allergy Study. This prospective birth cohort study gathered a range of information in order to identify factors that might cause a child to develop asthma and allergies. In their 2002 analysis, Ownby and colleagues looked at parental allergy history, parental smoking, IgE levels in cord blood, birth month, dust mite and cat allergen levels in the child’s bedroom at age 2, and pet exposure. They wanted to investigate the effect of dog or cat exposure during a child’s first year on allergic sensitization, lung function, and allergen-specific serum IgE that was present by an average age of 6.7 years. The 474 children who completed the study lived in a northern Detroit (Michigan) suburb.

‘In this prospective study,” the authors state, “we found that exposure to 2 or more dogs or cats in the first year of life was associated with a lower prevalence of allergic sensitization at age 6 to 7 years regardless of exposure to dogs and cats at age 6 years” (my emphasis). They defined “allergic sensitization” as a reaction of a 4 mm-diameter wheal (or larger) with a 10 mm flare (or larger) to any one of six commercial extracts used in a skin prick test while displaying no reaction to the control substances saline and histamine. The six allergen extracts were dog, cat, two types of dust mites, short ragweed (Ambrosia artemisiifolia), and blue grass (Poa pratensis). The researchers also took blood samples to measure total serum IgE concentration and allergen-specific IgE antibody concentrations.

According to Table 4 in the article, 33 of 473 children had asthma by the time they were evaluated between age 6 and 7. Also, 145 children of 470 tested positive for allergic sensitization, using skin testing (atopy); and 157 of 407 showed allergic sensitization according to blood analysis (seroatopy). Children without a dog or cat in their home had the highest rate of allergy sensitization: 33.6% tested positive in the atopy and 38% were positive in seroatopy. Those with just one dog in the house did better: 29.7% (atopy) and 36.7% (seroatopy). Children with two or more dogs in the home had the lowest rates: 8.3% (atopy) and 12.9% (seroatopy). Although cat exposure during the first year of life showed a similar pattern, the decline was not as dramatic and did not “reach statistical significance.” Boys benefited more to exposure to dogs and cats than girls.

The researchers found no correlation between parental histories of asthma, allergies, and hay fever and pet ownership. Apparently, pet lovers would rather suffer some allergy symptoms than give up the companionship of a beloved dog or cat.

This study has limitations. First, it did not consider possible exposure to dogs or cats in the homes of other caretakers. Some children may have spent significant time in another home with animals, skewing the results. Secondly, the study population lacked racial, socioeconomic, and geographic diversity. Socioeconomic factors can apparently affect the relationship between animal contact and allergies. A European 2010 study, led by C. J. Apfelbacher, concludes: “Cat contact seems to increase the odds of sensitization to cat only [not hay fever] in children whose parents have a high level of education.” Interestingly, children whose parents had the highest educational levels were the least likely to have contact with dogs or cats. These children were also more likely to have hay fever, eczema, and/or sensitization to pollen or house dust mite. The study abstract does not say if the 30,794 6-year-olds in the study were exposed to dogs or cats during their first year or simply living with pets at age 6.

Apfelbacher CJ, Ollert M, Ring J, Behrendt H, Krämer U. Contact to cat or dog, allergies and parental education [abstract]. Pediatr Allergy Immunol. March 2010;21(2p1):284–291. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2009.00893.x/full. Accessed January 20, 2012.

Ownby DR, Johnson CC, Peterson EL. Exposure to dogs and cats in the first year of life and risk of allergic sensitization at 6 to 7 years of age. JAMA. August 28, 2002;288(8):963–972. Available at http://phdres.caregate.net/curriculum/pdffiles/JAMA288-963.pdf. Accessed January 20, 2012.

Non-Eosinophilic Asthma

Corticosteroid medications for asthma target eosinophils, a type of white blood cell that produces inflammation in the respiratory tract. Unfortunately, a large percentage of asthma sufferers do not have eosinophil-caused inflammation, according to a January 2012 study. Corticosteroids (prednisone, Aerobid, Azmacort, Flovent, and Symbiocort) cannot help them.

In their 2012 study, Kelly Wong McGrath and colleagues analyzed lung mucus samples from 995 asthmatic patients enrolled in the Asthma Clinical Research Network clinical trials. Only 53% of these patients had eosinophils in their mucus samples; 47% did not. While two weeks of anti-inflammatory therapy improved airflow in those with eosinophilic asthma, the medications did not help those with non-eosinophilic asthma. The bronchodilator albuterol produced similar results in both types of asthma.

