Complementary medicine and allergy - an evaluation of the facts.
by Dr. A.J. Morris.
Reprinted from: Current Allergy and Clinical Immunology - September 1996 Issue
A. Treatments commonly employed by complementary medical practitioners in allergy treatment
Homeopathy Acupuncture Herbal medicine Enzyme Potentiated Desensitization Ionisation Speleotherapy Ozone Therapy
B. Diagnostic tests commonly used in complementary medicine
The Vega test and applied kinesiology Hair Analysis Leucocytotoxic test
C. Conditions popularised by alternative practitioners which they consider to be associated with allergy
Systemic Candida hypersensitivity syndrome Post viral fatigue syndrome and ME Mercury toxicity
D. Complementary Sites
Welcome to the 1990’s - the New age of complementary medicine. This subject has become very topical in the lay-press ever since physical fitness and "total well-being" have been popularised. People have become pro-active in their own health promotion and illness prevention by exercising at gymnasiums or aerobic clubs and placing special emphasis on "good" eating habits and dietary "supplementation". The role of diet and health have become inter-twined as society adopts the "you are what you eat" attitude to both physical and mental well being.
This movement seemed to commence with Feingold’s revelations in the mid 1970’s 1 relating illness and abnormal behaviour to dietary indiscretion and to so called "food allergy". From this point on there was great pressure to implicate poor diet with illness and a tendency to overdiagnose food allergy.
So called clinical ecologists emerged and highlighted the study of so called "environmental illnesses", implicating everyday factors such as air, water, food, drugs and our habitat as causes of multisystem chronic disorders. It is a common belief among clinical ecologists that humans have failed to adapt to the onslaught of modern day synthetic chemicals. They believe that this failure to adapt has led to a dysfunctional immune system and consequently a propensity to develop allergies, chronic viral and fungal illnesses and to accumulate chemicals and toxic heavy metals in the body.
It is interesting to note that the more affluent and educated people become, the more they begin to question existing medical dogma and often detecting certain inadequacies in modern medicine, prefer to experiment with alternative medicine. This has led to the growing popularity of a more "natural" approach to treating illness, using ancient remedies and medicinal herbs.
Complementary medicine does not usually talk of permanent cures, nor does it promise or give hope of eradicating the underlying illness, and the patients amazingly do not seem to expect it. The patients seem somehow content to accept their condition by being reassured that their symptoms have a physical basis.
Surprisingly many complimentary practitioners are medically qualified doctors who have chosen to try alternative therapeutic regimes - it is certainly no longer the domain of wacko’s or cranks. As a result of this the complementary medical movement is now gaining more and more allopathic medical acceptance. In Australia, a study has shown that in a group of over 100 asthmatics, at least one half had at some stage consulted an alternative medical practitioner.2 These people were not unusually dissatisfied with conventional medicine, but felt a need to explore alternative approaches to conventional treatment.
The fact that alternative ancient rituals and remedies are becoming more popular seems enigmatic when one considers the great strides we have seen in the understanding of the mechanisms of clinical immunology and modern medicine (new generation pro-drugs, detailed MRI scans, specific monoclonal antibodies, cytokines elucidation and molecular genetic mapping)
Unreasonable fear and suspicion of conventional medical treatment have become pervasive amongst the public. All sorts of horror stories abound regarding the misuse and complications of antibiotics, steroids, asthma inhalers and antihistamines. This is further inflamed by the popular press.
We see this, despite the obvious wonders of modern antimicrobials which include the near eradication of diseases such as rheumatic fever, glomerulonephritis, quinsy’s, mastoiditis, brain abscesses and meningitis. Instead, we are bogged down with "new age" popular press environmental diseases. These diseases now include chronic stress, chronic fatigue syndrome or ME, systemic candidiasis, and suspected heavy metal toxicity, all leading to a multitude of vague non-specific symptoms.
