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We have spoken of the problems of food allergy and chemical susceptibility as the two main components of environmental disease. This is technically correct, but in actuality these two problems are usually found together, tightly interlinked in the history of each chronically ill individual. One of the major ways in which these two elements interlock is in the chemical pollution of our food supply.

It is no secret that our food is now treated with synthetic chemicals of every sort. Some of these chemicals have been deliberately added, to impart color, flavor, or longer shelf life. These deliberately added substances are called additives. In addition, numerous chemicals accidentally enter the food supply as residues of pesticides, fertilizers, or environmental pollutants. These are called food contaminants.

Together, food additives and food contaminants have become a major source of the problem of chemical susceptibility in most Western countries, since everyone must eat, and most food now comes from the giant agribusiness conglomerates. These giant corporations are mainly concerned with maximizing profit, even if the health consequences for the population are negative. What is more, these companies are often closely linked to chemical companies and thus have a built-in bias in favor of synthetic pesticides and fertilizers.1

For any person who wants to avoid environmentally induced illness, it is necessary to understand the sources of such chemical contamination of the food supply. These chemicals can either cause, or help perpetuate, chronic illnesses of all sorts. However, their presence can be detected, and they themselves can be avoided, by methods which are explained later in this book.

I have already described how the role of chemical pesticides was discovered in the case of William Petersen, the man who found that he could eat unsprayed apples from an abandoned orchard, while commercial apples from a store gave him a headache. The principles discovered in this case were soon extended to many other food-allergy patients. It was determined that in some cases they were actually reacting only to chemical contaminants. Usually, however, patients with the chemical susceptibility problem also had the food allergy problem, and vice versa. Some patients appeared to react to commercial food in the winter, but to a much lesser degree in the warmer months. This was because in the cold months they were often cooped up in their houses and exposed to the cumulative effects of indoor air pollution (Chap. 6). The combination of food allergies, contaminated food, and such indoor pollutants greatly heightened their symptoms and made their winters miserable. Not infrequently their winter maladies, environmental in origin, masqueraded as colds or flus. In other cases, they did have genuine infections, but these were accentuated by allergic problems.

The variety of problems is endless, since environmental disease is above all things an individual problem. There is no single cause for all people, nor a single solution. Usually the disease is a result of the interaction between an individual, with his particular bodily makeup, and his environment. Certain exposures, however, stand out as most troublesome for the greatest number of patients. Of the food additives and contaminants, some of the most troublesome are residues of pesticide sprays which find their way into almost everything the average person eats.

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The main drug in this group is ipratropium (Atrovent) which is taken by inhalation. Side-effects are rare except at high doses. They include dry mouth, difficulty in passing urine and constipation. Other anti-cholinergics include butethamate and atropine. Anti-cholinergics help to reduce the amount of mucus present in the airways as well as relaxing the muscles,

and may be useful where asthma and bronchitis occur together.

Sympathomimetics, such as adrenaline and ephedrine, are sometimes combined with anticholinergics in inhalers. Atropine is combined with adrenaline and a muscle relaxant in Brovon and Rybarvin. Butethamate is combined with ephedrine in CAM, which is taken by mouth. Ipratropium is combined with the bronchodilator fenoterol in Duovent.

Other bronchodilators

Sympathomimetics were once the main drugs used for bronchodilation, but they are much less specific for the bronchial muscles than the drugs described above. They produce side-effects more easily than modern bronchodilators and are much less used now. They include adrenaline, ephedrine and phenylephrine. Typical side-effects include nervousness, anxiety, tremor, irregular heartbeat and dry mouth.

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For anyone with multiple food sensitivities, avoiding all their culprit foods can be very difficult. And it may mean that they eat too much of other foods, with die attendant risk of developing new sensitivities. Even those who are intolerant of just one or two foods may find it difficult to avoid them, especially if they eat away from home a lot. So there have been many attempts to develop alternative methods of treatment.

Given the lack of knowledge about how food intolerance arises, these attempts are largely a ’suck-it-and-see’ exercise: trying out treatments and seeing if they work. No treatment has yet been devised which is 100 per cent effective for all patients, and there are some on offer from ‘alternative’ practitioners that are quite ineffective and even potentially dangerous (eg urine therapy). However, there are two methods currently being tried out by some doctors, known as neutralization or desensitization treatments, that are worthy of further investigation.

In some studies, these treatments have performed quite well, but in others they have been less successful. Consequently such techniques are controversial and many doctors feel that they should not be used until there is more evidence that they work. But given the complex nature of food intolerance, and the evidence suggesting that it is caused in several different ways (see Chapter Twelve), perhaps it is not surprising if a treatment gives varying results – it might be expected to work for some patients and not for others. Our own experience suggests that such methods are effective for a proportion of people with food intolerance. But they are probably not worth trying unless there is no reasonable dietary alternative.