If eosinophilia isn’t the cause of 47% of asthma cases, what is? One possibility lies in a 2011 Dutch investigation of delayed asthmatic response (DYAR). DYAR occurs between 16 and 32 hours after bronchial exposure to an allergen, reaches a climax between 32 and 48 hours, and then resolves – within 56 hours after the exposure. In this study, Dutch researchers measured 15 substances in the blood – leukotriene B(4) (LTB(4)), LTC(4), LTC(4), LTE(4), prostaglandin D(2) (PGD (2)), PGE(2), PGF(2)(α), thromboxane B(2), lipoxin A(4), eosinophil cationic protein, eosinophil-derived neurotoxin/eosinophil protein X, eosinophilic peroxidase, myeloperoxidase, histamine and tryptase – and five substances in urine before and up to 72 hours after a bronchial allergen challenge. The only measurements that increased after the challenge were blood concentrations of leukotriene B(4) (< 0.05) and myeloperoxidase (p<0.05) at 24, 36, and 48 hours. No other substance levels changed significantly. “These results would indicate an active and prominent involvement of neutrophils, in addition to the previously demonstrated role of the Th1 lymphocytes, in the clinical DYAR,” says Z. Pelikan.

Goodman B. Why don’t some people with asthma respond to medication? WebMD Health News. January 6, 2012. Available at www.webmd.com. Accessed January 9, 2012.

McGrath KW, Icitovic N, Boushey HA, et al. A large subgroup of mild-to-moderate asthma is persistently non-eosinophilic [abstract]. Am J Respir Crit Care Med. January 20, 2012. doi:10.1164/rccm.201109-1640OC. Available at http://ajrccm.atsjournals.org/content/early/2012/01/18/rccm.201109-1640OC.abstract. Accessed January 25, 2012.

Pelikan Z. Delayed asthmatic response to bronchial challenge with allergen-mediators, eicosanoids, eosinophil and neutrophil constituents in the blood and urine (abstract). Respiration. 2011;82(3):225–236. Available at www.ncbi.nlm.nih.gov/pubmed/21454958. Accessed January 25, 2012.

Food Sensitivities, Probiotics,

and IBS

Jeanne Drisko, MD, CNS, and colleagues at the University of Kansas Medical Center conducted an open-label 2006 pilot study to investigate the use of an individualized food elimination diet and probiotics to treat irritable bowel syndrome (IBS). Twenty IBS patients who had not responded to standard medical care took part in the study. Participants completed IBS quality-of-life questionnaires and underwent breath-hydrogen testing at baseline. The breath-hydrogen test measures hydrogen and methane in breath samples, taken every 15 minutes for three hours, after a fasting patient ingests 30 cc of glucose syrup. “A peak within 90 minutes of hydrogen or methane concentration of > 20 ppm, or a baseline level of hydrogen or methane of > 10 ppm, which subsequently continued to increase after glucose challenge” indicates bacterial overgrowth in the small intestine, the authors explain. Abnormal microbial colonies in the GI tract can increase inflammation and immune response, which are typical of IBS.

Study participants also underwent serum IgE (allergic reactions) and IgG (delayed hypersensitive reactions) food and mold panels as well as comprehensive stool analysis at baseline. Foods that tested positive on the IgE/IgG test were eliminated from the individual’s diet. After two to four weeks, each IgG food was reintroduced in a controlled food challenge. Patients had to keep detailed symptom diaries because reactions can appear hours, even days after ingestion. “If a food was tolerated during the challenge phase, the food was reintroduced back into the diet with instructions to adhere to a rotation diet [eating the food once every three to four days],” the authors explain. “If IBS symptoms returned with food challenge, the food was eliminated from the diet for 6 months with instructions to re-challenge at a later date.” Rotations diets prevent antigen-antibody complexes from building up in the body. Some foods will never be tolerated. After food reactions were identified, participants were given a commercial probiotic to take during months two through six of the study.

At the one-year follow-up, most of the participants reported minimal IBS symptom problems and felt more control over their symptoms because of their continued use of the rotation diet. Probiotics had reportedly relieved symptoms during the trial, but participants did not judge probiotics to be as useful as the diet at the one-year follow-up. The researchers had not found a significant improvement in beneficial colony counts after four months of supplementation.

The researchers suggest that the probiotic used in the study may not have been taken in sufficient dosage. It is also possible that the product did not contain the most beneficial strain for the patients’ conditions. A 2008 Finish study, for example, found that “live Bifidobacterium lactis bacteria can counteract directly the harmful effects exerted by celiac-toxic gliadin…” while Lactobacillus fermentum had no effect. The probiotic in the Kansas study did not include B. lactis.

