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2 Allergy: A Medical Phenomenon

Defining the Term Allergy

The term allergy is not merely a modern catchword; it represents a major problem of our times that has yet to be overcome.

It seems that the increasing number of allergies worldwide is just as much part of our current environment as air pollution, dying forests, or similar developments that are not being adequately dealt with. Their source may also be the same.

The world we live in today is not the one we were made for. Our natural resources to adapt have long been exhausted and overextended. We are exposed to a variety of stressors for which we do not possess any naturally inherent adaptation mechanisms.

Clinical ecology calls this “total body load,” that is to say the total of all chemical, alimentary, physical, and psychological stressors and/or damage to which human beings are exposed via the environment. An organism inevitably reacts to these stressors by creating manifold illnesses that manifest themselves—though only partly—as hypersensitivities of a type of allergy.

Klemens von Pirquet, a famous pediatrician in his time, coined the term allergy about 100 years ago. In the classical definition, accepted even today by scientific allergology, allergy signifies:

”Sensitization causing a different reaction to a substance.”

Becoming increasingly popularized, the term lost its accuracy over the course of the years and is now used very generally for any kind of hypersensitivity, intolerability, or rejection.

Even in medicine the term is used vaguely and more often erroneously. In particular the proponents of the previously mentioned “clinical ecology”— researchers mainly established in the United States and working primarily empirically—use the term rather broadly. It is believed that hypersensitivities to foods and chemicals are the main causes of chronic illnesses and psychological disturbances (Randolph 1962, Mackarness 1986, Runow 1987, etc.). The term allergy is increasingly applied to any damage or negative influences in any way connected to the environment. It would be more correct to describe this as a clinical ecological syndrome. This mixing of terminology often causes misunderstandings with the supporters of clinical immunology who endeavor to limit the term to verifiable immunological processes.

The discovery of immunoglobulin E (IgE) clarified the interfacings of the actual allergy.

”Allergic reactions are caused by the allergen interacting with IgE antibodies, bound to mast cell receptors and basophilic leukocytes, and the subsequent release of mediators” (Ring 1982).

Hopes to be able to clearly delimit and declare allergic illnesses as such, by means of IgE test methodologies, were only partially realized. Thanks to many exact and controlled studies, we know now that the correlation between a positive test result of specific IgE antibodies (e. g., through serological and/or skin tests) and clinical symptomatology is often insufficient to draw definitive conclusions. Many food allergies fall into this category. Due to frequently negative test results, food allergies are often classified as non-allergic or pseudo-allergic even though all other criteria of an allergy are present.

A clear and scientifically unmistakable definition of the term allergy remains illusive.

Clinical allergology often uses the expression atopic allergies, which includes the genetic aspect. The term atopy, coined by Coca and Cooke in 1923, was meant to describe different experiences with allergies in human beings. These observations have also been made with animals. The term was finally accepted as the description for a congenital and inherited susceptibility to an allergen. The patient is sensitized to certain allergens and reacts to them according to clearly defined pathologies such as allergic asthma, urticaria, hay fever, perennial allergic bronchitis, rhinitis, and neurodermatitis.

The common thread among these clinical pictures is that they are undoubtedly allergic in nature and occur individually or combined in human beings that are genetically predisposed to allergies (atopics). To be included in this group a positive test of specific IgE antibodies is not absolutely necessary, as the example of neurodermatitis shows. Due to negative test results, dermatologists consider neurodermatitis a skin disorder of unknown origin. Many allergologists, however, regard it as an allergy as it is clearly an atopic illness. In this book, we use the term allergy in the sense of atopic allergies. We are following in the footsteps of the classical definition of clinical allergology. However, here we emphasize the characteristic and undoubtedly allergic pathology. We do not require positive IgE test results, whether serologically or otherwise obtained. As regards the necessity of a clear definition of the term allergy, we concur with the English immunologist D. Freed:

”Anybody who uses the word ‘allergy' ought to make sure that all participants in the conversation share the same definition of the term!” (Freed 1986)

Allergens throughout Medical History

If historians are to be believed, allergies are as old as human beings. Old writings report that allergies are not new to our times, even if diagnosing their symptoms depended on the Zeitgeist and ideas of the day.