Conventional medical practitioners really need to sit back and reflect on why this has happened, despite alternative therapies generally being of a dubious nature and benefit. Perhaps our modern "high tech" medicine has become to complex and consequently dehumanised. We often fail to explore the patients underlying disability and sickness seeking behaviour and rather tend to compartmentalise patients into specific specialty spheres such as psychiatric, rheumatologic, dermatologic etc.
Doctors give patients less time for their personal history and interrogation and instead perform more and more expensive tests. Patients may get a 15 minute consultation if they are lucky and then off they go with no insight into their illness or the treatment. No education or counselling is generally offered or given.
The philosophy of complimentary medicine is quite different, in that it proposes that one should treat the patient and not the disease. As a result of this, treatments are always individualised and no two patient’s treatments are identical. With this type of medicine it is particularly difficult to do standardised clinical trials. There is usually no one single active ingredient, therefore great difficulty is experienced in subjecting the treatments to double blind placebo controlled clinical trials.
The mechanisms employed in complementary medical treatment are also poorly understood. The practitioners themselves have great difficulty in explaining the mechanisms of action of their various remedies in conventional scientific terms. Is it a placebo effect? Fostered by supra-tentorial suggestion, or even as has been suggested, by a mechanism involving the neuroendocrine system. Perhaps the patient becomes so preoccupied with complex dietary manipulation and lifestyle changes that they "forget" all about the "allergy"or food intolerance.
Alternative medicine seems most effective in treating the more nebulous illnesses such as stress, so called allergy or food intolerance, hypoglycemia, subclinical hypothyroidism, systemic candidiasis, heavy metal intoxication and yuppie flu. Whilst it is of little value in treating the more clear-cut conditions such as diabetes, epilepsy, tuberculosis, angina and pneumonia
We should however keep an open mind to these practitioners and this group of so called illnesses. Consider how our recent understanding of the neuro-endocrine system and the synthesis of endorphins has made us reconsider and accept acupuncture as a possible therapeutic approach. Look how nutrition has begun to play an important role in treating heart disease and the use of antioxidants in preventing atherosclerosis is no longer ridiculed.
The idea that the environment is responsible for a multitude of human health problems is most appealing to the public in general but not to conventionally trained doctors. "Sick building" syndrome and environmental factors such as cigarette smoke, diesel exhaust particulate and preservatives inducing disease do not seem so far fetched anymore. Is the enormous increase in cancer we see in relatively young people a indictment of our unhealthy lifestyles and poor disease prevention programs, perhaps the clinical ecologists are not so far off the mark. We are not however advocating that everyone should have his or her tooth fillings removed to prevent heavy metal poisoning. Some alternative remedies will probably gain scientific approval in the near future if and when scientific explanations are found for their effects in neurophysiological and biochemical terms.
A. Treatments commonly employed by complementary medical practitioners in allergy treatment
Homeopathy was devised by Hahnemann in the last century and is based on the so-called law of similars - "like cures like". Homeopaths believe that any substance that produces symptoms similar to the symptoms under treatment would actually cure that same disease if taken in minute doses. Treatments are usually individualized for the specific patient and not the disease.
The British Society for Allergy and Clinical Immunology (BSACI) recently issued a position statement 3 in which it concluded that there is inadequate evidence for any benefit from homeopathy in treating allergic disorders. But a well designed study published in the Lancet by Reilly and Taylor from Glasgow4 did however show significant improvement in hayfever symptoms, as did Kleijnen’s review of clinical trials in homeopathy published in the BMJ. 5
Acupuncture is an ancient Chinese form of treatment that involves inserting tiny needles into specific meridians or areas of the body. It has been found to be particularly useful for pain relief and the practice has grown remarkably in recent years. Claims that the use of acupuncture is useful in treating allergies in general are not based on well-performed clinical trials. The BSACI does however concede that some studies have shown a small but temporary improvement in wheeziness when acupuncture was employed. (6)(7)
3. Herbal medicine
Many plants have therapeutic properties and one only has to remember that digoxin comes from the Foxglove, salicin from the bark of the Willow tree and opiates from the glorious Poppy. Herbal remedies such as the Ma Huang plant (Ephedra sinica) which contains ephedrine has been used to treat asthma for 5000 years but there is very little evidence that herbal medicines in general confer any major benefit. In some cases they may even be hepatotoxic. One recently noted exception is the use of traditional Chinese herbal tea in the treatment of atopic eczema. Studies by Atherton et al (8)in the UK have shown considerable benefit for intractable atopic eczema on this regime.
