Your allergy may be mild or may be life-threatening,
but it can probably be relieved
This 60-year-old gentleman presented with itchy blistering skin, mainly around his knees. Despite having few gut symptoms, I diagnosed Dermatitis Herpetiformis, a coeliac disease of the skin. I advised him to come off wheat (gluten) and his rash vanished.
He went on to consume a high quantity of gluten-free, processed food, such as cakes, biscuits and crisps. Unfortunately, he developed metabolic syndrome with belly fat, high blood pressure and high cholesterol, and later sustained a mini stroke.
He presented again with the same itchy blisters while on the gluten-free diet. Further enquiry revealed that he ate gluten-free oat porridge for breakfast. I made him aware that oats contain a different type of gluten called Avenin. He eliminated oats from his diet and his skin condition went into complete remission.
Allergies have escalated to epidemic levels over the last few decades. 3% of adults and 7% of children have allergies. 1 in 5 children has asthma. Whilst many outgrow their allergies by their 20s, 20% of these patients live in fear of having an asthma attack, anaphylactic shock or even sudden death from an allergic reaction. 44% of British adults suffer at least from one allergy, and nearly half of these have more than one.
In this article, I will discuss allergies that usually present as eczema, atopic dermatitis, asthma, hay fever (allergic rhinitis) or anaphylaxis, together with the causes of allergies and how to prevent them.
A study in Italy reported low incidence of allergies among adults who contracted childhood infections such as measles and mumps, but significantly high incidence of allergies among those who did not. It seems that early childhood infections are an indication that the immune system has had extensive training in sampling and identifying the surrounding environment and has developed a degree of tolerance.
The immune system aims to defend the body against any threat of attacking microbes or foreign proteins by launching an immune reaction. An allergy is an abnormal reaction to an ordinarily harmless substance – namely, allergens in food (milk, wheat, soya, eggs), grass pollen or dust mites. These present as a clinical condition, such as hay fever (allergic rhinitis), asthma, atopic dermatitis or eczema.
Immediate or delayed allergic reactions
There are two main types of allergic reactions – the immediate activation of mast cells and basophils within a few minutes, involving IgE antibodies, which can result in anaphylaxes, or a delayed hypersensitivity reaction, mostly in relation to food, which often takes 24 to 72 hours to develop, the immune cells being activated in this case by IgG antibodies.
The best example of the immediate type is a drug reaction, for instance a penicillin allergy that can progress to serious complications (anaphylactic shock.) This manifests immediately as hives, progresses to symptoms of wheezing, swollen lips, tongue and throat, often resulting in life-threatening airway obstruction, the patient fainting with a drop-in blood pressure, all happening within a few minutes.
To avoid this, doctors perform allergy tests in patients with no previous exposure, particularly to an antibiotic. This involves giving a small test dose under the skin of the forearm and watching for signs of allergy, such as redness, itching or hives.
Peanuts can trigger an immediate allergic reaction in a susceptible person, with acute cases requiring immediate attention – urgent resuscitation with adrenalin to relieve airway obstruction and steroids to dump the immune reaction.
More frequently, food allergies present as delayed hypersensitivity reactions that take between 24 to 72 hours to develop. Food triggers include wheat, milk and dairy products, soya and eggs. IgG activates the immune cells to react, resulting in nonspecific symptoms of lethargy, headaches, nausea, vomiting, diarrhoea or constipation.
All diseases begin in the gut!
Food allergy is mostly related to the inability of the person to digest certain types of proteins, resulting in larger partially-digested molecules hanging around, which can potentially cross the gut wall. The normal gut lining only allows fully-digested small molecules to cross over, namely mono sugar (glucose), fully digested protein (amino acids) and fat (fatty acids), vitamins, minerals and water.
Damage to the gut makes it leaky, allowing larger molecules to cross into the bloodstream. This irritates the immune system, which becomes overactive, mounting allergic reactions in various parts of the body.
The gut lining integrity is frequently damaged by sugar and refined carbohydrates, wheat and dairy. Certain types of bacteria (gram negative) in the gut often produce toxins called lipopolysaccharides (LPS) known to break the tight junctions between the gut lining cells. Medications such as antibiotics cause imbalance in gut bacteria that damage the gut lining. Other medications such as pain-relieving pills can directly damage the lining.
On the other hand, having good beneficial bacteria in the gut supports gut integrity and prevents allergies.
The allergic reaction is launched when the protein trigger (antigen), attached to the immunoglobulin (IgE or IgG), activates the immune cells to release inflammatory chemicals such as histamine. The immediate allergic reaction uses IgE to activate mast cells and basophil, whilst the delayed hypersensitivity reaction activates basophil, eosinophil and T cells via IgG to release inflammatory chemicals.
The crisis in allergies is related to high levels of histamine. This usually happens due to over-production of histamine, and an inadequate amount of diamine oxidase (DAO), the enzyme that breaks it down. This all happens while the sufferers are intolerant to histamine.