The first record of an anaphylactic allergic reaction and ensuing death is from the third millennium BC. The Egyptian Pharaoh Menes died from a wasp sting in 2540 BC. The Papyrus of Ebers, dating back to about 1600 BC, clearly describes allergic asthma. Hippocrates, however, coined the actual term asthma more than 1000 years later.

Physicians of Classical Greece seemed to have been quite familiar with allergies, even though they did not know what caused these mysterious reactions. Ptolemaios called them idiosyncrasies. At the time this was meant to describe a particular mix of bodily fluids that denoted neither a state of health, “eucrasia,” nor illness, “dyscrasia.”

Even the powerful emperors of Rome had allergies. Both Augustus and Claudius are said to have had symptoms like asthma, chronic rhinitis, and atopic eczema.

Historians report that Richard III broke out in a rash and had edema after eating strawberries. The symptoms were thought to be the effects of poisoning. The king used this opportunity as a welcome excuse to have a disliked lord executed on grounds of poisoning.

Hay fever was already well-known in the Middle Ages. Occurring when roses were in bloom, it was called rose fever. Hay and grass were also suspected causes of the peculiar seasonal symptoms. In the 19th century, people were already talking about “hay fever” without knowing any details. In 1873, experimenting on himself, the English physician C. H. Blackley was able to prove that pollen in the air caused the mysterious symptoms. He was the first to conduct skin and provocation tests. His exact experiments introduced a new era of allergy research: The steady illumination of the various pathophysiological allergy mechanisms was brought about by scientific studies and experimentation. The independent specialties of clinical immunology and allergology came into being. By the end of the 20th century it was difficult to keep abreast of the enormous field of knowledge they had developed.

Scientific and Clinical Allergology

Scientific research conducted over the course of almost a century has created an incredibly impressive database of knowledge. One would think this sufficient to solve, if not all, at least the most important practical problems relating to allergies. Surprisingly, and maybe significantly, this is not the case.

Millions of allergy sufferers know very well that true healing is elusive despite many time-consuming therapy attempts that are often dangerous for and place stress on the body. Hundreds of thousands of physicians, even the most specialized allergologists, experience daily the frustration of not being able to provide relief to their patients.

Very recently, W. Aberer, an experienced clinical dermatologist and allergologist, has resigned himself to consider “allergies a chronic illness that cannot be cured and for which medicine has not yet discovered an easy solution.” He laments therefore that, “people are increasingly turning to alternative medicine whose motives are often, this is well known, commercially driven” (Aberer 1992).

Beginning with diagnosis, clinical allergologists experience practical difficulties and unresolved problems.

The discovery of immunoglobulin E in 1967 (by K. and T. Ishizaka at the same time as Johansson and Bennich) made it possible to prove allergenically relevant factors in the patient's blood. However, the initial great expectations that positive proof of specific IgE antibodies invariably signify a manifested allergy to a particular substance soon had to be scaled back considerably.

Leading experts of allergology agreed meanwhile that a correlation between positive proof of specific IgE antibodies and clinical symptoms may not always be sufficient to conclusively diagnose an allergy. In a broad study of 5000 randomly selected people who did not have any apparent allergies, more than one-third showed positive skin reactions to one or more of the common allergens.

”These people produce specific IgE without developing allergic symptoms” (Roitt 1987).

Fig. 2.1 Importance of anamnesis in allergy diagnosis (according to Ring).

It is generally known that skin and blood tests, particularly with regard to food allergies, are unreliable (Reimann 1989, Wahn 1987 etc.).