The Kansas researchers discuss several limitations of this small trial, the greatest being the controversial (and nonblinded) use of IgG testing to identify delayed hypersensitivities. They would like to see blinded food challenges in hypersensitive patients and healthy controls to evaluate the sensitivity and specificity of IgG food testing. They also point out that IgG is just one part of the body’s immune response system: “…  there may be other causes of food hypersensitivity or increased inflammation in the GI tract besides the antigen/antibody complex formation.” Nonetheless, this small study offers a very systematic, nonpharmaceutical approach for dealing with a multifaceted, distressing condition.

Drisko J, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006;25(6):514–522. Available at www.jacn.org/content/25/6/514.full.pdf+html. Accessed January 31, 2012.

Lindfors K, Blomqvist T, Juuti-Uusitalo K, et al. Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture. Clin Exper Immunol. 2008;152:552–558. Available at CINAHL Plus with Full Text. Accessed January 25, 2012.

Homeopathic Treatment of Allergies

Homeopath and author Dana Ullman, MPH, and Michael Frass, MD, a professor of medicine at Medical University of Vienna (Austria), wrote a 2010 review of homeopathic research that targeted respiratory allergies. The authors explain the difference between three types of homeopathic allergy treatment: classic, isopathic, and constitutional. Classic homeopathic practice prescribes a remedy that most closely matches an individual’s acute symptoms. For example, allergy sufferers with profuse, burning, runny nasal discharge, reddened eyes, nonburning tearing, and violent sneezing would take Allium cepa (onion), while someone whose nasal discharge has the consistency of egg whites along with a hammering frontal headache and salt craving would take Natrum muriaticum (sodium chloride).

Isopathic homeopathy, like conventional allergy desensitization treatments, uses small doses of actual allergens to treat allergy sufferers. Those with a dust mite allergy, for example, would take a homeopathic dilution containing the energetic signature of the dust mite. Homeopathic doses are much smaller than those used in conventional allergy treatment – so small, in fact, that critics have claimed that any results must be due to placebo effect.

The third homeopathic option is the constitutional remedy, which requires the help of a classically trained homeopath. The homeopath takes a thorough history of the individual’s physical and psychological acute and chronic patterns and symptoms to choose a matching constitutional remedy. Classical homeopaths believe that a correctly chosen constitutional remedy will move the body toward healing both chronic ailments and acute complaints, such as allergic reactions. Unlike the other two types of homeopathy, constitutional homeopathy’s effect on respiratory allergies has not been evaluated in clinical trials. Constitutional homeopathic treatment tends to be more subtle and take longer than acute or isopathic homeopathy.

Ullman and Frass discuss several studies, reviews, and meta-analyses that evaluate homeopathic treatment of allergies. A 1986 randomized, double-blind placebo-controlled Lancet study, led by D.T. Reilly, tested the ability of homeopathic doses of mixed grass pollens (30C potency) to alleviate hay fever symptoms. All 144 hay fever patients were given a placebo during their first week. Then, about half were given the homeopathic preparation while the rest continued to take the placebo. By the end of the five-week study, “The mean change in [visual analogue scale] symptom score from baseline to the end of the trial in homeopathy subjects was significant compared to those in the placebo group (p=0.0004).” In addition, 16 of 47 in the homeopathy group compared with 9 of 45 in the placebo group had discontinued antihistamine drug use. “The mean number of antihistamine tablets taken by placebo subjects at the end of the trial was double that of the homeopathy group (p=0.03),” according to Ullman and Frass.

Unlike the preceding isopathic study, a 2002 retrospective Israeli study looked at individualized homeopathic treatment for respiratory allergies. Again, homeopathic use led to a reduced use of conventional allergy medications (antihistamines, steroids, and decongestants). The researchers analyzed patient data from an alternative health clinic affiliated with a health maintenance organization. They looked at drug usage three months before homeopathic treatment and three months after and found that “… 27 of 31 patients who used conventional allergy medications … reduced usage of these drugs after homeopathic treatment; two patients experienced an increase in drug usage, and two showed no change. Patients used an average of 3.1 medications before homeopathic treatment and 1.6 after (p=0.001).”

Ullman and Frass urge practitioners who are not trained in classical homeopathy to consider isopathic homeopathic treatment as an option for their patients with respiratory allergies. They suggest using conventional allergy testing to uncover a patient’s primary allergen and have a homeopathic pharmacy prepare a homeopathic medicine with the allergen at 30C potency. The patient can take the remedy, as needed, every month. “Select homeopathic pharmacies can [also] provide homeopathic combinations of mixed pollen, mixed grasses, and mixed molds,” Ullman and Frass explain. Some patients with hay fever also obtain symptom relief with the homeopathic Galphimia glauca (4X or 6X potency).

Ullman D, Frass M. A review of homeopathic research in the treatment of respiratory allergies. Alt Med Rev. 2010:15(1). Available at CINAHL Plus with Full Text. Accessed November 30, 2011.