Herbal Health

The word allergy is fairly young but the signs and symptoms have been noted for centuries. Of course Hippocrates referred to it long before Christ. Four centuries ago a cardinal was said to have been forced to withdraw every year at the time the roses were in bloom. Thomas Willis is well known to us doctors for describing some little blood vessels at the base of the brain which occasionally force themselves on our attention by rupturing. About the time that Charles II was living his riotous life, and our austere ancestors were developing our eastern seaboard, Willis described asthma. Only in the last century has “hay fever” been recognized. The English in particular have continued to be hay-fever minded, while we in America are more disturbed by other plants.
The man who really told us something was Dr. Morrill Wyman, of Harvard Medical School, who eighty years or so ago wrote a book on Autumnal Catarrh. He was the one who put a finger on that wicked, wicked villain, ragweed. Somewhat before his time there was a pretty strong opinion that asthma was a nervous affliction. One man whom I cannot identify told of “an asthmatic little boy who would say to his father, ‘Don’t scold me or I will have the asthma,’ and so he did: his fears were as correct as they were convenient.” We all recognize now that both nervous and physical effects play a part.
There certainly is no routine way to dodge allergy, whether or not your equanimity and peace of mind are catered to. I have a fortunate friend who is fond of the mountains and at the proper time he takes his vacation in the White Mountains, where he is free from the pollen and happy. Such travel is worth while. It is a different story when home life is broken up to seek some distant location where bodily reactions will be no longer vile. There are pollens and molds practically everywhere. Often at first there is temporary improvement, but too often it is short lived. But always if a move is tried it should first be on a temporary basis. Do not burn your bridges behind you.  Arrange it so that a return may be made to the scenes, friends, and associates of a lifetime if permanent relief is not found in the new place. Perhaps your psyche will come to your aid with your final return to your familiar and formerly loved surroundings.
The identification, regulation, and treatment of a case of allergy is a time-consuming, difficult job. Here is a rough outline of the manner in which it is usually done.
1.    An exhaustive survey is made of clues and possible causes.
2.        A general physical examination is made to appraise the patient as a whole.
3.        Such tests as are called for to verify or disprove the clues obtained are now performed.
4.        The non-essential items to which the patient is allergic or sensitive are eliminated. Common examples of these are pets, egg, lobster, feathers.
5.        Injections are given to immunize against those things which cannot be eliminated from the environment. Examples: pollens, molds, and dust.
Successful management of allergic problems demands not only tests but the survey of the patient as a whole and the employment of previous experience of like cases. All possible approaches should be used. Patience on the part of the doctor and the patient is essential. Trial and error are often necessary and that takes time.
There is a tremendous amount of enthusiastic study of allergy going on at the present time. Several of my friends attend frequently what they call their Sneeze, Wheeze, and Itch Club. I should think that they would need a little of this jocosity to brighten up their work which to an onlooker would seem to be long and difficult, often baffling, and with many discouraging setbacks.  Yet its rewards are great.
Few things not lethal that happen to the human body are more distressing than the manifestations of allergy. To restore to comfort a child covered with itching eczema, or an older person gasping and fighting day and night for barely enough air to keep alive, is indeed a rewarding experience. Diligent study by devoted physicians and the discovery of numerous new agents are bringing this about with increasing frequency.
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The same sort of problems which are caused by hidden food allergies can also be caused by exposure to common environmental chemicals. Many people now know that such chemicals may have long-term, harmful effects on the body and may cause cancer and other diseases. The damage done actually goes far beyond this, however. Common environmental chemicals have become a major source of chronic illnesses of many types in the United States and other industrialized countries.

Knowledge of this problem emerged slowly from the study of food allergy. Dr. Albert Rowe, one of the fathers of this field, reported in the 1930s on a peculiar reaction which he called “multiple fruit sensitivity.” A characteristic of this problem was that certain patients tended to become ill when they ingested a wide variety of fruits.

Susceptibility to fruit is fairly common, but usually such allergies center on one or more of the botanically distinct fruit families (see Appendix A). These patients, however, had allergies to most, or all, domestically grown fruit, including examples of up to ten different food families. It would be understandable for a person who was allergic to peaches also to be allergic to apricots, for they both form part of the same botanical group—the rose family. But why should a person react to peaches and also to, say, pineapples, bananas, and dates, which are members of two other distinctly different biological families?