“We have to admit that we do not have good test methods when it comes to foods” states Aberer. He goes on to say that in the case of in vitro methods showing positive test results of numerous differing IgE antibodies in the same patient, which occurs quite often, “allopathic medicine is unable to determine which ones are relevant” (Aberer 1992).

Again and again anamnesis is emphasized. According to Ring, it amounts to a good 50% of the diagnosis (Fig. 2.1). Aberer estimates it to be as high as 80%.

We will show later on that, due to the masking effect, a patient often does not know that he or she is allergic to a particular substance. This occurs mainly with the most important food allergies, that is to say chronic forms where allergens are ingested daily. According to Ring, in vivo test methods designed to provoke an allergy or eliminate allergens are critical to confirming the existence of a food allergy. Various elimination diets as well as the search for allergens by adding suspected allergy-provoking foods may cause problems for the patient. Besides taking a long time, they are not reliable and cause additional stress on the patient's body.

The intragastric method of provocation using endoscopy (IPEC) exemplifies the difficult situation that arises when diagnosing foods allergies (Fig. 2.2). The suspected allergen is endoscopically introduced to the gastric mucous membrane whose reaction is then assessed macroscopically and microscopically. At the same time the antihistamine release can be measured in loco. Undoubtedly this heroic method was developed only because the conventional immunological diagnosis of food allergies is essentially ineffective.

Fig. 2.2 Intragastric method of provocation using an endoscope (IPEC according to Reimann).

We do not want to dispute the serious attempts of allergologists to solve the manifold problems concerning allergy diagnosis. However, viewed critically, a certain perplexity and helplessness must be acknowledged.

Serological in vitro methods as well as different tests on skin and mucous membrane are part of the daily allergological routine. Even though they form the indispensable basis of clinical allergology for numerous physicians, clinicians, and specialists, it does not mean that the results are relevant.

Erroneous negative as well as positive test results are more common than admitted.

A typical example is the allergy to chicken egg proteins, which is often overrated. According to a study by Hattewig and Kjellmann (1984), specific IgE antibodies to chicken egg protein can be found in almost one-third of all healthy children after they have started eating chicken eggs. Bear in mind that these are children who never had any allergic symptoms until the time of the examination. Minute quantities passed on through the mother's milk commonly appear as sensitivities to chicken egg protein in breast-fed babies. Serological test results are positive, but no symptoms can be observed (Gerrard 1979). In the case of babies and infants, initial contact with a substance seems to be sufficient to stimulate the creation of specific IgE antibodies. These are not necessarily a definitive sign of a clear allergy.

Obviously other factors play a role, besides the creation of antibodies, for allergy symptoms to occur. This conclusion led to the theory of allergy manifestation. It purports that an allergy does not create symptoms unless immune activity exceeds a certain point. When this threshold is reached depends on the encompassing circumstances such as allergen exposure, genetic predisposition, and the ability to create IgE antibodies (IgE low responder, IgE high responder). Various circumstances may play a role such as temporary IgA deficiency, lower suppressor T-cell activity, and viral infections. The latter may expedite the release of histamines from basophils. By no means evident, the postulated factor obviously essential to manifest allergies was called factor x to express a hypothetical mechanism (Fig. 2.3).

The therapy itself is also confronted with considerable unsolved problems despite worldwide research and significant financial investment.

In the words of the German immunologist W. Müller, allergy treatment aims to “develop immunological tolerance (to the allergen) over the course of many years.” He continues with resignation: “To date we have no therapeutic modality that has achieved this even though individual cases show an eradication of symptoms after avoidance of and subsequent renewed exposure to the allergen” (Müller 1987).

Meanwhile we have experienced that the avoidance of allergens has been successful in only a few cases. The significance of “avoidance even to the point of complete isolation from the allergen” was unknown and consequently had not been taken into consideration.