These methods have also had some success in treating classical allergies, and in this context they may be very useful. The traditional method of desensitization, once widely used for hay fever and other allergies, cannot now be given by family doctors in Britain. This method involved injecting minute, but gradually increasing, doses of the allergen over a period of many months. There is a risk of collapse, due to anaphylactic shock, with this method, and a few patients have died as a result. Such desensitization treatment can now only be given in hospital, where resuscitation equipment is available.

Other uses claimed for these techniques include desensitization to environmental chemicals, such as exhaust fumes, and desensitization to Candida, where there is a sensitivity to the yeast’s products as a consequence of candidiasis.

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Most of the cross-reactions that are seen (or suspected) in patients do not match so well with the biological classification. For many foods, the use of the family group to predict cross-reactions is more a matter of faith than science, but it is still the most useful guide we have. There are also some unexpected cross-reactions, which do not tally with classification schemes.

If you have reason to suspect any food before starting on your elimination diet (because you eat it in large amounts, for example) you should check the food-family list to discover which family it belongs to. All its relatives should be excluded during the first phase of the diet, along with the food itself. The food families may also be useful later, in interpreting your reactions to tested foods, and in planning your diet afterwards – just as you should not eat too much of any one food, you should not eat too much from any one food family either.

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For the older baby, early weaning may be the answer, although it involves the risk of sensitizing the child to even more foods or – if all the high-risk foods are avoided – failing to give the child an adequate diet. Early weaning is only recommended if the baby is suffering quite badly and you have exhausted all other possibilities. It would not be appropriate, for example, in the case of a colicky baby who was otherwise well and growing normally. If you decide to try early weaning, remember the following points:

1. Certain foods seem to contain more potent allergens than others. Do not give the child eggs, fish, chocolate, wheat, oranges, peanuts or other nuts for at least the first six months, and preferably for the first year of life. If you introduce them before a year old, do not give them every day. Test out beef and chicken cautiously, as these can cross-react with milk and eggs respectively. If they seem to cause no problems, you can include them in the child’s diet.

2. Formula feeds commonly contain maize (corn) and tapioca, as well as cow’s milk, so your child may have become sensitive to these. Avoid these foods for at least six months and then try them out carefully. Maize comes in many guises, including cornflour, cornflakes, corn oil, corn syrup, sweetcorn, corn-on-the-cob and popcorn. Some medicines contain corn syrup: ask your pharmacist for advice if you are concerned about avoiding all corn products.

3. No food should be eaten in very large quantities, and it is best not to give any one food every day. This means using your imagination and buying some fairly unusual items. Foods such as millet and sweet potatoes make a good basis for baby foods, and if the baby does become sensitive to them, at least they are no trouble to avoid in later years.

4. Do not force the child to eat any food that is obviously disliked. Most children reject new foods the first time they are offered, but if your child clearly finds the food disagreeable, even after trying it three or four times, then don’t serve it up again. A dislike of the taste is sometimes an early sign of sensitivity.

5. If a child is not eating eggs, milk or fish, there is a risk of protein being in short supply. Make sure that you include other protein-rich foods, such as lamb, pork and other meats. Beans are a good source of protein, but they are also rather indigestible and cause wind; chickpeas (p303) are less of a problem, and have a milder taste.

6. Your child will probably need a calcium supplement, and the overall diet should be checked by a paediatric nutritionist to see if it contains enough of other minerals, as well as vitamins. Ask your doctor to arrange this for you.

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Anyone who lives in a town or city will have been kept awake, at some time or another, by the sound of a burglar alarm ringing endlessly in an empty shop or house. The alarm is only meant to ring if someone breaks in, but it is triggered off by some other quite innocent event, such as a strong wind or the vibrations of a passing lorry. This is more or less what happens in the case of allergies. The mast cells, which are meant to respond to invasion by parasites, are triggered off by an innocuous substance such as eggs or cow’s milk. But why should this happen?

The answer is that the body misguidedly makes IgE antibodies that fit the antigens in these substances. A very complex and intricate set of controls normally prevent the body from making IgE in response to such harmless materials, but in the allergic individual something goes awry and the control mechanisms break down.

In the case of Jane, her body had mistakenly made IgE antibodies to an antigen in peanuts, probably a protein. The strange symptoms that she experienced on eating peanuts were all produced by mediators released from her mast cells. Mast cells in the tissues of the mouth were triggered as soon as the food came into contact with them, producing symptoms almost immediately. Her lips and tongue swelled up because tiny blood vessels inside them became leaky, allowing fluid to seep out into the surrounding tissues.