4. Enzyme Potentiated Desensitization
This treatment is popular in the UK but not often employed in SA. It involves mixing the alleged allergen with beta-glucuronidase ( a common enzyme in the body) and applying it to the skin in very low doses. It has been used to treat hayfever and alleged food allergies. Double blind studies have failed to show any significant benefit with this regime9.
Ionising machines emit negative electric charges into the air, and this supposedly causes airborne allergens to cluster and fall to the ground. These machines have been claimed to help hayfever and asthma sufferers by decreasing the allergen load on the nasal mucosa and lungs. There are no studies available to substantiate this claim.
Speleotherapy or underground climatotherapy is an alternative treatment for asthma used in Eastern Europe10. It involves spending 2-3 hours a day underground in subterranean caves or salt mines over a 2-3 month period. This rather old therapeutic modality without a scientific explanation seems to give some benefit to patients with COAD and asthma.10
7. Ozone Therapy
Ozone therapy in treating allergy is a new addition to complementary medical treatment. At a recent seminar held at the UCT medical school11, it was advocated by proponents of this therapy that the allergic patient’s blood be exposed to ozone gas and then re-injected or ozone be directly insufflated rectally or vaginally. This practice could have serious adverse results, as ozone is a very well documented trigger for allergy and asthma.
B. Diagnostic tests commonly used in complementary medicine
1. The Vega test and applied kinesiology
The Vega test employs a Wheatstone bridge circuit to measure electrical conductivity in the body - so called bioenergetic activity. The apparatus is connected to the patient and the circuit is completed by a metallic honeycomb containing the test allergen. The machine is calibrated using a glass vial containing a poison like paraquat to give a "disordered "reading. Test substances that then give a disordered read as paraquat does, are considered to be potential allergens. Katelaris et al in Australia found no valid trials to show any diagnostic value for this procedure.12
Applied kinesiology is a variation of the Vega test in which the patient experiences a temporary muscle weakness when exposed to the allergen held in a glass vial in front of a magnetic field. The deltoid muscle is commonly used and the examiner presses the patients arm down noting any temporary weakness. There have been limited studies on this test, but a double blind study in the BMJ failed to find any benefit from applied kinesiology13.
2. Hair Analysis
Hair analysis as a method of detecting allergies was quite popular in the 1980’s, but seems to be less popular now. The test supposedly noted toxic levels of heavy metals or low levels of selenium, zinc, chromium, manganese and magnesium in hair samples which apparently indicated allergy. Double blind studies failed to show any diagnostic value to this test.14
3. Leucocytotoxic test
TheLeucocytotoxic test involves mixing the patients white blood cells with the allergen and detecting cell damage. The test has a high number of false positive and negative reactions and is of no value according to the American Academy of Allergy.15
C. Conditions popularized by alternative practitioners which they consider to be associated with allergy
1. Systemic Candida hypersensitivity syndrome
According to Clinical Ecologists, Candida albicans is considered to depress the patients immune system causing a vague illness characterised by fatigue, depression, headache, bloatedness, inability to concentrate etc. The condition was popularized by the book - "The Yeast Connection" written by Crook in 198416. The suggested treatment is to "starve" the yeasts by temporarily withdrawing fruit, sugar, refined cereals, mushrooms, milk and mould containing foods from the diet. Antioxdants and antifungal agents are then also prescribed. The condition is said to be triggered by overuse of antibiotics, cortisone or diets rich in carbohydrates and yeast and it occurs commonly in allergic individuals. The candida theory is unsubstantiated and extensive scientific reviews have found no evidence for the existance of such a condition.17
2. Post viral fatigue syndrome and ME
This condition, associated with fatigue, muscle weakness and pain and poor concentration is extremely commonly diagnosed by alternative practitioners and self diagnosed by patients suffering from vague symptomatology. The symptoms usually appear to follow a viral illness perhaps due to the Epstein Barr virus, Coxsackie virus or Herpes virus. There is no evidence to support the belief that the chronic fatigue syndrome is the result of an allergy, a candida infection or from dietary factors.