I confirmed Rowe’s observations in my own practice, but neither he nor I could offer any logical explanation of the problem, and our reports caused a good deal of scepticism among some of our colleagues.

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Histamine is one of the mediators released by mast cells when they degranulate. It is also released by various other cells in the body, since it acts as a local messenger substance, conveying instructions to neighbouring cells.

The main effects of histamine are to make smooth muscles (in the bronchi, gut, bladder etc) contract, to make the small blood vessels enlarge, and to make the capillaries (tiny blood vessels) become more leaky. These last two effects cause a drop in blood pressure. Locally, the increased leakiness of the capillaries contributes to inflammation.

Antihistamines (more correctly referred to as ‘histamine H1-receptor antagonists’) block the effects of histamine. They do this by binding to the H1 receptors on cells. Histamine normally binds to these receptors triggering off a reaction by the cell. So by blocking the receptors, antihistamines prevent histamine from affecting those cells.

There are a wide range of antihistamines available today. Most of these are rather unspecific and can also bind to the receptors for other messenger substances, such as adrenaline and serotonin. They tend to cause drowsiness through blocking messengers such as adrenaline, and they can also cause dizziness, nervousness, tremors, stomach upsets, dry mouth, blurred vision and impotence. These side-effects are not damaging in the long term, although they can be inconvenient. Some patients develop a tolerance of these drugs after a while, and the side-effects diminish. So if an antihistamine controls the allergic symptoms well, but causes side-effects, it is worth persisting with it for a while. Sometimes the sedative effects of antihistamines can be advantageous, as in children with urticaria who tend to scratch at night.

More specific drugs, which show a stronger preference for histamine receptors, have now been introduced. Astemizole (Hismanal) and terfenadine (Triludan) are the main ones. These can have some side-effects but should not cause as many problems as the other antihistamines.

Antihistamines, taken by mouth, are useful in hay-fever and perennial rhinitis, where there are symptoms in both the nose and eyes, together with itching in the mouth or ears. Where there are only symptoms in the nose, a sodium cromoglycate or corticosteroid spray may be more appropriate, as these have fewer side-effects. Some medicines contain antihistamines combined with sympathomimetics (see Section 3).

Antihistamines are also effective in some cases of chronic urticaria.

including cold-induced urticaria. They are not effective in asthma, because other mediators, besides histamine, play a major role in producing the symptoms.

2A Antihistamines

acrivastine (Semprex) astemizole (Hismanal) brompheniramine (Dimotane) cetirizine (Zirtek)

chlorpheniramine (Piriton, Haymine) clemastine (Tavegil) dimethindene (Fenostil) diphenylpyraline (Histryl Spansule, Lergoban)

hydroxyzine (Atarax) mebhydrolin (Fabahistin) mequitazine (Primalan) oxatomide (Tinset) phenindamine (Thephorin) pheniramine (Daneral) promethazine (Phenergan) terfenadine (Triludan) trimeprazine (Vallergan) triprolidine (Actidil, Pro-Actidil)

Ketotifen (Zaditen) acts both as an antihistamine and a mast-cell stabilizer (Section 1), and is used to prevent asthma attacks. Its side-effects are similar to those of most antihistamines.

Azatadine (Optimine) and cyproheptadine (Periactin) act both as antihistamines and serotonin antagonists. They are used for allergic rhinitis and urticaria.

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The reintroduction phase should take about seven or eight weeks. If it takes any longer than this, there is a risk of lost sensitivity: the food-intolerant person becomes less reactive after avoiding the culprit food for a time. If you are still testing foods eight weeks after starting the exclusion phase, then you need to test the foods more rigorously still. This means eating each reintroduced food every day for a week before declaring it safe.

If there are some foods that you have still not tested after 12 weeks then you have two options. One is to reintroduce all those foods for three to four weeks and see if any symptoms return. If they do, cut all those foods out again, wait until you feel better, then reintroduce them one at a time. Use three-day testing for preference, or one-day testing if you have a lot to get through.

The second option is to reintroduce each of the foods in turn, one per day. If there is no reaction, continue eating the food, but only on a once-every-four-days basis, for about six months. After that time, you should have become much less sensitive and be able to eat all these foods more freely.

