Mens Health Blog. Medical Blog

Chemical tinkering with the hydrocortisone molecule has produced drugs such as prednisolone. This suppresses inflammation but has very little effect on the excretion of salt by the kidneys, so it will not cause water retention.

Unfortunately, these are not the only bad effects of corticosteroids. Because they suppress inflammation, which is a valuable part of the body’s fight against disease, they tend to make infections more likely. Viruses and fungi, in particular, are likely to flourish.

If corticosteroids are taken over a long period of time, the adrenal glands’ natural activity is suppressed. Stopping the drug leaves the body without corticosteroids which can lead to collapse in the worst cases. This means that corticosteroids taken by mouth should never be stopped abruptly if they have been taken for more than a few weeks. The glands must be given time to recover their natural level of activity, by gradually reducing the dosage. Even after as little as two weeks, corticosteroids should be withdrawn gradually, by halving the dose each day, to avoid a flare-up of the original problem.

In general, applying corticosteroids locally lie where they are needed) is preferable to taking them by mouth or injecting them, because it reduces the dose needed and thus minimizes side-effects. This means applying the drug in creams or ointments for eczema, inhaling it for asthma, or injecting it directly into an affected joint for rheumatoid arthritis. Some of the drug still gets into the bloodstream however-for example, it can be absorbed through the skin. Children with eczema who are smothered in high-dose corticosteroid cream by their parents can develop Cushing’s Syndrome, although this is now very rare as doctors are more aware of the dangers.

Corticosteroids are valuable weapons in the fight against many diseases, but must always be used with some caution. The doctor’s instructions, as regards the amount and timing of the dose, must be followed exactly.

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Tags: Allergies

Sublingual therapy is approached in exactly the same way, the neutralizing dose being determined by a series of injections. But the mixture of extracts for home use is supplied as drops, one of which is placed under the tongue. There is rapid absorption into the bloodstream from this area, and it bypasses the liver, so the extract is not broken down rapidly. The effect of drops is not as long-lasting as that of a subcutaneous injection – the treatment has to be repeated every few hours. However, they are useful for inhalant allergies, or reactions to substances that are “only encountered occasionally, because the drops can be used only when needed. Sublingual therapy has been successfully used to treat patients with allergic reactions to house-dust mite and pollen. It is also claimed to be effective for patients sensitive to synthetic chemicals, where industrial alcohol is used instead of an extract. The question of using mixtures of extracts for neutralization is a difficult one. The trials of this technique have all involved solutions containing single food extracts. Yet some practitioners use up to 70 food extracts in a mixture. Whether the method still works under these conditions is uncertain.

There is also concern over the possible dangers of this technique to patients with violent allergic reactions. It is theoretically possible for such a person to suffer anaphylactic shock when injected intradermally with their allergen, and this could be fatal. However, this technique has now been widely used for many years, and no fatal (or even near-fatal) reactions have occurred. Nevertheless, anyone who has experienced immediate and violent allergic reactions to food (or other allergens) should be carefully assessed before such treatment begins.

Finally, it is claimed that the provocation-neutralization method can be used as a diagnostic test, to determine which foods are the culprits and avoid the need for an elimination diet. These claims are rejected by the majority of doctors because they feel the test is too unreliable. Detailed trials show that there are often positive reactions to extracts of foods that do not provoke symptoms when eaten (false positives). Occasionally foods that cause symptoms will not produce a positive wheal (false negatives).

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Tags: Allergies

Before embarking on an elimination diet, some understanding of how foods can cross-react with one another is necessary. Foods derived from two related plants (or two related animals) will have similar proteins. They do not have to look like one another to be alike chemically – our own proteins are 99 per cent the same as those of the chimpanzee and the gorilla, our nearest living relatives. In the same way, the potato and the tomato may look quite different, but the plants they come from are closely related.

If you are allergic to one sort of food, you may show a reaction to food from a related source, because the IgE antibodies that bind to the first protein will also bind to a similar related protein. Cross-reactions also seem to occur in food intolerance, although the mechanism is not understood in most of these cases.