3. Mercury toxicity
There has been concern for many years that the mercury found in dental fillings may be absorbed by the body and cause hypersensitivity or toxic reactions. Supposed symptoms include: lethargy, depression, irritability and loss of concentration. Many a patient has had all their dental fillings replaced at great personal cost and suffering, after mercury hypersensitivity had been diagnosed. The mercury in dental amalgam is absorbed but at very low levels and there is no evidence that it causes either hypersensitivity or toxicity to humans via dental fillings.
In this issue, reputable complementary medical practitioners will explain the rationale for their approach to allergy diagnosis and treatment. We should examine the evidence available and draw our own conclusions, making sure we keep an open and critical mind. We should not be bogged down by previous medical attitudes and dogma but examine whatever new evidence is available. Medicine is dynamic art and we are constantly discovering new physiologic explanations for the success of older treatment regimes. Safe treatments that prove beneficial should be validated and encouraged, while those that offer no benefit, are misleading or are potentially dangerous should be strongly discouraged.
D. Complementary Sites:
NCCS Proceedings of the National Conference on Children with Sensitivities
Feingold B. Hyperkinesis and learning disabilities linked to artificial food flavors and colors. American Journal of Nursing 1975;75:797-803. Donnelly WJ, Spykerboer JE, Thong YH. Are patients who use alternative medicine dissatisfied with orthodox medicine? Med J Australia 1985. 142:539-41 Allergy: Conventional and alternative concepts. The Royal College of Physicians, London,in Clin Exp Allergy: 22 :suppl 3 ;Oct. 1992 Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as a model. Lancet 1986; ii:881-886 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of Homeopathy. Br Med J. 1991 302:316-22 Editorial. Alternative and complementary medicine in asthma. Thorax 1991;46:787-797 Kleijnen J, ter Riet G, Knipschild P. Acupuncture and asthma: a review of controlled trials. Thorax 1991;46:799-802. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J. Dermatol 1992;126:179-84. Fell P, Brostoff J. A single dose desensitization for summer hayfever. European J. Clinical Pharmacology 1990; 38:77-79. Karakoca Y, Demir G, Kisacik G et al. Speleotherapy in asthma and allergic diseases. Clin Exp Allergy 1995;25:666-667. Shallenberger F, Seminar: Ozone in Clinical Medicine, UCT Medical School, Cape Town July 26-27 1996 Katelaris CH, Weiner Jm, Heddle RJ, Stuckey MS, Yan KW. Vega testing in the diagnosis of allergic conditions. Med J Australia 1991;155:113-114. Garrow JS. Kinesiology and food allergy. Br Med J 1988;296:1573-1574. Sethi TJ, Lessof MH, Kemeny DM, Lambourn E, Tobin S, Bradley A. How reliable are commercial allergy tests? Lancet 1987;i:92-94. American Academy of Allergy: Position statements - controversial techniques. J Allergy Clin Immunol 1981;67:333-338. Crook WG. The yeast connection. Jackson, Tennessee: Professional Books, 1984. Candidiasis hypersensitivity syndrone. Executive committee of the American Academy of Allergy and Immunology. J. Allergy Clin Immunol 1986;78:271-273.