December 26, 2008

Introduction - Aug. 2008


Updating April 29, 2015---

Technically this is a blog, but I am using it as a simple web site to share what I’ve learned about allergies (especially non-IgE allergies); to help others manage their allergies; to suggest theories and avenues for further research; and to push the medical establishment to accept and use information about non-IgE allergies to help their patients and stop using the word 'allergy' in a narrow way that confuses patients and other non-allergists.

Update - since I wrote this in 2008, the term "non-IgE allergy" has become much more common and was used in 2009 in the NIH proposed guidelines for management of food allergy.

Before I go on, there are three important things for people with allergies to know:

1. Chamomile cross-reacts with ragweed allergy. Allergy to ragweed pollen is very common. Hay fever symptoms in late summer and fall are usually caused by ragweed. Chamomile is related to ragweed and may cause symptoms in people with ragweed allergy.

Chamomile is present in most tea blends and many natural cosmetics such as lotions, moisturizers and deodorants. I have ragweed allergy and I’ve gotten symptoms from chamomile in both teas and cosmetics.

2. People with mold allergy may get symptoms from cheese, because cheese is often made with mold.

3. Aged foods contain naturally occurring histamines which can raise the histamine load in a person with allergies and cause symptoms. In my experience aged foods are usually cheeses or meats.

Update - I forgot to mention dried fruits, including tomatoes.

I’ve had both IgE and non-IgE allergies all my life. (Please see “Terminology of Allergies” for an explanation of these terms). I have non-IgE allergies to soy products, sugars, and eggs, and they were never diagnosed because the allergy/immunology establishment didn't recognize and treat non-IgE allergies. In fact, the allergists I saw growing up did not acknowledge the possibility of food allergies at all. I figured out by myself that I’m allergic to soy, and an internet support group assisted me in figuring out the sugar and egg allergies, both of which are mild compared to my soy allergy.

I got allergy shots as a child, but I don’t know what allergens they were for. That was a long time ago. In July of 2006 I went to an allergist for the first time since then and got skin prick and intradermal allergy tests. The reaction within 20 minutes showed IgE allergies to molds and ragweed.

The next morning I had a delayed reaction to one of the allergens – a 2-inch itchy red bump. Unfortunately I had not asked for a copy of the diagram the nurse made of the injections, and I couldn’t remember which allergen this was. I called my allergists office. For delayed reactions like this the nurses have been trained to say “don’t worry about that, it doesn’t matter”.

I said, “Excuse me, I happen to know this indicates a non-IgE reaction, and it does matter! I insist on knowing what this allergen is.” After checking with the doctor, she said I had to come in so they could tell me. Luckily my boss let me leave work. After the nurse, the assistant, and my allergist had all looked at it, they told me it’s a T-cell reaction to dust. The 24-hour delay indicates a T-cell reaction.

This does matter! It is very important information! I had already noticed from my symptoms that I might be allergic to dust, but this explains why I sometimes had a delayed reaction to it. When a person knows she is allergic to dust, she can manage it by using an air purifier, wearing a dust mask to do housework, avoiding dusty situations, etc. My allergist’s office is part of one of the most respected medical centers in the country, but they routinely pass up opportunities to help their patients with non-IgE allergies by training their nurses to say “don’t worry about that, it doesn’t matter.” This needs to change!

I’m posting just two pages now, but there will be more. I plan to post some simple recipes and cooking suggestions for people who aren’t used to cooking their own meals, but may have to because of food allergies. I also plan to post some research and suggestions on the root cause of allergies.

Julia Baresch
August 2008
Chicago


Thanks to my brother, Brian Baresch, for his help editing this site.
If you need to contact me, my info is in the Profile section.

Dairy and Allergies

(If you are a researcher and would like to use my ideas, please let me know. My info is in the Profile section.)

Dairy and allergies

It is widely believed that dairy increases congestion, and people with allergies, including myself and several I’ve talked with, notice relief from symptoms when we avoid dairy.

I searched PubMed and Google, but found only one study of the congestive effects of dairy. (Am Rev Respir Dis. 1990 Feb;141(2):352-6 http://www.ncbi.nlm.nih.gov/pubmed/2154152?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum, accessed 12/25/08.)