The cause of Jane’s collapse (anaphylactic shock) when she ate peanuts again was a sudden drop in blood pressure, likewise produced by the mediators. This time, it seems, more IgE was present and far more mediators released. By making the blood vessels all over her body expand, and at the same time become more leaky, the mediators left her without enough blood pressure to keep the vital organs functioning.

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Take special care when things are new. Air or wash whatever you can. If you air things off or wash them before you use them, you may have no problem at all. If you buy new furniture or furnishings – such as curtains, beds, cushions or rugs – always leave them in a spare room, or get the supplier to air them for you before delivery. Even if they are of materials that you can tolerate reasonably, airing will help. Let new shoes or bags air before using them to get rid of fumes. Wash new clothes before wearing, especially if they are pure cotton, polycotton or viscose, as they may have fabric finishes.

Air a newspaper, magazine or book before reading it. Keep newspapers and magazines in a drawer when not in use; their fumes can be very bothersome. Use an old plastic bag rather than a new one. Put new paper, stationery or sticky tape into a drawer or box to air before you use it. Air a new plastic appliance – a radio or audio equipment -before you bring it into the living-room for constant use. Air and wash new toys before use.

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Stabilisers and sealants are used to stabilise the surface of flaking or crumbly walls or plasterwork. Polyvinyl acetate (PVA) without fungicide is relatively problem-free. You can use Polycell Super Bond or Evobond Building Adhesive as a stabiliser and sealant; these are available in DIY stores. You can also use Cuprinol Stabilising Solution, a water-based acrylic solution without fungicide, available to order through the trade or DIY shops.

Paving

Stone slabs, bricks, concrete and gravel used for paving will not cause sensitivity. Take care with tar or asphalt paths and drives; the asphalt can give off persistent fumes, especially in hot weather, and is best avoided if possible.

Putty

Putty is made either of linseed oil and chalk, or of acrylics. Use the linseed oil version for preference. It can irritate the skin, and gives off mild fumes at first but is unlikely to cause reactions over time. Vapours from linseed oil evaporate fast and putty is usually problem-free. Brands of linseed oil and chalk putty include B & Q, available from their stores, and Vallance, from DIY stores. Livos sell a linseed putty by post.

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There is much that a parent can do in the first two to three years of a child’s life to help prevent allergic disease or sensitivity developing later in life, or to minimise its effects. Care taken in early childhood can improve your child’s chance of not developing sensitivity, and help his or her resilience if they once become sensitised to something.

Statistically, a child with one or both parents with a history of sensitivity or allergy is much more likely to develop the tendency – called ‘atopy’. Babies can be born with allergies and intolerance; they can be sensitised already in the womb, particularly to foods. Preconceptual care and care in pregnancy can sometimes prevent or minimise this and are worth finding out about if you have the opportunity.

There are things you can do to your environment by way of preparation in advance of the birth; and precautions you can take with toiletries, nappies, clothes, soap powder or any equipment you use for the baby which can minimise the load of substances that potentially cause trouble.

There are also ways of feeding and weaning babies that give them the best possible chance of not developing food sensitivity. It can be hard work sometimes, but it is much less hard (and much less distressing) than the work involved in caring for a baby or child with severe eczema, asthma, colic or other symptoms. If there is a history of food sensitivity in either parent, or in an older brother or sister of the baby, special care taken when feeding and weaning is valuable, especially in the first two years of a baby’s life when you have much more control, and you can establish eating patterns for the future.

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Beds, bedding and bedtime toys are also prime triggers for house dust mite reactions. Humans lose on average half a litre Oust under a pint) of fluid overnight, so beds are invariably damp, unless thoroughly dried and aired. Not only do house dust mites love the damp, warm dark of mattresses, pillows, blankets or duvets, with their abundance of human skin scales, but they thrive in other places such as teddies, soft toys, padded headboards and bed-bases.

A damp environment encourages house dust mites. Living close to damp areas significantly increases mite populations: it has been shown that even living over an underground water course can correlate with increased incidence of house dust mite allergy. Rising or penetrating damp in the structure, using humidifiers, drying laundry indoors, having a lot of house plants, using heating such as gas fires or paraffin stoves which create water on burning, can all contribute to an increased population of house dust mites.

Poor ventilation, or failing to ventilate also contributes. Fixed windows, or keeping double glazing or windows tightly shut to conserve heat will stop through draughts, circulation of air and hence drying of the environment.

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