Biologists use various methods to work out how closely two animals or plants are related. Having done so, they express these relationships by grouping creatures together in a hierarchical scheme – very closely related creatures belong to the same species, related species belong to the same genus (plural genera), related genera belong to die same family, related families belong to the same order, and so on. There are often further subdivisions within each level, such as the subfamily and the tribe, which are subdivisions of the family.

How is this sort of classification scheme relevant to food sensitivity? Practical experience of thousands of patients suggests that they can cross-react to related foods, although they do not always do so. It also seems, from this collected experience, that the family level in biological classifications is a useful one in deciding which foods will cross-react – although sometimes one has to look at higher or lower levels to understand the cross-reactions that are seen. For example, all cereals are grasses, and belong to the grass family, Gramineae. Some food-sensitive people react to all cereals – to all members of the family. But others react only to wheat or maize, the two most commonly eaten cereals in the West. Many who react to wheat also react to rye and barley, and sometimes oats. If one looks at the classification of the Gramineae, one finds that wheat, rye, barley and oats all belong to the same subfamily, the Pooidae, and wheat, rye and barley are in the same tribe, the Triticeae. Maize is in a different subfamily, and rice in a different subfamily again, so there is less likely to be a cross-reaction between wheat and these cereals. This nicely explains the observation that wheat-sensitive folk are more likely to tolerate rice than any other commonly eaten cereal.

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Tags: Allergies

The foods that are most likely to cause problems are those that you always eat in large quantities or hinged on during pregnancy, those you have a craving for, and, paradoxically, those that you actively dislike but eat because they ‘do you good’. You should also be suspicious of foods that are known to be potent allergens. Apart from milk, these are: eggs, peanuts, other nuts, wheat, chocolate, fish, oranges and other citrus fruits, chicken and beef. If you eat a lot of any of these foods, then add them to your list.

Anything with a drug-like action, such as coffee, tea, wine (especially red wine), beer, spirits or other drugs, is also a prime suspect, especially in the case of colic. Try cutting out all these drug-like items, plus cow’s milk, for two weeks and see if the baby improves. Eat extra protein from other sources and take a calcium supplement, which your doctor can prescribe.

If there is no improvement, then you should try eliminating all the other suspect foods that you have listed. Avoid them for two weeks, but substitute other foods that will fulfil your nutritional needs. Remember to cut out all the ‘hidden’ forms of foods, especially with ubiquitous foods such as milk, eggs and wheat. Read the labels on packaged foods carefully and see p292 for some of the synonyms used, as these can be deceptive. Avoid all restaurant or takeaway food during this time as it is difficult to know what you are eating.

If you have cut out more than two or three foods, and your baby gets better, then you will probably wish to test the foods to see which ones were the cause of the trouble – often it will just be one food. Wait until the baby has been well for about a week, and then reintroduce each food in turn, beginning with those least likely to cause trouble, and testing cow’s milk last. Eat a normal-sized portion of the food to be tested, every day for a week. If the baby remains well, discontinue that food and go on to test another one, again eating it every day for a week. Make a note of which foods cause symptoms and which do not. When all have been tested, those that produced no symptoms in the baby can become part of your normal diet again.

It is possible that the baby will remain well, and not respond to any of the foods – a brief period of avoidance can sometimes clear up the sensitivity. If this happens, continue with your normal diet, but be careful not to eat too much of any one food.

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Tags: Allergies

In the case of asthma, it is the effect of histamine on the smooth muscles of the bronchi that produces the symptoms. These vital tubes, which carry air to the lungs, go into a spasmodic contraction. How the allergens reach the airways, and the types of allergens involved, will be dealt with in Chapter Three. The way in which mast cells cause other allergic reactions, such as hay-fever and perennial rhinitis, will also be described there.

As one might expect, people with these allergic disorders tend to have a higher level of IgE in their blood than others. But there are a few whose IgE levels are normal. Conversely, there are quite a large number of people who have high levels of IgE, and give positive skin-prick tests to common allergens (see box), but who display no symptoms. Perhaps these symptom-free individuals have fewer, or less accessible, mast cells than others, making them less susceptible to high IgE levels. Or perhaps the mechanisms behind allergy are more complex than they appear, and IgE is only part of the story.

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Tags: Allergies