“Those who believe "milk makes mucus" [~ 27.5%] or reduce milk intake with colds reported significantly more cough and congestion symptoms, but they did not produce higher levels of nasal secretions. “

The authors clearly believe the patients who felt more congested from drinking milk with a cold felt this way because they expected to, but I have a different interpretation.

Does dairy cause inflammation?
Inflammation in the sinuses or lungs feels like congestion. The subjects who felt more congested but did not produce more mucous may have been experiencing inflammation.

If dairy does cause inflammation, this would explain why people with allergies notice an increase in symptoms from eating dairy products. It would also explain why inflammatory diseases are common in America, where our culture has us eating dairy all the time.

My suggestions for more research:
- Determine whether dairy does cause inflammation. There are many people who avoid dairy, I’m sure several would be happy to volunteer. If dairy is determined to cause inflammation, answer these corollaries:
o Does dairy cause inflammation in everyone, or only some?
o If it causes inflammation only in some, what is the determining factor?

Does dairy cause allergies?
This theory is only partially developed. Something causes the immune system to react to normally benign substances.

Dairy food is not intended by nature for humans, it’s intended for baby cows. It’s not a natural food for us. Since it’s usually given to babies and children with immune systems that are still developing, could dairy be a root cause of allergies?
- There would have to be studies done on populations that do not feed their children non-human milks and compare the rate of allergies.
- Or, comparisons of allergies in genetically similar children who are and who are not fed dairy products.

September 21, 2008

My T-cell Allergy Symptoms

My T-cell Dust Allergy Symptoms
September 19, 2008

Since the immune system is not fully understood and non-IgE allergies are usually not addressed by mainstream physicians, I think it might help if I describe the symptoms I get from my T-cell allergy to dust. Maybe it will be of interest to researchers or others with similar symptoms. If not no harm done, I hope. :-)

Yesterday there were workmen at my day job who were replacing the kitchen floor. My boss was hoping we would be able to work, so my colleague and I came in at our usual time. I had a project I could work on at home, but I had a couple of things I wanted to get done before I left for the day.

While I was working the workmen began tearing up the floor in the room next to my desk. They had covered the doorway with plastic, but I smelled dust anyway and put on a mask. I continued to work for a little more than an hour before I left, and I probably inhaled some of the dust in spite of the mask. I didn’t get any severe symptoms, but for the rest of the day I had a mild stomach ache, and I also ate twice as much for lunch as usual. I’ve noticed this effect before from my inhalant allergies, especially dust. When a person inhales, some of the air goes into her stomach, and inhaled allergens can cause discomfort and spasms. At least, they do for me.

Last night I fell asleep on the couch. Unfortunately it had been too long since I washed the couch cover and pillow case, and they were quite dusty. Today I woke up with sinus pain and pressure, a somewhat worse stomach ache, and fatigue. These symptoms are a little better in the afternoon after two doses of sudafed and tylenol, but they won’t completely go away until later this evening. I wish I could go back to bed. :p

September 14, 2008

Too Confrontational?

My brother is a professional editor, and one of his comments was that my site is a bit too confrontational towards the allergy/immunology establishment। I do have strong feelings about this, but my intention is to help and persuade the establishment to do better, not to fight with them. I hate fighting.

The failure of my childhood doctors to diagnose my non-IgE allergies held me back. I had a low energy level and other uncomfortable symptoms because I didn't know I had food allergies. Imagine what I, and others with undiagnosed non-IgE allergies, could have accomplished. Some are much worse off than I was. The establishment seems to focus its energy on trying to change the meaning of the word "allergy" (please see Terminology of Allergies for a discussion of this) instead of using information about non-IgE allergies to help patients. Thousands of people continue to suffer, some with debilitating symptoms, because doctors are either not informed or not allowed to use this information.

My primary care doctor and my allergist are both wonderful smart, open people who are aware of non-IgE allergies and do as much as they can to help patients with them, but are constrained by the establishment standard of pretending they don't exist. There are blood tests for non-IgE allergies, but mainstream doctors often don't use them either because their boss won't let them, or because they're afraid it will make them look bad to the AMA (please see Introduction for a description of a comparable situation).