If you suspect that you are sensitive to pesticide residues, you should be eating mainly unsprayed food during the exclusion phase of the diet. When you come to test foods, you should test unsprayed versions first, then a sprayed version of the same food, to see the difference. Leave a gap of at least four days between tests – try some other food in the meantime.

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One of the step up from here is the few-food diet or the rare-food diet. On a few-food diet the exclusion phase consists of a dozen or more foods that most people do not eat all that often. The exact foods chosen vary from one doctor to another, but they tend to include things such as parsnips, turnips and carrots which most of us do not eat in great quantity. The allowed foods also vary from patient to patient, because the doctor will ask the patient if any of the foods on the allowed list are eaten often – if they are, these must be excluded too. Most doctors have a second version of their few-food diet, with a different list of allowed foods: patients who do not get better during the first exclusion phase are switched to the second diet, in the hope that they will fare better. Of course, there is always a chance that both lists will include one or two foods which cause symptoms.

The rare-food diet is an extension of the few-foods idea, but instead of the patient eating uncommon foods such as turnips or parsnips during the exclusion phase, they are asked to eat exotic items such as yams or buckwheat. Since these items may never (or only rarely) have been eaten before, they are very unlikely to cause any reaction. In a sense the rare-food diet is an improvement on the few-food diet, because if the person fails to get better during the exclusion phase, they are probably not food-sensitive. With the few-food diet there is always some doubt – perhaps they were sensitive to parsnips, even though they only ever ate them for Sunday lunch? The drawbacks of the rare-food diet are principally cost – exotic foods are expensive -and the problem of getting such foods for those who do not live in a large city. The foods have to be prepared differently and the taste may take some getting used to, but on the whole they are at least as palatable as turnips! For those with multiple sensitivities who can afford the exotic foods, and have access to them, this type of diet is well worth considering.

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Do not attempt any diet without consulting your family doctor or specialist. If your child is under a child psychiatrist who is totally unsympathetic to dietary ideas, then ask your family doctor to refer you to someone else – an allergist for example, or a more open-minded psychiatrist – who will be prepared to supervise an elimination diet.

The specialist may have their own preferences as regards the diet, but if not. Children may need a calcium supplement, to compensate for the lack of milk in the diet, and the doctor can prescribe this. Children who also have asthma should be tested cautiously. Any child who has had severe allergic reactions in the past should not be tested for foods at home as the reaction can occasionally be life-threatening.

Drugs used to control behaviour, such as amphetamine derivatives, can be continued during the diet. If there appears to be an improvement in behaviour then you can try delaying the medication, or reducing the amount, but keep an eye on the situation and be prepared to top up the dose if necessary. Drugs used to control specific symptoms such as asthma or hay-fever should not be used routinely during the diet – only use them if they are actually needed. Needless to say, you should discuss all these points with your doctor before making any changes to the child’s medication.

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Antibodies are Y-shaped molecules, as the picture opposite shows. At the tip of each arm is an antigen-binding site where the antibody can bind to the particular feature of the antigen that it recognizes. These antigen-binding sites are the most changeable part of the antibody molecule – they vary enormously from one antibody to another. Their chemical structure determines which antigen is bound by that antibody.

The stem of an antibody can also vary, although nothing like as much. There are five basic types of stem, and they produce five different types of antibody, known as isotypes. The names of these isotypes (in order of abundance) are: IgG, IgA, IgM, IgD and IgE. In all cases the letters ‘Ig’ stand for immunoglobulin – another name for antibody. Imbalances between the different isotypes of antibody may play a role in food intolerance,

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Reduce your exposure to chemicals and fumes as much as you can during the test period. Stay out of places where chemicals are heavily used, such as hospitals, doctors’ surgeries, hairdressers’ or barbers’, and swimming baths. Some shops are full of chemical fumes -chemists’, perfumeries, newsagents’, shoe shops, DIY shops, television shops, clothes shops – so do not spend too long in any of these. Keep out of dry-cleaners’ and away from agricultural spraying. Drive or travel as little as you can. If you walk through traffic, try to stay away from busy roads and junctions.

Ban smoking in your home and elsewhere around you if you can. Avoid pubs, or public places where people smoke. If you go out to a cinema, concert or evening event, other people’s toiletries may bother you – perfumes, cologne and hairsprays, in particular – so limit how much you go out during the elimination programme.

