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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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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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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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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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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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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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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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 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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Bakery products and flours

The following firms supply bakery products and flours by post, including special mixes and food substitutes. Custom Bake will supply baked cakes and other products, using any ingredients you specify.

Cantassium Foodwatch International

Custom Bake Nutricia

Diet Care Suma

General Designs

Organic foods

Church Farm Natural Foods (London area)

Countryside Wholefoods Naturally Yours

Green Farm Foodwatch Organic Farmers and Growers

Infinity Foods Suma

Organic fruit and vegetables Organic Farmers and

Growers Red House Farm

Church Farm

Countryside Wholefoods

Natural Foods (London area)

Organic meat, conservation-grade and additive-free meat, poultry, sausages, ham, bacon

Church Farm      Organic Farmers and Growers

Greenway Organic Farms Pure Meat Company

Heal Farm Real Meat Company

Longwood Farm Red House Farm

Murray Meats

Natural Foods (London area)

For sausages made to your recipe:

Church Farm

Heal Farm

Red House Farm

For goat’s meat:

Murray Meats

Goat’s cheese, goat’s milk powder

Countryside Wholefoods Paxton & Whitfield Suma

Green Farm Foodwatch

Market Pantry Natural Foods (London area)

Sheep’s cheese, sheep’s milk powder

Foodwatch International Suma

Market Pantry Natural Foods (London area) Sussex High Weald Wells Stores

Paxton & Whitfield

Yogurt culture, cheese culture, rennet

Smallholding Supplies

Suma

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