I've been learning about allergies for several years. In the early 2000's I learned about Irritable Bowel Syndrome (IBS) on a support group, and saw cases in which a patient's IBS-D or IBS-cyclic symptoms cleared up after they learned what foods they were allergic to and changed their diet. In 2004 I worked with a company, Signet Diagnostics, that has a blood test for non-IgE food allergies, and I learned more from this experience. If you're interested, here is their link http://www.nowleap.com/. In their studies non-IgE allergies were also linked to frequent migraines.

The failure of the medical establishment to accept this information has far-reaching consequences. Non-IgE food allergies can cause symptoms of IBS-D or IBS-cyclic, and when I was learning about this I saw some horrifying stories. People who couldn't leave the house because of their IBS, accidents on dates or business trips, marriages ending because the spouse couldn't deal with the symptoms. And the frequent migraines, which are very debilitating. Surely some, maybe most, of these patients could clear their symptoms simply by changing their diet. How can the medical establishment continue to let people suffer like this? Why doesn't it accept and use information that has been around for decades? So you see why I feel a bit confrontational. :-)

As patients, we can insist that our doctors use this information. It's out there on the web and in books, and we can bring it to them. We can challenge confusing terms like "non-allergic ________" and insist our doctors make themselves clear. We need to push the establishment on this, because they are not moving forward on their own.

Thank you,
Julia Baresch
September 2008


Reference: Food Allergies and Food Intolerance: The Complete Guide to their Identification and Treatment by Jonathan Brostoff, MD and Linda Gamlin, 2000.

August 24, 2008

Terminology of Allergies

Why it should be called “Non-IgE Allergy

The immune system is very complex and only partially understood. There are several different kinds of immune system reactions. Some of the better understood reactions involve immunoglobulins.

Immunoglobulins are antibodies present in the blood and tissues of all vertebrate animals. They are called IgA, IgD, IgE, IgG, and IgM. IgE reactions are unique in that IgE antibodies reside in the tissues on mast cells (Other Ig antibodies circulate in the blood and lymph systems). When IgEs encounter the molecules to which they are sensitized, they can trigger violent muscle contractions and inflammation. This is what causes the life-threatening reaction anaphylactic shock, as well as less severe reactions of inflammation and congestion.

An allergy is an immune system reaction to a normally benign substance, such as pollen or food. The allergy/immunology establishment acknowledges and treats only IgE allergy reactions. They use the word "allergy" to mean only IgE reactions, which is not the way the word was defined in 1906.

There can also be allergies that do not involve IgE, but do involve other immune system components, such as the other immunoglobulins or T-cells. These can also become sensitized and react to normally benign substances, just like IgE.

Since the allergy/immunology establishment hasn’t accepted the existence of this type of allergy, they haven’t agreed on what to call it either. Some of the terms used by medical professionals include:

Immune sensitivity
Food sensitivity
Food intolerance
Hypersensitivity
Hypersensitivity reaction
And by far the most confusing,
“Non-allergic _____________”

examples: “non-allergic rhinitis”, “non-allergic asthma”

The A/I establishment uses the term “allergy” to refer only to IgE-mediated reactions. They resist calling immune reactions that are not IgE-mediated an “allergy”, and this is why they use other, less clear and confusing terms for it.

Most people understand the word “allergy” to mean the symptoms of illness without being sick, caused by a normally harmless substance. Calling non-IgE allergies by other terms (especially “non-allergic __________”) causes a lot of unnecessary confusion for patients and other non-allergists. Managing allergies is already hard enough. Why make it harder for the people you are presumably trying to help?

The word “allergy” was not originally and is not currently defined as being only an IgE reaction. A search on dictionary.com shows 10 definitions, none of which define "allergy" as being exclusively an IgE reaction. Below I copy the most comprehensive definition.

allergy (āl'er-jē) An abnormally high immunologic sensitivity to certain stimuli such as drugs, foods, environmental irritants, microorganisms, or physical conditions, such as temperature extremes.
These stimuli act as antigens, provoking an immunological response involving the release of inflammatory substances, such as histamine, in the body. Allergies may be innate or acquired in genetically predisposed individuals. Common symptoms include sneezing, itching, and skin rashes, though in some individuals symptoms can be severe. See also
anaphylactic shock.
American Psychological Association (APA):
allergy. (n.d.). The American Heritage® Science Dictionary. Retrieved December 13, 2007, from Dictionary.com website:
http://dictionary.reference.com/browse/allergy
Note that it says “an abnormally high immunologic sensitivity”, not “an abnormally high IgE sensitivity”.