Some microbes in the gut produce histamine using an enzyme called histidine decarboxylase to convert the amino acid to histamine. The same enzyme in fish makes them a high histamine food. Again, the beneficial bacteria lactobacillus can also produce histamine in patients suffering with SIBO, making their symptoms worse.
These patients usually find it hard to tolerate huge amounts of histamine in foods such as fermented food, frozen, smoked or canned fish, salami, leftover meals, most berries, dried fruits, vinegar, pickles, alcohol, chocolates, cola and tomato ketchup.
The severity of the reaction depends on the amount of allergen ingested, whether it is stable enough to resist digestion, and the permeability of the gut mucosal burrier. High levels of histamine are cleared by another enzyme that requires a methyl group (CH3) to break down histamine anywhere in the body.
Are you at risk?
The risk of allergies is high in babies born by Caesarean section, who were not lucky enough to have the essential probiotics dose gained from the birth canal. Bottle-fed babies experience a double whammy, not enjoying the immune support that comes from breast milk, and being exposed to cow protein in the formula milk at an early age, usually resulting in their having various types of allergies such as eczema.
Those missing the usual childhood infections are also at risk, and allergies may also prevent the immune system from launching an appropriate fight against serious infection.
The most common seasonal allergy is a type 1 IgE allergic reaction, triggered by pollens that activate mast cells and basophils to release histamine and other allergy mediators. Sufferers have symptoms in spring and summer of itchy eyes, nose and skin due to inflammation, with excessive mucus production, causing nasal blockage, associated with general fatigue, headaches and sneezing attacks.
The best approach is to keep triggers out of your home by fitting a high-quality air filter, getting rid of pollen by showering before going to bed at night, and washing the bedclothes frequently.
Patients with severe symptoms may benefit from nasal douches (irrigation) with saline or ½ teaspoon of non-iodised salt triphala.
Food intolerance is a digestive rather than an immune system issue. It means difficulty in digesting certain types of food, resulting in unpleasant symptoms such as bloating, diarrhoea or tummy cramps. Symptoms occur a few hours after the ingestion of the offending foot. The best example is lactose intolerance. People with intolerance may be able to tolerate a small amount of milk in their coffee but may suffer severe symptoms with a huge amount.
Strategies to reduce allergies
- Breast feeding during the first 4 to 6 months is recommended by the European Society of Allergies. Breast milk provides secretory IgA (SIgA), preventing synthetisation from exposure to allergen at an early age.
- Probiotics increase the number and diversity of beneficial bacteria in the gut, including fermented foods, particularly those that degrade histamine such as lactobacillus and Bifidobacterial.
- Bacteria chew fermentable fibre to make short chain fatty acids (SCFA) such as butyrate acetate and propionate. This will help to heal the gut, and feed the microbiome and the immune system.
- You can reduce inflammation by eating real food – fruits and vegetables, beans, healthy fats, nuts and seeds, and eliminating allergens such a wheat, milk and dairy, soya and peanuts.
- You can heal the gut wall by taking bone broth, glutamine and cabbage soup.
- You can adapt to your local environment by taking local raw honey, as this contains beneficial bacteria.
- You can lower your histamine levels by taking a diet low in histamine, and high in Quercetin (natural antihistamines), foods high in Quercetin include red onions and apples.
- Supplements with great benefits for allergies include probiotics, Quercetin, Boswellia, B vitamins, selenium, vitamins C and D, and fish oil.
- You can also take diamine oxidase (DAO) as a supplement to break down and lower histamine.
Immune therapy for allergies
The avoidance of allergic food over time can result in lowering IgE levels below the threshold that causes symptoms. You can take food allergens to stimulate the production of the protective IgG antibodies. This may gradually lower the effect of reactive IgE antibodies. Be aware that insufficient IgG levels may result in the overproduction of the reactive IgE antibodies.
The elimination diet
This can help to identify whether your body does not agree with any food by giving you unpleasant symptoms. You remove suspect foods from your diet – these may include wheat, milk and dairy, soya, eggs, peanuts and nightshades.
You reintroduce one item at a time of the eliminated foods, usually 3 to 6 weeks later. Watch for a recurrence of symptoms for 3 days before you introduce the next item.
If you experience no symptoms, then it is okay to continue taking the item. Recurrence of symptoms indicates that you have a problem with this item of food. Whether the problem is temporary, or whether you need to avoid the item for the rest of your life, will depend on further assessment.
The symptoms you are likely to experience during the reintroduction phase include joint pain, fatigue, headaches, migraines, sleep disturbance, difficulty breathing, bloating and stomach cramps.
Please note that the Introduction of IgE allergens should take place under professional healthcare supervision, whilst the introduction of IgG trigger food items can happen safely at home.
And now, my friends, I would love to hear your stories – your experiences of success and failure – in relation to allergies. Your journey may well help or encourage someone else suffering along the same lines.