In contrast to avoidance, clinical allergology uses hyposensitization to treat allergies. The patient frequently receives small amounts of the allergen. The goal is twofold: to prevent the appearance of allergy symptoms and/or for the patient to be able to tolerate a higher dose when he or she comes into contact with the natural allergen. True healing through hyposensitization treatment has yet to be documented. The effectiveness of this therapy has been the subject of discussions since the first controlled study by Frankland and August in 1954 (Uhlmann).

Fig. 2.3 The theory of allergy manifestation (according to Roitt et al. 1987).

The decrease in IgE antibodies concurrent with an increase in immunoglobulins of type IgG (Djurup and Osterballe 1984), often apparent with this therapy, bear little correlation to the clinical symptoms. Its significance has yet to be explained.

The efficacy of hyposensitization immunotherapy has been unequivocally proven solely in the case of bee and wasp allergies. This is very risky for the patient and currently is generally only recommended as in-patient treatment in specialized departments with specialized equipment, staff, and experience.

Decreasing patients' sensitivity has been somewhat successful with pollinosis. Generally, however, therapy extends over a very long period. There is always the risk of a fatal anaphylactic reaction.

Oral treatment with liquid allergen extracts is less risky. Even though it has been proven to be utterly ineffective (Urbanek et al. 1983, Wahn et al. 1987), it is still widely practiced, particularly in pediatrics, due to a lack of effective alternatives.

Food allergies, one of the most important groups within allergies, cannot be treated by hyposensitization. To date there has been no documented success story.

Industry undoubtedly plays a big role in overestimating treatment via hyposensitization, painting an exaggeratedly positive picture of hyposensitization treatment.

Commerce with regards to allergen extracts amounts to billions of dollars worldwide. It is not surprising that representatives of allergen-producing pharmaceutical companies regularly appear in the physician's office optimistically touting their company's products as effective therapy treatments. At the same time they may occasionally forget to mention less optimistic reports found in technical literature.

Chemical drug therapy is often aggressively propagated due to similar interests. Chemical substances administered in response to IgE-causing allergies of Type 1, without exception, only prevent the onset of symptoms or suppress them (Coombs and Gell 1963). This fact is readily overlooked or not mentioned. Chemical drug therapy is unable to alter the actual mechanism of an allergy. This applies to various antihistamines (H1 receptor antagonists) as well as mast cell stabilizers (DNCG, NAA-glutamic acid) and corticosteroids, the most potent and problematic of all allergy pharmaceuticals.

It becomes apparent that to date, clinical allergology possesses only two therapy modalities that address the cause: the avoidance of allergens and hyposensitization. Even though they have been used routinely for millions of patients, neither is completely effective. W. Müller fittingly sums up the current situation of allergology as follows: “The therapeutic dilemma in allergology can be clearly seen in the opposing therapy modalities of the avoidance of allergens and hyposensitization. Both act under the same premise, to induce immunological tolerance to the particular allergen. We still do not know which one of the two therapies might be the more successful” (Muller 1987).

Against this globally frustrating background, the assertion that there is an incredibly easy way to heal allergies using exclusively physical means, as previously defined, sounds like malevolent provocation. Could it be possible that the impressive knowledge clinical allergology has amassed is worth nothing? Can many thousands of serious researchers be mistaken?

In this, as in many similar situations, a response to these questions is futile as it would be based on “either/or” rather than “as well as.”

The “either/or” thinking between allopathic medicine and the so-called alternative methodologies is one of the big, seemingly ineradicable misunderstandings.

We do not need physicians to discard their allopathic knowledge. This knowledge has contributed to a doubling of the average life expectancy, victory over numerous diseases, epidemics, and other threats to mankind.

We need physicians who are willing to supplement their knowledge. They have to be open-minded in order to enter new dimensions, even if these are initially surprising and hard to understand.

In the following chapters we attempt to explain what we mean by “a new biophysical aspect of allergy.” We also want to present resultant, impressive, and to date unexploited practical opportunities.