Do what you can at work. If you work with chemicals, say in a shop, at a hairdressers’, at a garage, in a dry-cleaners’ or in a factory, there may be little you can do, but try. In offices, computers, photocopiers, paper stores, and new furniture are potent sources of fumes. You may have no choice but to stay close to them, but keep away as much as you can. Make sure the office is well ventilated and take frequent breaks in the fresh air.

At home, it helps if you can avoid using gas and paraffin cookers and fires that give off strong fumes. Use alternative heaters; perhaps borrow a microwave for cooking if you can. If you have to use a gas cooker, keep its use to a minimum, and ventilate well. (Gas central heating, and gas Agas, offer little problem unless you are extremely sensitive, so continue using these unless you notice they are causing you to react.)

Keep television watching to a minimum; only have your set on if you are actually watching something. Fumes from televisions do not bother some people at all, but they can give others real trouble. Take care with computers in the same way.

Put newspapers, brochures, magazines and any other paper away, in a drawer or cupboard for preference, unless they are actually being read or used. These can be potent sources of fumes. Stop using paper handkerchieves and kitchen paper towels.

Avoid buying anything new during the test period. If you do, leave it in a spare room or outside the home to air.

Once you have done these things, you should have eliminated most of the major hazards in your immediate environment. If you find anything around you that particularly bothers you (such as a piece of furniture, or plastic equipment), then put it in a spare room, outside the home, or cover it up with a sheet or cloth for the period of testing.

Follow this programme for at least a week, and up to three weeks, if you can sustain it.

After this time, you can reintroduce things you want to use, or increase your exposure to everyday chemicals and see what you are able to tolerate. Do this one thing at a time, preferably only once every few days, and no more than one a day. Monitor your symptoms as you proceed. See how things go, and gradually find out exactly what you can and cannot tolerate.

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Particle boards, of which the most common is called chipboard, are made of chips of wood bonded together by adhesive resins, usually formaldehyde resins. They are used in many applications in building and fumiture-making, often as a base for wood veneer, and as a base for plastic or melamine decorative finishes. They provide the structure for most fitted kitchen and bedroom cupboards, the core for work surfaces and can be used for partitions, wall and ceiling linings, and for flooring.

These boards have a high resin content relative to other building boards, and can give out significant amounts of free formaldehyde, especially when new, or when being cut or installed. If you have relatively small amounts of chipboard in your home, say only in the kitchen, and if it is not new, then it will probably not bother you too much. But chipboard can be a problem if you are exceptionally sensitive to formaldehyde, if you have large amounts in your home, or if you have newly installed chipboard – say in a new floor or fitted kitchen, for instance.

Unless chipboard bothers you a great deal, it may be better to leave it in place, and allow it to gas out over time, rather than to go to the expense and risk of replacement. If chipboard is exposed anywhere, or if it is used as flooring, sealing it with varnish will reduce the level of fumes escaping. Fit an impervious floor covering such as linoleum, rather than carpets, to reduce vapours.

If you decide to replace chipboard, or have to have work done, then wherever possible use alternatives without formaldehyde resins, or with lower resin contents.

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The most powerful versions of filters, probably better suited to office or workroom use, are the Filtaire 600S, the Enviracaire and the NSA 7100A.

The Filtaire 600S is identical in technical design to the Anatomia Filtaire 300, with fabric and carbon filters. It is larger in capacity and size, more effective and made with a metal casing. It is available at about £400 from Ascot Heath. Filters are of similar cost to the Anatomia and need replacing at similar intervals.

The Enviracaire is round and quite bulky to move. It has a HEPA filter, thick fabric and activated carbon filters. It produces very pure air, but also a draught at ground level, and can be noisy even on low operation. It is priced at £215 (at 1992). Carbon filters need replacing every three to six months at £11 each, and the HEPA filter needs renewing every four to five years at £70.

The NSA 7100A is tall and looks like a piece of office equipment. It has a HEPA filter, plus carbon filters that are thinner than the Enviracaire. It can be manoeuvred easily, being light and on castors. The air it produces is very clean, but the unit itself is made up of a slightly aromatic plastic and can be troublesome to some people with chemical sensitivity. It costs £360 (at 1992). The carbon filters need replacing every six months at £20 each, and the HEPA filter every two years at £60. It is available from Beta-Plus or NSA distributors (addresses below).

All suppliers of devices should offer you a trial period in case a machine does not suit you, or you do not find it effective. Check that you can return a machine before you make a purchase.

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