On wikipedia.com, the history of the word “allergy” is explained:

The concept "allergy" was originally introduced in 1906 by the Viennese pediatrician Clemens von Pirquet, after noting that some of his patients were hypersensitive to normally innocuous entities such as dust, pollen, or certain foods.[2] Pirquet called this phenomenon "allergy" from the Greek words allos meaning "other" and ergon meaning "work".[3]Historically, all forms of hypersensitivity were classified as allergies, and all were thought to be caused by an improper activation of the immune system. Later, it became clear that several different disease mechanisms were implicated, with the common link to a disordered activation of the immune system. In 1963, a new classification scheme was designed by Philip Gell and Robin Coombs that described four types of hypersensitivity reactions, known as Type I to Type IV hypersensitivity.[4] With this new classification, the word "allergy" was restricted to only type I hypersensitivities (also called immediate hypersensitivity), which are characterized as rapidly developing reactions.
http://en.wikipedia.org/wiki/Allergy

Note that Dr. von Pirquet called the observed reactions of the immune system “allergy” without specifying that the term was only for IgE reactions. At the time immunoglobulins had not been discovered yet. The word continued to be used in this way for 57 years, from 1906 till 1963.

I was able to get a copy of the second edition (1968) of the Gell and Coombs book, Clinical Aspects of Immunology, from interlibrary loan. It does not say the word allergy should only be used for IgE reactions. I read all the sections about allergies, and it does not say this. At the time IgE had barely been discovered and it is called “reagin” through most of the book. This is what it does say in the Introductory Chapter on page xxiii:

Allergy, allergist, allergic reaction: MEANINGS: defined by von Pirquet who introduced the words, see Chapter 20 and Appendix A. USAGE: so varied and inconsistent at present that the words actively hinder understanding, but broadly equivalent to hypersensitivity, etc. BAD USAGE: we recommend a return to the use of von Pirquet as meaning broadly ‘altered in reactivity’.”
Appendix A is a translation of von Pirquet’s original article that identified and named allergy.

“The vaccinated person behaves towards vaccine lymph, the syphilitic towards the virus of syphilis, the tuberculosis patient towards tuberculin, the person injected with serum towards this serum, in a different manner from him who has not previously been in contact with such an agent. Yet he is not insensitive to it. We can only say of him that his power to react has undergone a change.

For this general concept of a changed reactivity I propose the term Allergy.”
Throughout the book the authors use the term “allergy” more broadly than any use it today, so they obviously did not wish to restrict the use of the word. They call auto-immune diseases “auto-allergic”, they refer to sensitized cells as “allergized”, and there are many other examples.

As my primary doctor pointed out, the term “non-IgE allergy” would also be useful to medical professionals as a reminder that the reaction is not IgE-mediated. The word can be adapted in many ways. Instead of saying “allergy” medical professionals can be more precise and clear by saying “IgE allergy” or “Type I allergy”. They could also say, for example, “T-cell allergy” or “Type IV allergy” and so on. These terms would be much clearer for everyone, including themselves, than the terms they currently use.

Everyone except medical professionals already use the term “allergy” in the way originally defined by von Pirquet and on dictionary.com. When I tell people I can’t eat certain foods, I say I have food allergies. This is much more clear than saying I have a hypersensitive immune reaction. In terms of normal conversation between lay people, it would be ridiculous to use any term except “allergy” to describe these reactions.

Even if the allergy/immunology establishment can’t bring themselves to use the term “non-IgE allergy”, they need to settle on one term that clearly describes the concept. Please, no more “non-allergic”!!!

I plan to continue pushing them to stop trying to change the meaning of the word and instead focus their energy on accepting and using information about non-IgE allergies to help their patients. Maybe if all of us patients do this, they will let go of their confusing and territorial ways and use the language the way the rest of us do, and maybe they’ll also accept and use the available information about non-IgE allergic reactions. :-)

References:
Clinical Aspects of Immunology, 2nd edition, edited by P.G.H. Gell and R.R.A. Coombs, 1968.
The Immune System by Peter Parham, 2000.
Food Allergies and Food Intolerance: The Complete Guide to their Identification and Treatment by Jonathan Brostoff, MD and Linda Gamlin, 2000.